HYPOGLYCEMIA ASSOCIATED WITH USE OF INHIBITORS OF ANGIOTENSIN-CONVERTING ENZYME

The use of angiotensin-converting-enzyme (ACE) inhibitors has been ass ociated with increased insulin sensitivity in diabetic patients. Altho ugh such an effect could be beneficial in the treatment of hypertensio n or congestive heart failure in diabetic patients, it might also prec ipitate severe hypoglycaemia. To test this hypothesis we carried out a nested case-control study, using data in the Dutch PHARMO system (198 6-92), among diabetic patients treated with insulin or with oral antid iabetic drugs, who were admitted to hospital with hypoglycaemia. We id entified 94 patients who had been admitted with hypoglycaemia and sele cted 654 controls from the same cohort. With adjustment for a wide ran ge of potential confounding factors, hypoglycaemia was significantly a ssociated with current use of ACE inhibitors (odds ratio 2.8 [95% CI 1 .4-5.7]). Both among users of insulin and among users of oral antidiab etic drugs, use of ACE inhibitors was significantly associated with an increased risk of hospital admission for hypoglycaemia (2.8 [1.2-6.4] and 4.1 [1.4-12.2], respectively). Although ACE inhibitors have sever al advantages over other antihypertensive drugs in diabetes, the risk of hypoglycaemia should be taken into account. Further investigation o f the mechanism is needed since as many as 13.8% of all hospital admis sions for hypoglycaemia might be attributable to use of ACE inhibitors .