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Serum angiotensin-converting enzyme and frequency of severe hypoglycaemia in Type 1 diabetes: does a relationship exist?

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Abstract Aims 

An association has been described between elevated serum angiotensin-converting enzyme (ACE) and an increased risk of severe hypoglycaemia (SH). To ascertain whether this reported association could be replicated in a different country, it was re-examined in 300 individuals with Type 1 diabetes. Methods 

People with Type 1 diabetes, none of whom was taking renin–angiotensin system blocking drugs, were recruited. Participants recorded the frequency with which they had experienced SH. Glycated haemoglobin (HbA1c) and serum ACE were measured. The difference in the incidence of SH between different quartiles of ACE activity and the relationship between serum ACE and SH were examined using non-parametric statistical tests and a negative binomial model. Results 

Data were obtained from 300 patients [158 male; HbA1c median (range) 8.2% (5.2–12.8%), median age 36 years (16–88); duration of diabetes 14.5 years (2–49)]. The incidence of SH was 0.93 episodes per patient year. The mean incidence of SH in the top and bottom quartiles of ACE activity was 0.5 and 1.7 episodes per patient year, respectively, but this difference was not statistically significant (P = 0.075). Spearman's test showed a very weak, although statistically significant, association between serum ACE level and SH incidence (r = 0.115, P = 0.047). The binomial model also showed a statistically significant (P = 0.002), but clinically weak, relationship between serum ACE and SH. Conclusions 

The present survey showed a weak relationship between serum ACE and the frequency of SH, the clinical relevance of which is unclear. This limits the proposed role for serum ACE as an index of risk for SH.

Diabet. Med. 24, 1449–1454 (2007)
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Keywords: Type 1 diabetes; hypoglycaemia; serum angiotensin converting enzyme

Document Type: Research Article

Affiliations: 1: Division of Community Health Sciences, University of Edinburgh and 2: Department of Clinical Chemistry, Western General Hospital, Edinburgh, UK

Publication date: 01 December 2007

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