Older diabetics not getting heart, kidney drugs

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Despite the fact that drugs known as ACE inhibitors and ARBs prevent damage to the heart and kidneys in people with diabetes, fewer than half of older individuals in the US with diabetes are actually prescribed one of these agents, according to a new study.

“These are drugs that we know save lives and save money, and still we’re only using them in less than half of the people who could benefit,” study author Dr. Allison B. Rosen remarked in a news release.

To estimate the proportion of older diabetic patients being prescribed ACE inhibitors or ARBs, Rosen, from the University of Michigan in Ann Arbor, extracted data from the National Health and Nutrition Examination Survey for 1999 to 2002. 

Rosen reports in the Journal of General Internal Medicine that her study sample included 742 subjects ages 55 or older with diabetes, all of whom had at least one good reason for being prescribed an ACE inhibitor or ARB—that is they, they were losing protein in their urine (a sign of kidney impairment), or they had cardiovascular disease, or heart failure, High Blood Pressure, High cholesterol, or they smoked.

According to the subjects’ responses to the survey, 43 percent were taking an ACE inhibitor or ARB.

Even among individuals with four or more indications for the drugs, the likelihood of being on an ACE/ARB was only 53 percent—“not much higher than the toss of a coin,” Rosen writes.

She adds that, because indications for ACE inhibitor or ARB therapy are so prevalent among people with diabetes, it may be time to simplify treatment guidelines “by expanding indications for ACE/ARB to include all older individuals with diabetes regardless of their measured risk factors.”

SOURCE: Journal of General Internal Medicine, April 2006.

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