Renin-Angiotensin-Aldosterone System Antagonists and the Prevention of Type 2 Diabetes Mellitus

ACE inhibitors have established their role in the management of hypertension as well as in the primary and secondary prevention of cardiovascular events. Furthermore, they have proven their role in delaying the worsening of renal function in patients with chronic renal disease. Over the last few years their use to prevent the new onset of diabetes has come to the forefront. Post-hoc analyses of large mutli-center clinical trials such as the Captopril Prevention Project and the Heart Outcomes Prevention Evaluation have suggested that their use may delay or prevent the onset of diabetes. However many of these results are based on secondary analyses and few prospective clinical trials exist. In the two prospective trial so far conducted regarding the use of ACEi and ARB as a means to diabetes prevention the effects of these drugs compared to lifestyle modifications have been minimal and do not yet warrant their use to this effect. While there is strong evidence for modulation the Renin-Angiotensin System in patients with hypertension, coronary heart disease and renal dysfunction the evidence for preventing diabetes remains scarce and will need to be investigated further.