Why the study?
Does high adherence to ACEIs or ARBs reduce the risk of end-stage renal disease and death in patients with diabetes?
Does high adherence to ACEIs or ARBs reduce the risk of end-stage renal disease and death in patients with diabetes?
Higher adherence to ACE inhibitors or ARBs in diabetic patients is associated with a progressively lower risk of developing end-stage renal disease and death.
Answers are grounded in this paper and cite their sources.
High adherence may support lower ESRD and death risk in diabetes; leaves open whether adherence interventions alter outcomes.
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have become standards of care for diabetic nephropathy. The authors assessed the association between treatment adherence to ACEIs and ARBs and the development of end-stage renal disease (ESRD). The cohort comprised the 9895 members of the Central District of Clalit Health Services aged 40 to 70 years, diagnosed with diabetes before 2002, who filled at least four ACEI or ARB monthly prescriptions during 2002-2011. Forty-six percent of patients made 10 or more purchases a year. Hazard ratios for ESRD development and death decreased as adherence increased, with no evidence of a cutoff threshold or plateau. For both outcomes, hazard ratios were significantly lower among patients who purchased at least 10 monthly prescriptions (83% adherence), after adjusting for age, sex, and a number of clinically relevant factors. While ACEIs/ARBs have become standards of care in diabetes, treatment adherence is essential to achieve full benefit.
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Shani et al. (2017) studied this question.
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