Evaluation of angiotensin-converting enzyme inhibitor use in patients with type 2 diabetes in a state managed care plan.
OBJECTIVE
To compare angiotensin-converting enzyme (ACE) inhibitor use in patients with type 2 diabetes at 1 year and 3 years after guidelines were published.


METHODS
Retrospective database review.


METHODS
The drug utilization review database of a state managed care plan was accessed to retrieve 2 random samples of 500 patients each. These patients had an International Classification of Diseases, Ninth Revision, Clinical Modification code for diabetes mellitus (250) and a National Drug Code for an oral hypoglycemic agent in both 1998 and 2000. Specific clinical modification codes, prescription claims, and diagnostic codes were obtained from patient profiles. Use of ACE inhibitors in 1998 and 2000 then was evaluated by using Pearson's chi-square test.


RESULTS
The proportion of patients with diabetes and hypertension who were taking an ACE inhibitor increased by 10 percentage points over the 2 years; however, ACE inhibitors were only used in 46% of those patients in 2000. A few of the patients receiving an ACE inhibitor had a contraindication to use of the agent. Microalbuminuria screening and glycosylated hemoglobin screening were found to have been conducted in only 4.6% and 54.6%, respectively, of the 496 patients in 2000.


CONCLUSIONS
The results of this study indicate that although ACE inhibitor use improved, fewer than 50% of patients received appropriate therapy. Awareness of and adherence to the recommendations in the guidelines need to be improved. Larger studies may be beneficial to determine more clearly the extent of this problem.
Timpe
Erin M
EM
University of Tennessee Health Science Center, Memphis, Tenn, USA. etimpe@utmem.edu
Amarshi
Naseem
N
Reed
Pamala J
PJ
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors