Effects of telmisartan on glucose levels in people at high risk for cardiovascular disease but free from diabetes: the TRANSCEND study

Abstract

Objective: Several large clinical trials suggest that ACE inhibitors may reduce the incidence of diabetes. Less is known about the effects of angiotensin receptor blockers (ARBs) on reducing incident diabetes or leading to regression of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) to normoglycemia.

Research design and methods: Participants were 3,488 adults at high risk for cardiovascular disease but free from diabetes (mean age 67 years; 61% male) in the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND) study. The participants were randomized to the ARB telmisartan 80 mg (n = 1,726) or placebo (n = 1,762) in addition to usual care.

Results: During a median 56 months, 21.8% of participants treated with telmisartan and 22.4% of those on placebo developed diabetes (relative ratio 0.95 [95% CI 0.83-1.10]; P = 0.51). Participants originally diagnosed with IFG and/or IGT were equally likely to regress to normoglycemia (26.9 vs. 24.5%) or to progress to incident diabetes (20.1 vs. 21.1%; P = 0.59) on telmisartan or placebo.

Conclusions: There was no evidence that addition of the ARB telmisartan to usual care prevents incident diabetes or leads to regression of IFG or IGT in people at high risk for cardiovascular disease but free from diabetes.

Trial registration: ClinicalTrials.gov NCT00153101.

Figures

Figure 1

Prevalence of IFG and/or IGT in the nondiabetic TRANSCEND cohort at baseline. DM, diabetes mellitus.

Figure 2

Incident diabetes in the nondiabetic TRANSCEND cohort. The criteria for physician diagnosis of diabetes (during every 6-month visit) were predefined as one or more of the following: 1) use of glucose-lowering agents, 2) HbA1c 1.1 times the upper limit of normal, and 3) FG >125 mg/dL (>6.9 mmol/L) with performance of a confirmatory OGTT with cutoff criteria identical to those in the main study. Participants who did not satisfy any of the OGTT criteria or the FG criterion were considered free of diabetes. DM, diabetes mellitus.