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【drug-news】雷米普利对于糖尿病只有有限的疗效
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NEW YORK (Reuters Health) Oct 11 - Contrary to previous research suggesting that ramipril may check the progression to diabetes in pre-diabetics, 3-year results of a multinational, prospective trial failed to show that ramipril is superior to placebo in reducing the incidence of diabetes or death in a cohort of patients with impaired fasting glucose levels or impaired glucose tolerance.
However, ramipril may improve glucose metabolism by promoting regression to normoglycemia, according to investigators participating in the DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) trial.
In their report in the New England Journal of Medicine for October 12, the trialists note that other studies evaluating the effects of the angiotensin-converting-enzyme (ACE) inhibitor ramipril were focused on patients with or at high risk for cardiovascular disease, and did not include standard assessments of glucose levels.
The ramipril arm of the DREAM trial included individuals age 30 and over who had impaired fasting glucose levels between 110 and 126 mg/dL or a glucose level of 140 to 200 mg/dL 2 hours after an oral glucose load (impaired glucose tolerance) and were free of cardiovascular disease.
The researchers randomly assigned 2623 patients to ramipril, up to 15mg/day, and 2646 to placebo.
After a median of 3 years follow-up, there were no significant differences between groups in deaths or the development of diabetes. Similarly, median fasting plasma glucose levels were unaffected by group assignment.
However, significantly more patients treated with ramipril had normal fasting plasma glucose levels and normal 2-hour plasma glucose levels (42.5% versus 38.2%, hazard ratio 1.16, p = 0.0001), compared with placebo. Moreover, median 2-hour post-load plasma glucose levels were lower in the ramipril group (135.1 versus 140.5, p = 0.01).
The investigators acknowledge that the trial's duration may have been too short to catch more significant differences in progression to diabetes or mortality.
They conclude: "The effect (of ramipril) with respect to regression to normoglycemia and the totality of the available data suggest that drugs that block the renin-angiotensin system may have a modest, favorable effect on glucose metabolism."
Still, the DREAM team advises that "for now, routine use of ramipril for the express purpose of preventing diabetes is not indicated."
New England Journal of Medicine deputy editors Dr. Julie R. Ingelfinger and Dr. Caren G. Solomon concur. "Ongoing attention to diet and exercise remains our best hope for reducing the rising rate of diabetes," they write in an accompanying editorial.
N Engl J Med 2006; 355:1441-1562,1608-1610. 认领这篇 Ramipril of Limited Benefit in Preventing Diabetes
雷米普利预防糖尿病的作用有限
NEW YORK (Reuters Health) Oct 11 - Contrary to previous research suggesting that ramipril may check the progression to diabetes in pre-diabetics, 3-year results of a multinational, prospective trial failed to show that ramipril is superior to placebo in reducing the incidence of diabetes or death in a cohort of patients with impaired fasting glucose levels or impaired glucose tolerance.
美国纽约路透社（健康专栏）10月11日电 以前的研究显示雷米普利能够阻止前驱糖尿病患者发展为糖尿病，与此相反，一项随访3年的多中心前瞻性临床研究显示：雷米普利在降低空腹血糖受损或糖耐量减低患者糖尿病的发病率与死亡率方面并不优于安慰剂。
However, ramipril may improve glucose metabolism by promoting regression to normoglycemia, according to investigators participating in the DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) trial.
但是，参加雷米普利与罗格列酮预防糖尿病的评价试验（DREAM试验）的研究人员称，雷米普利可以通过促进血糖恢复正常水平来改善糖代谢。
In their report in the New England Journal of Medicine for October 12, the trialists note that other studies evaluating the effects of the angiotensin-converting-enzyme (ACE) inhibitor ramipril were focused on patients with or at high risk for cardiovascular disease, and did not include standard assessments of glucose levels.
该项研究发表在10月12日的《新英格兰杂志》上。研究者称，其他评价血管紧张素转换酶抑止剂（雷米普利）的研究都选用伴有心血管高危因素的患者，而且没有对血糖水平进行标准评价。
The ramipril arm of the DREAM trial included individuals age 30 and over who had impaired fasting glucose levels between 110 and 126 mg/dL or a glucose level of 140 to 200 mg/dL 2 hours after an oral glucose load (impaired glucose tolerance) and were free of cardiovascular disease.
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作者:admin@医学,生命科学 2010-11-23 17:11
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