Observational study of ACE inhibitor prescribing habits of diabetes physicians in the UK

ACE inhibitors are recognised as playing an increasingly pivotal role in the prevention and treatment of diabetic complications, although prescribing remains controversial. The aim of this study was to assess current practice in the prescribing of ACE inhibitors for patients with type 1 or type 2 diabetes.

A simple postal questionnaire was devised to examine ACE inhibitors prescribing habits for patients with diabetes and was sent to all diabetologists in England, Wales and Northern Ireland.

The response rate to the questionnaire was 57% (220/389 replies). Significant differences between ACE inhibitor prescribing in type 1 and type 2 diabetes were observed in patients with hypertension (92.3% first‐line therapy in type 1 diabetes versus 72% in type 2 diabetes, p < 0.001), microalbuminuria (95.5 versus 52.9%, p > 0.001) and retinopathy (30.3 versus 19%, p > 0.001). Less than 10% of clinicians advocated the use of ACE inhibitors for patients with the cardiovascular risk factors (other than hypertension and microalbuminuria) defined as entry criteria in the MICRO‐HOPE study. In the context of acute myocardial infarction (MI), 96% of physicians would use an ACE inhibitor in the presence of clinical heart failure, 60% would use an ACE inhibitor for uncomplicated anterior MI and 30% would use an ACE inhibitor in an uncomplicated inferior MI. Few respondents would investigate for renal artery stenosis prior to commencing ACE inhibitors. However, there was a significant difference in responses depending on type of diabetes (5 versus 9.5%, p > 0.004). 87.5% of clinicians would monitor renal function within a month of the introduction of ACE inhibitors and there was a heterogeneous response to the concentration of serum creatinine resulting in drug withdrawal in the context of deteriorating renal function (within normal range to normal range + 150µmol/L). 10.2% of respondents had withdrawn the drug due to erectile dysfunction and 2.5% due to hypoglycaemia. The most commonly prescribed ACE inhibitors were lisinopril (70.3%), ramipril (54.6%) and perindopril (40.5%).

Although some consensus of opinion regarding the prescription of ACE inhibitors in the management of diabetes exists, there are many areas in which the lack of conclusive evidence results in considerable variation in clinical practice. Copyright © 2003 John Wiley & Sons, Ltd.