ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes

Andrew D. Morris (Lead / Corresponding author), Douglas I.R. Boyle, Alexander D. Mcmahon, Hilary Pearce, Josie M.M. Evans, Ray W. Newton, Roland T. Jung, Thomas M. Macdonald, DARTS/MEMO Collaboration

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Abstract

OBJECTIVE - To evaluate the association between the use of ACE inhibitors and hospital admission for severe hypoglycemia and to explore the effects of potential confounding variables on this relationship. RESEARCH DESIGN AND METHODS - The association between the use of ACE inhibitors and the incidence of hypoglycemia is controversial. A recent study reported that 14% of all hospital admissions for hypoglycemia might be attributable to ACE inhibitors. We performed a nested case-control study, using a cohort of 6,649 diabetic patients taking insulin or oral antidiabetic drugs, on the Diabetes Audit and Research in Tayside, Scotland (DARTS) database. From 1 January 1993 to 30 April 1994, we identified 64 patients who had been admitted to Tayside hospitals with hypoglycemia and selected 440 control patients from the same cohort. RESULTS - Hypoglycemia was associated with the use of ACE inhibitors (odds ratio [OR] 3.2, 95% CI 1.2-8.3, P = 0.023), whereas use of β-blockers and calcium antagonists was not associated with an increased risk of hospitalization for hypoglycemia with ORs of 0.9 (95% CI 0.3-3.3) and 1.7 (95% CI 0.2-2.1), respectively. There were significant differences between case and control patients in type of diabetes treatment, diabetes duration, place of routine diabetes care, and congestive cardiac failure. These differences did not confound the relationship between ACE inhibitors and hypoglycemia (adjusted OR 4.3, 95% CI 1.2-16.0). CONCLUSIONS - The results show that the association between ACE inhibitor therapy and hospital admission for severe hypoglycemia is not explained by these confounding factors. Although ACE inhibitors have distinct advantages over other antihypertensive drugs in diabetes, the risk of hypoglycemia should be considered.

Original languageEnglish
Pages (from-to)1363-1367
Number of pages5
JournalDiabetes Care
Volume20
Issue number9
DOIs
Publication statusPublished - Sep 1997

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    Morris, A. D., Boyle, D. I. R., Mcmahon, A. D., Pearce, H., Evans, J. M. M., Newton, R. W., Jung, R. T., Macdonald, T. M., & DARTS/MEMO Collaboration (1997). ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes. Diabetes Care, 20(9), 1363-1367. https://doi.org/10.2337/diacare.20.9.1363