The use of ACE inhibitors as renoprotective agents in medicaid patients with diabetes

K. K. Scarsi, D. C. Bjornson

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE: To establish a relationship between angiotensin-converting enzyme (ACE) inhibitor therapy and renal outcomes in Medicaid patients with diabetes, and compare the use of ACE inhibitors between 1994 and 1998. METHODS: One thousand patients with either type 1 or type 2 diabetes were randomly selected from the Iowa Medicaid database and followed retrospectively from 1994 through 1998. Data on medication use (insulin, oral antidiabetic agents, or both) and medical services were collected from prescription claims and diagnostic codes. Differences were evaluated with nonparametric statistics. RESULTS: Overall, 402 patients (40.2%) were prescribed an ACE inhibitor during the study period before any adverse renal outcomes occurred; 25 of the patients in this group (6.2%) had a subsequent adverse renal outcome. One hundred patients (16.7%) not receiving an ACE inhibitor had an adverse renal outcome (p = 0.006). We evaluated four subgroups and found that patients with hypertension had fewer adverse renal outcomes if they were receiving ACE inhibitors whether they were taking (p = 0.0006) or not taking insulin (p = 0.047). There was no difference in adverse renal outcomes and ACE inhibitor use in normotensive patients who were taking (p = 0.15) or not taking insulin (p = 0.96). The pattern of use of ACE inhibitors in this population increased more than twofold between 1994 and 1998 (38.1% vs. 80.1%; p < 0.001). Of those patients who had adverse renal outcomes, almost one-half (43.2%) were not taking an ACE inhibitor in 1998. CONCLUSIONS: ACE inhibitors were renoprotective in patients with diabetes in the Iowa Medicaid population. All patients with diabetes who had hypertension had fewer renal outcomes when taking an ACE inhibitor. ACE inhibitors were used more frequently in 1998 than in 1994. The use of ACE inhibitors in this population is improving, but remains less than optimal.

Original languageEnglish (US)
Pages (from-to)1002-1006
Number of pages5
JournalAnnals of Pharmacotherapy
Volume34
Issue number9
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

Fingerprint

Medicaid
Angiotensin-Converting Enzyme Inhibitors
Kidney
Insulin
Population
Hypertension
Enzyme Therapy
Nonparametric Statistics
Hypoglycemic Agents
Type 2 Diabetes Mellitus
Prescriptions
Databases

Keywords

  • ACE inhibitors
  • Diabetes
  • Kidney
  • Nephropathy

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

The use of ACE inhibitors as renoprotective agents in medicaid patients with diabetes. / Scarsi, K. K.; Bjornson, D. C.

In: Annals of Pharmacotherapy, Vol. 34, No. 9, 01.01.2000, p. 1002-1006.

Research output: Contribution to journalArticle

@article{48c12badcd8548f897f6666d183660ab,
title = "The use of ACE inhibitors as renoprotective agents in medicaid patients with diabetes",
abstract = "OBJECTIVE: To establish a relationship between angiotensin-converting enzyme (ACE) inhibitor therapy and renal outcomes in Medicaid patients with diabetes, and compare the use of ACE inhibitors between 1994 and 1998. METHODS: One thousand patients with either type 1 or type 2 diabetes were randomly selected from the Iowa Medicaid database and followed retrospectively from 1994 through 1998. Data on medication use (insulin, oral antidiabetic agents, or both) and medical services were collected from prescription claims and diagnostic codes. Differences were evaluated with nonparametric statistics. RESULTS: Overall, 402 patients (40.2{\%}) were prescribed an ACE inhibitor during the study period before any adverse renal outcomes occurred; 25 of the patients in this group (6.2{\%}) had a subsequent adverse renal outcome. One hundred patients (16.7{\%}) not receiving an ACE inhibitor had an adverse renal outcome (p = 0.006). We evaluated four subgroups and found that patients with hypertension had fewer adverse renal outcomes if they were receiving ACE inhibitors whether they were taking (p = 0.0006) or not taking insulin (p = 0.047). There was no difference in adverse renal outcomes and ACE inhibitor use in normotensive patients who were taking (p = 0.15) or not taking insulin (p = 0.96). The pattern of use of ACE inhibitors in this population increased more than twofold between 1994 and 1998 (38.1{\%} vs. 80.1{\%}; p < 0.001). Of those patients who had adverse renal outcomes, almost one-half (43.2{\%}) were not taking an ACE inhibitor in 1998. CONCLUSIONS: ACE inhibitors were renoprotective in patients with diabetes in the Iowa Medicaid population. All patients with diabetes who had hypertension had fewer renal outcomes when taking an ACE inhibitor. ACE inhibitors were used more frequently in 1998 than in 1994. The use of ACE inhibitors in this population is improving, but remains less than optimal.",
keywords = "ACE inhibitors, Diabetes, Kidney, Nephropathy",
author = "Scarsi, {K. K.} and Bjornson, {D. C.}",
year = "2000",
month = "1",
day = "1",
doi = "10.1345/aph.19346",
language = "English (US)",
volume = "34",
pages = "1002--1006",
journal = "Annals of Pharmacotherapy",
issn = "1060-0280",
publisher = "Harvey Whitney Books Company",
number = "9",

}

TY - JOUR

T1 - The use of ACE inhibitors as renoprotective agents in medicaid patients with diabetes

AU - Scarsi, K. K.

AU - Bjornson, D. C.

PY - 2000/1/1

Y1 - 2000/1/1

N2 - OBJECTIVE: To establish a relationship between angiotensin-converting enzyme (ACE) inhibitor therapy and renal outcomes in Medicaid patients with diabetes, and compare the use of ACE inhibitors between 1994 and 1998. METHODS: One thousand patients with either type 1 or type 2 diabetes were randomly selected from the Iowa Medicaid database and followed retrospectively from 1994 through 1998. Data on medication use (insulin, oral antidiabetic agents, or both) and medical services were collected from prescription claims and diagnostic codes. Differences were evaluated with nonparametric statistics. RESULTS: Overall, 402 patients (40.2%) were prescribed an ACE inhibitor during the study period before any adverse renal outcomes occurred; 25 of the patients in this group (6.2%) had a subsequent adverse renal outcome. One hundred patients (16.7%) not receiving an ACE inhibitor had an adverse renal outcome (p = 0.006). We evaluated four subgroups and found that patients with hypertension had fewer adverse renal outcomes if they were receiving ACE inhibitors whether they were taking (p = 0.0006) or not taking insulin (p = 0.047). There was no difference in adverse renal outcomes and ACE inhibitor use in normotensive patients who were taking (p = 0.15) or not taking insulin (p = 0.96). The pattern of use of ACE inhibitors in this population increased more than twofold between 1994 and 1998 (38.1% vs. 80.1%; p < 0.001). Of those patients who had adverse renal outcomes, almost one-half (43.2%) were not taking an ACE inhibitor in 1998. CONCLUSIONS: ACE inhibitors were renoprotective in patients with diabetes in the Iowa Medicaid population. All patients with diabetes who had hypertension had fewer renal outcomes when taking an ACE inhibitor. ACE inhibitors were used more frequently in 1998 than in 1994. The use of ACE inhibitors in this population is improving, but remains less than optimal.

AB - OBJECTIVE: To establish a relationship between angiotensin-converting enzyme (ACE) inhibitor therapy and renal outcomes in Medicaid patients with diabetes, and compare the use of ACE inhibitors between 1994 and 1998. METHODS: One thousand patients with either type 1 or type 2 diabetes were randomly selected from the Iowa Medicaid database and followed retrospectively from 1994 through 1998. Data on medication use (insulin, oral antidiabetic agents, or both) and medical services were collected from prescription claims and diagnostic codes. Differences were evaluated with nonparametric statistics. RESULTS: Overall, 402 patients (40.2%) were prescribed an ACE inhibitor during the study period before any adverse renal outcomes occurred; 25 of the patients in this group (6.2%) had a subsequent adverse renal outcome. One hundred patients (16.7%) not receiving an ACE inhibitor had an adverse renal outcome (p = 0.006). We evaluated four subgroups and found that patients with hypertension had fewer adverse renal outcomes if they were receiving ACE inhibitors whether they were taking (p = 0.0006) or not taking insulin (p = 0.047). There was no difference in adverse renal outcomes and ACE inhibitor use in normotensive patients who were taking (p = 0.15) or not taking insulin (p = 0.96). The pattern of use of ACE inhibitors in this population increased more than twofold between 1994 and 1998 (38.1% vs. 80.1%; p < 0.001). Of those patients who had adverse renal outcomes, almost one-half (43.2%) were not taking an ACE inhibitor in 1998. CONCLUSIONS: ACE inhibitors were renoprotective in patients with diabetes in the Iowa Medicaid population. All patients with diabetes who had hypertension had fewer renal outcomes when taking an ACE inhibitor. ACE inhibitors were used more frequently in 1998 than in 1994. The use of ACE inhibitors in this population is improving, but remains less than optimal.

KW - ACE inhibitors

KW - Diabetes

KW - Kidney

KW - Nephropathy

UR - http://www.scopus.com/inward/record.url?scp=0033842948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033842948&partnerID=8YFLogxK

U2 - 10.1345/aph.19346

DO - 10.1345/aph.19346

M3 - Article

C2 - 10981244

AN - SCOPUS:0033842948

VL - 34

SP - 1002

EP - 1006

JO - Annals of Pharmacotherapy

JF - Annals of Pharmacotherapy

SN - 1060-0280

IS - 9

ER -