title: Important treatment gaps in vascular protection for the elderly after type 2 diabetes therapy initiation.
abstract: BACKGROUND
  Canadian practice guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) for vascular protection in individuals with diabetes who are at high risk of cardiovascular events, including those ≥ 65 years. We estimated the proportion of elderly persons who initiated an ACEI or an ARB in the year after beginning oral antidiabetes (OAD) treatment, and we identified factors associated with this initiation.
  
  
  METHODS
  Using the Quebec Health Insurance Board (RAMQ) databases, we conducted a population-based cohort study of individuals ≥ 65 years recently prescribed an OAD. We excluded those who were already taking an ACEI or ARB. Factors associated with ACEI or ARB initiation were identified using multivariate logistic regression.
  
  
  RESULTS
  Among 43,700 individuals, 13,621 (31.2%) initiated an ACEI or ARB in the year after beginning OAD. Individuals were more likely to begin an ACEI or an ARB if they initially received both metformin and a sulfonylurea, lived in a rural region, began OAD treatment between 2001 and 2006, were hospitalized, or had ≥ 22 medical visits in the year before OAD initiation. Individuals ≥ 75 years, those who were prescribed an OAD by a general practitioner, initially received a sulfonylurea, or received ≥ 4 different medications in the year before OAD initiation were less likely to begin an ACEI or ARB.
  
  
  CONCLUSIONS
  In the elderly not already taking ACEIs or ARBs, a low proportion of those undertaking OAD treatment are prescribed the recommended cardioprotection of an ACEI or ARB in the following year. Interventions are needed to close this treatment gap.
authors.affiliation: Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada; Chair on Adherence to Treatments, Université Laval, Québec City, Québec, Canada; Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Québec City, Québec, Canada. Electronic address: line.guenette@pha.ulaval.ca.
authors.forename: Line
authors.initials: L
authors.lastname: Guénette
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Breton
authors.forename: Haithem
authors.initials: H
authors.lastname: Hamdi
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Grégoire
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Moisan
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D015999:Multivariate Analysis; D011792:Quebec; D012424:Rural Population / Q000706:statistics & numerical data; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin