Reversal of diuretic-associated impaired glucose tolerance and new-onset diabetes: results of the STAR-LET study.
Reversal of new-onset diabetes secondary to thiazide diuretic use remains questionable. STAR-LET was a 6-month extension of the Study of Trandolapril/Verapamil SR and Insulin Resistance (STAR), which assessed the effects of a fixed-dose renin-angiotensin system inhibitor (RASI)/hydrochlorothiazide (HCTZ) combination on changes in 2-hour oral glucose tolerance test (OGTT) results. STAR-LET explored whether the glycemic impact of HCTZ could be reversed by conversion to a RASI/verapamil combination. The primary outcome was change in 2-hour OGTT results. Fifty-one percent of the STAR patients were enrolled in STAR-LET. The 2-hour OGTT value (mmol/L) was unchanged from STAR baseline in the RASI/verapamil group (7.7+/-2.4 vs 8.1+/-3.3; P=.18) and improved in those who were switched from RASI/HCTZ to RASI/verapamil (8.5+/-3.0 vs 7.2+/-2.3; P<.001). This exploratory study suggests that the impairment in glycemic control seen with use of a thiazide diuretic combined with a RASI can be reversed by switching to a regimen that does not include a diuretic.
Bakris
George
G
University of Chicago Pritzker School of Medicine, Chicago, IL 60612, USA. gbakris@earthlink.net
Molitch
Mark
M
Zhou
Qian
Q
Sarafidis
Pantelis
P
Champion
Annette
A
Bacher
Peter
P
Sowers
James R
JR
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control*; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects*; D006973:Hypertension / Q000188:drug therapy*; D007211:Indoles / Q000627:therapeutic use*; D007333:Insulin Resistance; D019808:Losartan / Q000009:adverse effects*; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy*; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects; D014700:Verapamil / Q000627:therapeutic use*
D004232:Diuretics; D007211:Indoles; D006852:Hydrochlorothiazide; C052035:trandolapril; D014700:Verapamil; D019808:Losartan