title: Spironolactone and glucose metabolism, a systematic review and meta-analysis of randomized controlled trials.
abstract: Diabetes predicts cardiovascular disease (CVD); some drugs are effective for CVD prevention but increase the risk of diabetes. In a systematic review and meta-analysis of placebo-controlled trials, we assessed if spironolactone, a mineralocorticoid receptor antagonist, affected glycemic control. We searched PubMed using ("spironolactone" or "aldactone") and trial and ("glucose" or "diabetes" or "insulin" or "insulin resistance") until January 4, 2016. In total, 18 eligible trials were identified; 10 on fasting glucose, 8 on hemoglobin A1c (HbA1c), 7 on homeostatic model assessment (HOMA)-insulin resistance (IR), and 8 on insulin. Spironolactone increased HbA1c (0.16%, 95% confidence interval 0.02 to 0.30) but had no clear effect on fasting glucose, HOMA-IR, and insulin. A mechanistic randomized controlled trial in people with and without diabetes might provide insight concerning these pleiotropic effects on diabetes and CVD relevant to prevention of both diseases.
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Jie V
authors.initials: JV
authors.lastname: Zhao
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Shi Lin
authors.initials: SL
authors.lastname: Lin
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; CUNY Graduate School of Public Health and Health Policy, New York, USA. Electronic address: cms1@hku.hk.
authors.forename: C Mary
authors.initials: CM
authors.lastname: Schooling
mesh_terms: D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000139:chemically induced*; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D005215:Fasting / Q000502:physiology; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000032:analysis; D007328:Insulin / Q000032:analysis; D007333:Insulin Resistance / Q000502:physiology; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D057466:Nonsteroidal Anti-Androgens / Q000009:adverse effects* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D004232:Diuretics; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000451:Mineralocorticoid Receptor Antagonists; D057466:Nonsteroidal Anti-Androgens; D013148:Spironolactone
keywords: Anti-androgen; diabetes mellitus; hypertension; placebo-controlled trial