Effects of valsartan compared with telmisartan in reducing insulin resistance on type 2 diabetes mellitus (T2DM) patients with hypertension

Hemi Sinorita; Luthfan Budi Purnomo; R.Bowo Pramono

doi:10.19106/JMedSci005302202102

Effects of valsartan compared with telmisartan in reducing insulin resistance on type 2 diabetes mellitus (T2DM) patients with hypertension

https://doi.org/10.19106/JMedSci005302202102

Hemi Sinorita^(1*), Luthfan Budi Purnomo⁽²⁾, R.Bowo Pramono⁽³⁾

(1) Division of Endocrinology and Metabolic, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
(2) Division of Endocrinology and Metabolic, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
(3) Division of Endocrinology and Metabolic, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital Yogyakarta, Indonesia.
(*) Corresponding Author

Abstract

Insulin resistance is a major risk factor for patients with type 2 diabetes
mellitus (T2DM). Telmisartan and valsartan are angiotensin II type I receptor
blockers (ARBs) that are often used in patients with metabolic syndrome and
T2DM. This study aimed to compare the effect of valsartan and telmisartan in
reducing insulin resistance on T2DM with hypertension. Patients of T2DM were
open-label screened at the Endocrinology Policlinic, Department of Internal
Medicine, Dr. Sardjito General Hospital, Yogyakarta, and then randomized into
two groups. The first group received valsartan 80 mg per day up to 160 mg per
day, the second group received telmisartan 40 mg per day up to 80 mg per day
in addition with life-style modifying and diabetes therapy. Homeostasis model
assessment of insulin resistance (HOMA-IR), triglyceride and HDL cholesterol
levels of patients were measured before and after receiving telmisartan and
valsartan for 12 weeks. A total of forty-nine outpatients were involved in this
study comprised of 25 female patients (51%) and 24 male patients (49%) with
27 patients (55.1%) received telmisartan and 22 patients (44.9%) received
valsartan as the hypertension therapy. No significantl difference were observed
between telmisartan group compared with valsartan group in HOMA-IR (14.01
± 16.39 vs. 5.31 ± 3.51; p=0.053), triglyceride levels (165.71 ± 94.70 vs 144.41 ±
48.33 mg/dL; p=0.620), HDL-C level (48.57 ± 9.78 vs 49.24 vs 49.24 ± 12.56 mg/dL;
p=0.999). In conclusion, telmisartan demonstrated no difference compared to
valsartan in reducing insulin resistance on T2DM patients with hypertension.

Keywords

valsartan; telmisartan; insulin resistance; T2DM; hypertension;

Full Text:

PDF

References

Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Targher G, et al. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Diabetes1998; 47(10):1643-9. https://doi.org/10.2337/diabetes.47.10.1643
American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care 2010; 33(Suppl 1):11-61. https://doi.org/10.2337/dc10-S011
Mudaliar S, Chang AR, Henry RR. Thiazolidinediones, peripheral edema, and type 2 diabetes: incidence, pathophysiology, and clinical implications. Endocr Pract 2003; 9(5):406-16. https://doi.org/10.4158/EP.9.5.406
Benson SC, Pershadsingh HA, Ho CI, Chittiboyina A, Desai P, Pravenec M, et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPAR-γ modulating activity. Hypertension 2004; 43(5):993-1002. https://doi.org/10.1161/01.HYP.0000123072.34629.57
Fujimoto M, Masuzakia H, Tanakaa T, Yasuea S, Tomitaa T, Okazawaa K, et al. An angiotensin II AT1 receptor antagonist, telmisartan augments glucose uptake and GLUT4 protein expression in 3T3-L1 adipocytes. FEBS Lett 2004; 576(3):492-97. https://doi.org/10.1016/j.febslet.2004.09.027
Pershadsingh HA, Benson SC, Ho CI, Kurtz TW. Identification of PPAR-γ activators that do not promote fluid retention and edema: implications for treating insulin resistant hypertension and the metabolic syndrome. In: Proceedings from the Symposium on Nuclear Receptors in Cardiovascular Disease: Hot Topics in Endocrinology, San Diego, California, 8–12 October (Abstract). Webb P, Evans RM, Hsueh WH, Eds. Chevy Chase, MD, The Endocrine Society. 2003;p. 29.
Takagi H, Umemoto T. Telmisartan improves insulin sensitivity: a meta analysis of randomized head-to-head trials. Int J Cardiol 2012; 156(1):92-122. https://doi.org/10.1016/j.ijcard.2011.11.070
Ichikawa Y. Comparative effects of telmisartan and valsartan on insulin resistance in hypertensive patients with metabolic syndrome. Intern Med 2007; 46(17):1331-6. https://doi.org/10.2169/internalmedicine.46.7173
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289(19):2560-72. https://doi.org/10.1001/jama.289.19.2560
Matthew DR, Hosker JP, Rudenski AS, Naylor BA. Homeostasis model assesment : insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia 1985; 28(7):412-9. https://doi.org/10.1007/BF00280883
Smith U, Kahn BB. Adipose tissue regulates insulin sensitivity: role of adipogenesis, de novo lipogenesis and novel lipids. J Intern Med 2016; 280(5):465-75. https://doi.org/1111/joim.12540
Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab 2008; 93(11 Suppl 1):S57-63. https://doi.org/10.1210/jc.2008-1585
Hawkins M, Rossetti L. Insulin resistance and its role in the pathogenesis of type 2 diabetes. Joslin’s Diabetes Mellitus, 14th ed, Philadelphia: Lippincott Williams & Wilkins, 2005: 425-41.
Khan BB, Flier JS. Obesity and insulin resistance. J Clin Invest 2000; 106(4):473-81. https://doi.org/10.1172/JCI10842
Al-Mahmood AK, Afrin SF, Hoque N. Dyslipidemia in insulin resistance: cause or effect. Bangladesh. J Med Biochem 2014; 7(1):27-31. https://doi.org/10.3329/bjmb.v7i1.18576
Derosa G, Cicero AFG, D’Agelo A, Ragonesi PD, Ciccarelli L, Piccini MN, et al. Telmisartan and irbesartan therapy in type 2 diabetic patients treated with rosiglitazone: effects on insulin-resistance, leptin and tumor necrosis factor-α. Hypertens Res 2006; 29(11):849-56. https://doi.org/10.1291/hypres.29.849
Nakayama S, Watada H, Mita T, Ikeda F, Shimizu T, Uchino H, et al. Comparison of effects of olmesartan and telmisartan on blood pressure and metabolic parameters in Japanese early-stage type-2 diabetes with hypertension. Hypertens Res 2008; 31(1):7-13. https://doi.org/10.1291/hypres.31.7
Arao T, Okada Y, Mori H, Nishida K, Tanaka Y. Antihypertensive and metabolic effects of high-dose olmesartan and telmisartan in type 2 diabetes patients with hypertension. Endocr J 2013; 60(5):563-70. https://doi.org/10.1507/endocrj.ej12-0326
NaruseI M, Koike Y, Kamei N, Sakamoto R, Yambe Y, Arimitsu M. Effects of azilsartan compared with telmisartan on insulin resistance in patients with essential hypertension and type 2 diabetes mellitus: an open-label, randomized clinical trial. PLOS One 2019; 14(4):1-14. https://doi.org/10.1371/journal.pone.0214727

DOI: https://doi.org/10.19106/JMedSci005302202102

Article Metrics

Abstract views : 840 |

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

View My Stats

Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Based on a work at http://jurnal.ugm.ac.id/bik/.

Username
Password
Remember me