The renin–angiotensin–aldosterone system: a pivotal role in insulin sensitivity and glycemic control

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Abstract

Purpose of review

Diabetes mellitus is an exploding epidemic costing billions of dollars yearly. Type 2 diabetes mellitus is characterized by insulin resistance and is closely associated with arterial hypertension. Emerging literature has demonstrated that modulation of the renin–angiotensin–aldosterone system by use of angiotensin-converting enzyme inhibitors or angiotensn II receptor blockers leads to improved insulin sensitivity, glycemic control and possibly prevention of type 2 diabetes mellitus.

Recent findings

Several major studies investigating angiotensn II receptor blocker or angiotensin-converting enzyme inhibitor use in either hypertensive or heart failure patients have found lower incidence of type 2 diabetes mellitus when compared with placebo, β-blocker, calcium-channel blocker or diuretic. None of these trials, however, studied prevention of diabetes as a primary endpoint. The Dream Trial and upcoming NAVIGATOR, ONTARGET/TRANSCEND trials specifically look at the prevention of diabetes as a primary endpoint. Several studies have evaluated possible mechanisms of how the renin–angiotensin–aldosterone system can alter insulin sensitivity and glycemic control.

Summary

This review will focus on the recent literature that demonstrates renin–angiotensin–aldosterone system modulation and its effects on diabetes prevention, glycemic control and insulin sensitivity, as well as possible mechanisms for achieving this goal.

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