Research Article Open Access Mongkolsomlit et al., J Diabetes Metab 2012, 3:4 DOI: 10.4172/2155-6156.1000188 Volume 3 • Issue 4 • 1000188 J Diabetes Metab ISSN:2155-6156 JDM, an open access journal Keywords: Microalbuminuria; Nephropathy; Angiotensin- converting enzyme; Angiotensin receptor blockers; Survival analysis; Type 2 diabetes Introduction Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are popular frst-line agents for delaying the onset of diabetic nephropathy and diabetic kidney disease because they are efective in reducing microalbuminuria [1- 4]. Te American Diabetes Association (ADA) recommends that for the treatment of non-pregnant patients with microalbuminuria, either ACEIs or ARBs should be prescribed [5]. A previous study has suggested that all middle-aged patients who meet the older diagnostic criteria for diabetes (glucose level ≥ 7.8 mmol/L) should receive ACEIs because it is a more cost-efective strategy in the diabetes population to give all middle-aged patients ACEIs than to screen for microalbuminuria [6]. A meta-analysis showed that ACEI treatment reduced all causes of mortality more than treatment with placebo and slowed progression from micro to macroalbuminuria [7,8]. However, long-term data showing a reduction in mortality from renal failure or all other causes in type 2 diabetes patients with an undetermined nephropathy status taking ACEIs/ARBs are not available. To fll this important gap in the current knowledge, we performed a retrospective cohort study comparing the fve-year mortality incidence to evaluate the efect of treatment with ACEIs/ARBs within the groups of diferent nephropathy statuses on the prevention of death in type 2 diabetes patients registered by Tailand Diabetes Registry Project (TDRP). Methods Study design and study population For this retrospective cohort study, we included type 2 diabetes *Corresponding author: Jayanton Patumanond, Department of Community Medi- cine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. Tel: (66)053-946306; Fax: (66)053-945476; E-mail: jayantorn.s@gmail.com Received March 24, 2012; Accepted April 17, 2012; Published April 23, 2012 Citation: Mongkolsomlit S, Rawdaree P, Komoltri C, Tawichasri C, Patumanond J (2012) Effect of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin Receptor Blockers on the Prevention of Death in Patients with Type 2 Diabetes and Undetermined Nephropathy : Five-Year Survival Data. J Diabetes Metab 3:188. doi:10.4172/2155-6156.1000188 Copyright: © 2012 Mongkolsomlit S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Effect of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin Receptor Blockers on the Prevention of Death in Patients with Type 2 Diabetes and Undetermined Nephropathy : Five-Year Survival Data Sirima Mongkolsomlit 1 , Petch Rawdaree 2 , Chulalux Komoltri 3 , Chamaiporn Tawichasri 1 and Jayanton Patumanond 1 * 1 Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 2 Department of Medicine, Bangkok Metropolitan Medical College and Vajira Hospital, Bangkok, Thailand 3 Department of Clinical Epidemiology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand Abstract Background: Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) are popular frst-line agents for delaying the onset of diabetic nephropathy and diabetic kidney disease in diabetic patients without nephropathy and for reducing all causes of mortality in diabetic patients with nephropathy. However, long-term data showing a reduction in mortality from all causes or renal failure in type 2 diabetes patients with undetermined nephropathy taking ACEIs/ARBs are not available. Objective: To compare renal and other causes of death between those treated and not treated with ACEIs/ARBs in type 2 diabetes patients who are non-nephropathic, nephropathic and have an undetermined nephropathy status. Methods: Type 2 diabetes patients (n = 7,946) who registered with the Thailand Diabetes Registry Project (TDRP) in 2003 were followed-up prospectively for 5 years until January 25, 2008. Baseline demographic data and diabetic nephropathy status were recorded when the patient registered in the TDRP. Living statuses were retrieved from the database of each study site and causes of death were retrieved from the death certifcates from the Bureau of Registration Administration of Thailand. Results: There were 716 type 2 diabetic patients that died within 5 years of registration in the TPDR from all causes of death. Of these cases, 66 died from renal causes. The mortality incidence from renal causes in undetermined nephropathy patients who were treated and not treated with ACEIs/ARBs was 1.25 and 1.30 per 1000 person-years, respectively. After controlling for the propensity score, the competing risk analysis showed that treatment with ACEIs/ ARBs was not signifcantly associated with prevention of death from renal or other causes in type 2 diabetes patients with an undetermined nephropathy status (HR = 0.83, 95% CI: 0.33-2.09, p-value = 0.688 for renal causes; HR = 1.26, 95% CI: 0.97-1.63, p-value = 0.085 for other causes). Treatment with ACEIs/ARBs was signifcantly associated with the prevention of renal and other causes of death in type 2 diabetes patients with nephropathy (HR = 0.49, 95% CI: 0.25- 0.95, p-value = 0.034 for renal causes; HR = 0.73, 95% CI: 0.56-0.95, p-value = 0.019 for other causes). Conclusions: Treatment with ACEIs or ARBs is not necessary for everyone, especially in type 2 diabetes patients with an undetermined nephropathy status. Healthcare services teams should screen for microalbuminuria before the treatment of all newly diagnosed type 2 diabetes patients with ACEIs or ARBs. J o u r n a l o f D i a b e t e s & M e t a b o l i s m ISSN: 2155-6156 Journal of Diabetes and Metabolism