Article (Scientific journals)
Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 2. Overview of physiological and biochemical mechanisms.
Scheen, André
2004In Diabetes and Metabolism, 30 (6), p. 498-505
Peer Reviewed verified by ORBi
 

Files


Full Text
Renin-angiotensin system inhibition prevents type 2 diabetes mellitus_ocr.pdf
Author postprint (152.29 kB)
Download

All documents in ORBi are protected by a user license.

Send to



Details



Keywords :
Angiotensin-Converting Enzyme Inhibitors/therapeutic use; Diabetes Mellitus, Type 2/prevention & control; Humans; Insulin/physiology; Muscle, Skeletal/blood supply; PPAR gamma/physiology; Receptor, Angiotensin, Type 1/physiology; Regional Blood Flow; Renin-Angiotensin System/drug effects/physiology
Abstract :
[en] The inhibition of the renin-angiotensin system (RAS) with either angiotensin converting enzyme inhibitors (ACEIs) or AT1 angiotensin receptor blockers (ARBs) consistently and significantly reduces the incidence of type 2 diabetes in patients with hypertension or congestive heart failure. The mechanisms underlying this protective effect appear to be complex and may involve an improvement of both insulin sensitivity and insulin secretion. These two effects may result, at least in part, from the well known effects of these pharmacological agents on the vascular system on the one hand, on the ionic balance on the other hand. Indeed, the vasodilation induced by ACEIs or ARBs could improve the blood circulation in skeletal muscles, thus favouring peripheral insulin action, but also in the pancreas, thus promoting insulin secretion. Preserving cellular potassium and magnesium pools by blocking the aldosterone effects could also improve both cellular insulin action and insulin secretion. However, besides these classical effects, new mechanisms have been recently suggested. A direct effect of the inhibition of angiotensin and/or of the enhancement of bradykinin on various steps of the insulin cascade signalling has been described as well an increase in GLUT4 glucose transporters after RAS inhibition. Furthermore, it has been demonstrated that angiotensin II inhibits adipogenic differentiation of human adipocytes via A1 receptors and, therefore, it has been hypothesised that RAS blockade may prevent diabetes by promoting the recruitment and differentiation of adipocytes. Finally, some lipophilic ARBs appear to induce PPAR-gamma activity in the adipose tissue. Hence, the protection against type 2 diabetes observed after RAS inhibition may be partially linked to a thiazolidinedione-like effect. In conclusion, numerous physiological and biochemical mechanisms could explain the protective effect of RAS inhibition against the development of type 2 diabetes in individuals with arterial hypertension or congestive heart failure. What might be the main mechanism in the overall protection effect of ACEIs or ARBs remains an open question.
Disciplines :
Endocrinology, metabolism & nutrition
Cardiovascular & respiratory systems
Author, co-author :
Scheen, André  ;  Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Language :
English
Title :
Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 2. Overview of physiological and biochemical mechanisms.
Publication date :
2004
Journal title :
Diabetes and Metabolism
ISSN :
1262-3636
eISSN :
1878-1780
Publisher :
Masson, Moulineaux Cedex 9, France
Volume :
30
Issue :
6
Pages :
498-505
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 06 May 2009

Statistics


Number of views
184 (4 by ULiège)
Number of downloads
643 (1 by ULiège)

Scopus citations®
 
141
Scopus citations®
without self-citations
136
OpenCitations
 
125

Bibliography


Similar publications



Contact ORBi