Effect of telmisartan on glycemic control in hemodialysis patients with type 2 diabetes

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  • ２型糖尿病合併の維持血液透析患者におけるテルミサルタンの糖代謝改善作用
  • 2ガタ トウニョウビョウ ガッペイ ノ イジ ケツエキ トウセキ カンジャ ニ オケル テルミサルタン ノ トウ タイシャ カイゼン サヨウ

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At present, angiotensinII receptor blockers (ARBs) are widely used for the treatment of hypertension in patients under hemodialysis. Although there have been some reports showing that the ARB telmisartan has a beneficial effect on glucose metabolism, however, the patients in those studies had normal renal function. We studied the effects of telmisartan on glucose metabolism for 24 weeks after the replacement of other ARBs by telmisartan in 19 hemodialysis patients with type2 diabetes. There were no differences in plasma glucose, HbA1c level or serum C-peptide in any patient. The HbA1c decreased from 7.07±0.22% to 6.61±0.24% (p<0.05) at 24 weeks in 12 patients with poor glycemic control (HbA1c above 6.0%) by telmisartan treatments. In the same group, glycoalbumin (GA) was 26.8±3.87% before telmisartan, but was 24.0±4.68% and 24.2±4.57% (p<0.05) after 12 and 24 weeks on telmisartan. There were no significant changes in adiponectin level during the 24 weeks on telmisartan ; however, the level of adiponectin showed a negative correlation with the percentage change of GA at 24 weeks. Our results indicate that in diabetics with poor glycemic control who are under hemodialysis, replacement of other ARBs by telmisartan has a beneficial effect on glucose metabolism, possibly resulting from activation of PPARγ, which in turn increases insulin sensitivity.

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