Association between angiotensin-converting enzyme insertion/deletion polymorphism and treatment response in type 2 diabetic patients

BackgroundOur objective was to determine whether the angiotensin-converting enzyme insertion-deletion (ACE I/D) polymorphism affects the treatment responses in type 2 diabetic patients.MethodsA total of 117 type 2 diabetic patients with poor metabolic control were evaluated and their treatment intensified before re-evaluation after a mean follow-up of 16.0 months. New insulin treatment was started in 61% of patients, the majority of whom used a combination of insulin and tablets. Earlier insulin treatment was continued and intensified for 9% of patients, and 19% of patients used oral treatment only. As antihypertensive treatment, 34% of patients used diuretics, 27% ACE-inhibitors, 38% β-blockers and 21% calcium-channel blockers during the follow-up. For dyslipidemia, 6% of patients used fibrates and none used statins.ResultsThere was a decrease in glycohemoglobin A1 levels [− 2.0 (0.3) (S.E.) %], plasma total cholesterol [− 0.2 (0.1) mmol/l] and plasma triglycerides [− 1.2 (0.4) mmol/l], and an increase in plasma HDL cholesterol [0.07 (0.02) mmol/l] and weight [2.1 (0.5) kg] in response to intensified treatment. The changes in glycohemoglobin A1 (GHbA1) levels and HDL cholesterol were significantly associated with the ACE I/D polymorphism. The patients with the ACE I/I genotype had a greater decrease [− 3.0 (0.7)] in their GHbA1 levels than the patients with I/D [− 2.1 (0.5)] or D/D [− 1.8 (0.4)] genotypes (P < 0.03). HDL cholesterol levels increased more among the subjects homozygous for the I allele [0.21 (0.05)] than the I/D [0.04 (0.03)] or D/D [0.04 (0.03)] subjects (P < 0.03).ConclusionsThe results suggest that the ACE I/D polymorphism is associated with treatment responses in type 2 diabetic patients.