The Fermantle Diabetes Phase II study on 1732 patients to determine whether ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) protect against lower–respiratory tract infections complicating type 2 diabetes revealed that the combination positively influences the lowering of respiratory tract infections in people with type 2 diabetes.

      Among the 1,732 patients recruited to the longitudinal observational Fremantle Diabetes Study Phase II (FDS2) between 2008 and 2011, 1,482 with a mean age 65.8 years and median diabetes duration 9.0 years and 51.6% were male had confirmed type 2. The cohort was followed for hospitalizations for or with or deaths from, pneumonia/influenza, ascertained from validated administrative data linkage from study entry to end. Cox regression and competing risk regression were used to identify independent predictors of the outcome. Two-thirds of participants (n = 982) were on ACEi and/or ARB at study entry (498 [33.6%] ACEi, 408 [27.5%] ARB, 76 [5.1%] both). During 9,511 person-years of follow-up (mean ± SD 6.4 ± 2.0 years), 174 participants had incident pneumonia/influenza (156 hospitalizations and 18 deaths without hospitalization). In Cox regression analysis showed that the baseline ACEi/ARB use was independently associated with a reduced risk of incident pneumonia/influenza (cause-specific hazard ratio 0.64 [95% CI 0.45, 0.89], P = 0.008). Reductions were also observed for ACEi, ARB alone, and ACEi/ARB combination therapy. There was no significant change in use of ACEi/ARB during follow-up [interaction with in(time), P = 0.70]. Other significant predictors of incident pneumonia/influenza were previously reported, clinically plausible variables.

      The study concluded that in people with type 2 diabetes ACEi/ARB shows promising results in reducing the risk of respiratory tract infections such as pneumonia/influenza.