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Open Access Highly Accessed Original investigation

Different angiotensin receptor blockers and incidence of diabetes: a nationwide population-based cohort study

Chia-Hsuin Chang123, Yi-Cheng Chang234, Li-Chiu Wu1, Jou-Wei Lin35*, Lee-Ming Chuang123* and Mei-Shu Lai1

Author Affiliations

1 Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

2 Department of Internal Medicine, National Taiwan University Hospital, 7, Chung Shan S. Rd, Taipei, Taiwan

3 Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

4 Department of Internal Medicine, National Taiwan University Hospital HsinChu Branch, HsinChu, Taiwan

5 Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, 579 Yun-Lin Road, Section 2, Dou-Liou City, Yun-Lin County, Taiwan

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Cardiovascular Diabetology 2014, 13:91  doi:10.1186/1475-2840-13-91

Published: 14 May 2014

Abstract

Background

Angiotensin receptor blockers (ARBs) have been shown to exert various peroxisome proliferator-activated receptor gamma (PPARĪ³) binding activities and insulin-sensitizing effects. The objective of this study was to investigate the association of different ARBs with new-onset diabetes mellitus.

Methods

In the respective cohort, a total of 492,530 subjects who initiated ARB treatment between January 2004 and December 2009 were identified from Taiwan National Health Insurance Database. The primary outcome was newly diagnosed diabetes, defined as at least one hospital admission or two or more outpatient visits within a year with an ICD-9-CM code 250. Cox proportional regression was used to estimate the risk of diabetes associated with each ARB, using losartan as the reference.

Results

A total of 65,358 incident diabetes cases were identified out of 1,771,173 person-years. Olmesartan initiators had a small but significantly increased risk of developing diabetes after adjusting for baseline characteristics and mean daily dose (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.12). After excluding those followed for less than one year, the increase in diabetes risk are more pronounced (HR, 1.09; 95% CI, 1.05-1.14). This association was consistent across all subgroup analyses. Similar results were observed when a more strict definition of diabetes combining both diabetes diagnosis and anti-diabetic treatment was used. On the other hand, there was no difference in diabetes risk between telmisartan and losartan.

Conclusions

Among all ARBs, olmesartan might be associated with a slightly increased risk of diabetes mellitus. Our data suggest differential diabetes risks associated with ARBs beyond a class effect.

Keywords:
Angiotensin receptor antagonists; Diabetes mellitus; Cohort studies