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3. Renin-Angiotensin Inhibitors lowers respiratory tract infections in T2D

      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.

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