The Effects Of AngiotensinⅡ Type 1 Receptor Blockers On Insulin Resistance In Prediabetes: A Meta-analysis Of Randomized Controlled Trials

Objective:This study performed a meta-analysis to evaluate the clinical efficacy of angiotensinⅡ type l receptor blockers(ARB)and calcium channel blockers(CCB)on insulin resistance(IR)in prediabetes.Methods:The PubMed,The Cochrane Library,Web of Science,CBM,Wan Fang Database and CNKI were searched to identify eligible randomized controlled trials(RCT)published from inception to July 2020 that compared the use of ARB and CCB to determine the effect on IR in prediabetes.Two investigators selected independently on the basis of inclusion criteria and extracted data.The primary outcomes were the homeostasis model insulin resistance index(HOMA-IR),insulin sensitivity index(ISI),fasting plasma glucose(FPG)and fasting plasma insulin(FPI).The secondary outcomes were systolic blood pressure(SBP),diastolic blood pressure(DBP).For each study,the continuous data regarding above indicators were used to calculate the weighted mean difference(WMD)and their 95% confidence intervals(CI).Review Manager 5.3 was used to conduct the meta analysis.Results:Six RCTs were identified and included across all comparisons with a total of 708 patients with prediabetes.Comparisons of changes before and after treatment with ARB group and CCB group revealed that ARB group reduced HOMA-IR [WMD=-1.17,95%CI:(-1.53,-0.81),P<0.05],FPI [WMD=-5.09 m IU/ L,95%CI:(-6.67,-3.51)m IU/ L,P < 0.05],SBP [WMD=-9.34 mm Hg,95%CI:(-16.92,-1.75)mm Hg,P < 0.05] and increased ISI [WMD=1.02,95%CI:(0.22,1.82),P<0.05].Compared with ARB group,CCB group reduced DBP [WMD=2.35 mm Hg,95%CI:(0.93,3.76)mm Hg,P<0.05].Our analyses found no evidence of significant differences in the therapeutic effects of FPG for ARB group as compared with CCB group(P>0.05).Conclusion:ARB were superior to CCB in terms of improving IR,lowering FPI and SBP in prediabetes,similar to CCB in lowering FPG,but inferior to CCB in lowering DBP.