Diabetologia

, Volume 34, Issue 2, pp 119–125 | Cite as

ACE-inhibition increases hepatic and extrahepatic sensitivity to insulin in patients with Type 2 (non-insulin-dependent) diabetes mellitus and arterial hypertension

  • E. Torlone
  • A. M. Rambotti
  • G. Perriello
  • G. Botta
  • F. Santeusanio
  • P. Brunetti
  • G. B. Bolli
Originals

Summary

To assess the effects of ACE-inhibition on insulin action in Type 2 (non-insulin-dependent) diabetes mellitus associated with essential hypertension, 12 patients with Type 2 diabetes (on diet and oral hypoglycaemic agents) and arterial hypertension were examined on two occasions, in a single blind, cross-over study, after two days of treatment with either captopril or a placebo. The study consisted of a euglycaemic-hyperinsulinaemic clamp (two sequential steps of insulin infusion at the rates of 0.25 mU·kg−1·min−1 and 1 mU·kg−1·min−1, 2 h each step), combined with an infusion of 3-3H-glucose to measure the rate of hepatic glucose production and that of peripheral glucose utilization. The results show that blood pressure was lower after captopril (sitting, systolic 148±5 mmHg, diastolic 89±2 mm Hg) compared to placebo (155±6 and 94±2 mm Hg) (p<0.05). Captopril treatment resulted in a more suppressed hepatic glucose production (2.7±0.4 vs 4.94±0.55 μmol·kg−1·min−1), and a lower plasma non-esterified fatty acid concentration (0.143±0.05 vs 0.200±0.05 mmol/l) (captopril vs placebo, p<0.05) at the end of the first step of insulin infusion (estimated portal plasma insulin concentration 305±28 pmol/l); and in a greater glucose utilization (36.5±5.1 vs 28±3.6μmol·kg−1·min−1, p<0.001) at the end of the second step of insulin infusion (arterial plasma insulin concentration of 604±33 pmol/l). We conclude that captopril improved insulin sensitivity in Type 2 diabetes associated with hypertension at the level of the liver and extrahepatic tissues, primarily muscle and adipose tissue. Thus, in contrast to other antihypertensive drugs such as diuretics and beta-blockers which may have a detrimental effect on insulin action, ACE-inhibitors appear to improve insulin action in Type 2 diabetes and essential hypertension, at least on a short-term basis.

Key words

Insulin resistance ACE-inhibitors Type 2 (non-insulin-dependent) diabetes mellitus essential hypertension captopril 

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Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • E. Torlone
    • 1
  • A. M. Rambotti
    • 1
  • G. Perriello
    • 1
  • G. Botta
    • 1
  • F. Santeusanio
    • 1
  • P. Brunetti
    • 1
  • G. B. Bolli
    • 1
  1. 1.Istituto di Patologia Speciale Medica e Metodologia ClinicaUniversità di PerugiaPerugiaItaly

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