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High-risk diabetic patients in Medicare Part D programs: are they getting the recommended ACEI/ARB therapy?

Yi Yang1, Vennela Thumula, Patrick F Pace

  • 1School of Pharmacy, The University of Mississippi, University, MS 38677, USA. yiyang@olemiss.edu

Journal of General Internal Medicine
|January 29, 2010
PubMed

Insights

Less than 60% of high-risk diabetes patients received recommended Angiotensin-Converting Enzyme Inhibitor/Angiotensin II Receptor Blocker (ACEI/ARB) therapy. Demographic and clinical factors were linked to suboptimal ACEI/ARB use in this population.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Diabetes mellitus significantly increases cardiovascular morbidity and mortality risk, especially when accompanied by hypertension and/or renal disease.
  • Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin II Receptor Blockers (ARB) are clinically recommended for managing these high-risk diabetic patients.
  • Understanding ACEI/ARB utilization patterns is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the utilization rates of ACEI/ARB therapy in high-risk diabetic patients.
  • To identify patient characteristics associated with suboptimal ACEI/ARB prescription.
  • To inform clinical practice and public health strategies for better cardiovascular risk management in diabetes.

Main Methods:

  • Retrospective cohort study design.
  • Analysis of Medicare Part D enrollees with diabetes and coexisting hypertension and/or renal disease across six states.
  • Assessment of ACEI/ARB use during the first six months of 2006.

Main Results:

  • ACEI/ARB utilization was 63% for patients with both hypertension and renal disease, 58.3% for hypertension only, and 43.1% for renal disease only.
  • Patients with hypertension only (OR 0.83) and renal disease only (OR 0.48) were less likely to use ACEI/ARB compared to those with both conditions.
  • Suboptimal ACEI/ARB use was associated with male gender, age over 65, and white race.

Conclusions:

  • Less than 60% of high-risk diabetic patients in the cohort received recommended ACEI/ARB therapy.
  • Significant disparities in ACEI/ARB utilization exist based on patient demographics and clinical comorbidities.
  • Further interventions are needed to ensure optimal ACEI/ARB therapy for all high-risk diabetic patients.
Abstract

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