The use of angiotensin-converting-enzyme (ACE) inhibitors has been associated

with increased insulin sensitivity in diabetic patients. Although such an effect could
be beneficial in the treatment of hypertension or congestive heart failure in diabetic
patients, it might also precipitate severe hypoglycaemia. To test this hypothesis we
carried out a nested case-control study, using data in the Dutch PHARMO system
(1986-92), among diabetic patients treated with insulin or with oral antidiabetic
drugs, who were admitted to hospital with hypoglycaemia. We identified 94 patients
who had been admitted with hypoglycaemia and selected 654 controls from the
same cohort. With adjustment for a wide range of potential confounding factors,
hypoglycaemia was significantly associated with current use of ACE inhibitors (odds
ratio 2·8 [95% Cl 1·4-5·7]). Both among users of insulin and among users of oral
antidiabetic drugs, use of ACE inhibitors was significantly associated with an
increased risk of hospital admission for hypoglycaemia (2·8 [1·2-6·4] and 4·1 [1·4-
12·2], respectively). Although ACE inhibitors have several advantages over other
antihypertensive drugs in diabetes, the risk of hypoglycaemia should be taken into
account. Further investigation of the mechanism is needed since as many as 13·8%
of all hospital admissions for hypoglycaemia might be attributable to use of ACE
inhibitors. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(95)91988-0/fulltext]

https://www.verywellhealth.com/ace-inhibitors-blood-pressure-control-in-diabetes-1087278

Several drugs used to treat cardiovascular disease in diabetic patients can disturb glycemic control. Although some reports have
linked angiotensin-converting-enzyme (ACE) inhibitors with hypoglycemia in . . .

Several drugs used to treat cardiovascular disease in diabetic patients can disturb glycemic control. Although some reports have
linked angiotensin-converting-enzyme (ACE) inhibitors with hypoglycemia in diabetic patients, these drugs are not generally
considered to be an important cause of hypoglycemia. This retrospective case-control study from the Netherlands examined this
association. Using a hospital admissions database with information about drug prescriptions, researchers identified 94 diabetic
patients who had hypoglycemia during a six-year period. They compared these cases with 654 randomly selected diabetic controls
from the same cohort. Hypoglycemia was 2.5 times more frequent among insulin users than among users of oral antidiabetic drugs.
However, after controlling for the type of diabetes treatment and other confounding factors, the risk of hypoglycemia was
significantly increased in patients who received ACE inhibitors (odds ratio, 2.8). The risk was higher for patients on oral agents (OR,
4.1) than for insulin users (OR, 2.8), and was somewhat higher with captopril than with enalapril. Beta-blockers and salicylates were
not associated with hypoglycemia. Comment: ACE inhibitors are used increasingly in diabetic patients, and the authors estimate that
they may account for almost 14 percent of hospital admissions for hypoglycemia in diabetic patients. Although the benefits of ACE
inhibitors are likely to outweigh the risks, physicians should be aware of the possible association with hypoglycemia.
[https://www.jwatch.org/jw199505230000001/1995/05/23/ace-inhibitors-and-hypoglycemia]