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- Title
Indications for and utilization of ACE inhibitors in older individuals with diabetes. Findings from the National Health and Nutrition Examination Survey 1999 to 2002.
- Authors
Rosen, Allison B
- Abstract
<bold>Background: </bold>Angiotensin-converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) improve cardiovascular outcomes in high-risk individuals with diabetes. Despite the marked benefit, it is unknown what percentage of patients with diabetes would benefit from and what percentage actually receive this preventive therapy.<bold>Objectives: </bold>To examine the proportion of older diabetic patients with indications for ACE or ARB (ACE/ARB). To generate national estimates of ACE/ARB use.<bold>Design and Participants: </bold>Survey of 742 individuals> or =55 years (representing 8.02 million U.S. adults) self-reporting diabetes in the 1999 to 2002 National Health and Nutrition Examination Survey.<bold>Measurements: </bold>Prevalence of guideline indications (albuminuria, cardiovascular disease, hypertension) and other cardiac risk factors (hyperlipidemia, smoking) with potential benefit from ACE/ARB. Prevalence of ACE/ARB use overall and by clinical indication.<bold>Results: </bold>Ninety-two percent had guideline indications for ACE/ARB. Including additional cardiac risk factors, the entire (100%) U.S. noninstitutionalized older population with diabetes had indications for ACE/ARB. Overall, 43% of the population received ACE/ARB. Hypertension was associated with higher rates of ACE/ARB use, while albuminuria and cardiovascular disease were not. As the number of indications increased, rates of use increased, however, the maximum prevalence of use was only 53% in individuals with 4 or more indications for ACE/ARB.<bold>Conclusions: </bold>ACE/ARB is indicated in virtually all older individuals with diabetes; yet, national rates of use are disturbingly low and key risk factors (albuminuria and cardiovascular disease) are being missed. To improve quality of diabetes care nationally, use of ACE/ARB therapy by ALL older diabetics may be a desirable addition to diabetes performance measurement sets.
- Subjects
UNITED States; ACE inhibitors; CARDIOVASCULAR disease prevention; DIABETES complications; DRUG utilization statistics; ANGIOTENSIN receptors; AGE distribution; ALBUMINURIA; CARDIOVASCULAR diseases; COMPARATIVE studies; DIABETES; HYPERTENSION; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; SURVEYS; EVALUATION research; THERAPEUTICS
- Publication
JGIM: Journal of General Internal Medicine, 2006, Vol 21, Issue 4, p315
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1111/j.1525-1497.2006.00351.x