title: High-risk diabetic patients in Medicare Part D programs: are they getting the recommended ACEI/ARB therapy?
abstract: BACKGROUND
  Diabetes patients with hypertension and/or renal disease are at an increased risk of cardiovascular morbidity and mortality. Clinical evidence suggests that the use of ACEI/ARB for these patients improves patient outcomes.
  
  
  OBJECTIVE
  To describe ACEI/ARB utilization among high-risk patients with diabetes and to identify patient characteristics that predict suboptimal utilization of ACEI/ARB.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Diabetic patients with coexisting hypertension and/or renal disease with continuous Medicare coverage from October 1, 2005 through June 30, 2006 in six states (Alabama, California, Florida, Mississippi, New York, and Ohio).
  
  
  METHODS
  Any ACEI/ARB use during the first 6 months of 2006.
  
  
  RESULTS
  A total of 1,250,466 Medicare Part D enrollees met our inclusion criteria. ACEI/ARB utilization rates were 63%, 58.3%, and 43.1% among diabetic patients with hypertension and renal disease, hypertension without renal disease, and renal involvement without hypertension, respectively. After adjusting for all other characteristics studied, patients in the hypertension only (OR 0.83; 95% CI: 0.82-0.84) and renal disease only (OR: 0.48; 95% CI: 0.46-0.50) risk groups were less likely to use ACEI/ARB compared to diabetes patients with both hypertension and renal disease. Several demographics, including male gender, age older than 65, and white race, were all predictors of suboptimal ACEI/ARB use. Results from state-specific analyses are consistent with those for all six states.
  
  
  CONCLUSIONS
  In this cohort, less than 60% of high-risk patients with diabetes were receiving the recommended ACEI/ARB therapy. Several patient demographic and clinical characteristics are strongly associated with suboptimal ACEI/ARB use.
authors.affiliation: School of Pharmacy, The University of Mississippi, University, MS 38677, USA. yiyang@olemiss.edu
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Vennela
authors.initials: V
authors.lastname: Thumula
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Pace
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Banahan
authors.forename: Noel E
authors.initials: NE
authors.lastname: Wilkin
authors.forename: William B
authors.initials: WB
authors.lastname: Lobb
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016001:Confidence Intervals; D048909:Diabetes Complications / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007674:Kidney Diseases / Q000150:complications / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents