A randomised controlled trial for the evaluation of risk for type 2 diabetes in hypertensive patients receiving thiazide diuretics: Diuretics In the Management of Essential hypertension (DIME) study

Shinichiro Ueda, Takeshi Morimoto, Shin-Ichi Ando, Shu-Ichi Takishita, Yuhei Kawano, Kazuaki Shimamoto, Toshio Ogihara, Takao Saruta, DIME Investigators, Shinichiro Ueda, Takeshi Morimoto, Shin-Ichi Ando, Shu-Ichi Takishita, Yuhei Kawano, Kazuaki Shimamoto, Toshio Ogihara, Takao Saruta, DIME Investigators

Abstract

Objectives: Thiazide diuretics are one of the first choice antihypertensives but not optimally utilised because of concerns regarding their adverse effects on glucose metabolism. The Diuretics In the Management of Essential hypertension (DIME) study was designed, for the first time, to assess the risk for type 2 diabetes mellitus in patients with essential hypertension during antihypertensive treatment with low-dose thiazide diuretics compared to those not treated with diuretics.

Design: Multicentre, unblinded, pragmatic, randomised, controlled trial with blinded assessment of end points and intention-to-treat analysis that was started in 2004 and finished in 2012.

Setting: Hypertension clinics at 106 sites in Japan, including general practitioners' offices and teaching hospitals.

Participants: Non-diabetic patients with essential hypertension.

Interventions: Antihypertensive treatment with low-dose thiazide diuretics at 12.5 mg/day of hydrochlorothiazide or equivalent (Diuretics group) or that without thiazide diuretics (No-diuretics group).

Main outcome: The primary outcome was new onset of type 2 diabetes diagnosed according to WHO criteria and the criteria of Japanese Society of Diabetes.

Results: 1130 patients were allocated to Diuretics (n=544) or No-diuretics group (n=586). Complete end point information was collected for 1049 participants after a median follow-up of 4.4 years. Diabetes developed in 25 (4.6%) participants in the Diuretics group, as compared with 29 (4.9%) in the No-diuretics group (HR 0.93; 95% CI 0.55 to 1.58; p=0.800).

Conclusions: Antihypertensive treatment with thiazide diuretics at low doses may not be associated with an increased risk for new onset of type 2 diabetes. This result might suggest safety of use of low doses of thiazide diuretics.

Trial registration number: ClinicalTrials.gov NCT00131846.

Keywords: essential hypertension; thiazide diuretics; type 2 diabetes.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Enrolment, randomisation and follow-up of study participants.
Figure 2
Figure 2
Kaplan–Meier curves of cumulative incidence of type 2 diabetes.
Figure 3
Figure 3
Effects of diuretics use on risk of new onset of diabetes according to the baseline characteristics. FBS, fasting blood sugar; BMI, body mass index; ACEI/ARB, ACE inhibitor or angiotensin receptor blocker.
Figure 4
Figure 4
Plasma fasting glucose (A) and glycated hemoglobin (B) over time by groups.
Figure 5
Figure 5
Serum potassium (A, *p=0.007, **p=0.002, †p=0.020, ††p=0.004) and uric acid (B, *p

Figure 6

Blood pressure over time by…

Figure 6

Blood pressure over time by treatment groups.

Figure 6
Blood pressure over time by treatment groups.
Figure 6
Figure 6
Blood pressure over time by treatment groups.

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