Risk factor assessment for new onset diabetes: literature review.
Metabolic syndrome (MS), typified by hypertension, abdominal obesity, dyslipidaemia and impaired glucose metabolism, is a precursor of type 2 diabetes. Thiazide diuretics (TD) and beta-blockers are associated with increased risk of diabetes in patients with hypertension; however, the role of these agents in development of diabetes in MS patients is unknown. We reviewed the literature regarding risk factors for diabetes development and compared this with data from the Study of Trandolapril/Verapamil SR And Insulin Resistance (STAR), which investigated the effects of two fixed-dose combinations (FDCs) [trandolapril/verapamil SR and losartan/hydrochlorothiazide (L/H)] on glucose control and new diabetes in MS patients. In STAR, logistic regression modelling identified haemoglobin A1c [odds ratio (OR) 4.21 per 1% increment; p = 0.003), L/H treatment (OR 4.04; p = 0.002) and 2-h oral glucose tolerance test glucose levels (OR 1.39 per 10 mg/dl increments; p < 0.001) as baseline predictors of diabetes. These data support prior analyses and suggest that choice of antihypertensive agent is important. Patients with MS may be at lower risk of diabetes when using a FDC calcium channel blocker + angiotensin-converting enzyme inhibitor compared with an angiotensin receptor blocker + TD.
Hypertension Center, Section of Endocrinology, Diabetes, & Metabolism, University of Chicago, Pritzker School of Medicine, Chicago, IL 60612, USA. gbakris@medicine.bsd.uchicago.edu
George
G
Bakris
Jack
J
Stockert
Mark
M
Molitch
Qian
Q
Zhou
Annette
A
Champion
Peter
P
Bacher
James
J
Sowers
D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D024821:Metabolic Syndrome / Q000139:chemically induced / Q000175:diagnosis*; D011236:Prediabetic State / Q000139:chemically induced / Q000175:diagnosis*; D018570:Risk Assessment
D000959:Antihypertensive Agents