The role of the renin-angiotensin-aldosterone system blockade in preventing type 2 diabetes

Abstract

The prevalence of type 2 diabetes is still increasing. It causes both growing burden for health insurance institutions and growing social costs of disability and premature mortality related to diabetes. Searching for methods which can reduce incidence of diabetes and thus limit consequences of forthcoming epidemic becomes urgent. It is well known that lifestyle changes and some oral antidiabetic agents (metformin, acarbose, troglitazone, pioglitazone) can reduce risk of developing diabetes in persons with impaired glucose tolerance. Such effect has been proven also for statins (pravastatin), antiobesity agents (orlistat) and for antihypertensive drugs. In this paper, on the basis of several large scale randomized clinical trials, the role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in prevention of type 2 diabetes is discussed. On the basis of experimental studies postulated mechanisms which can lead to reduction of the risk of developing diabetes are also presented. If thus observations will be confirmed by ongoing clinical studies directed to prevention of type 2 diabetes, the medical world will obtain a weapon which can diminish consequences and extent of expected epidemic of type 2 diabetes.