Underuse of ACE inhibitors and angiotensin II receptor blockers among patients with diabetic nephropathy in Taiwan

Abstract

National guidelines recommend angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) therapy for diabetic patients with hypertension and/or proteinuria to hinder renal disease progression. However, little is known about the adequacy of adherence to these guidelines in diabetic patients and about the predictors of such appropriate ACEIs or ARBs use. We sought to define the rates of ACEIs and ARBs use in a large population of patients with diabetic nephropathy (DN). Using linked medical claims from the National Health Insurance Research Database, we studied a cohort of patients with DN. We used multivariate logistic regression to measure the predictors of usage of the agents studied. Of the 7159 DN patients studied, 5564 patients (77.7%) had hypertension. Of these, only 50.6% were administered ACEIs or ARBs during the quarter studied. In multivariate analyses, greater rates for usage of ACEIs or ARBs were found in patients with coronary artery disease or congestive heart failure. Only 50% of the patients with DN received the recommended treatment with ACEIs or ARBs. This shortfall provides an opportunity for quality-improvement interventions that could provide beneficial clinical outcomes for these high-risk patients.