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Long-term Care

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Recommended medications are underused among elderly people with diabetes

Several medications reduce complications and death from diabetes, including statins to lower cholesterol, aspirin to prevent first-time or recurrent cardiovascular disease, and angiotensin-converting enzyme (ACE) inhibitors in those with diabetic nephropathy (diabetes-related kidney disease). However, these recommended medications are underused among elderly men and women who have diabetes, especially those with low incomes, according to Arleen F. Brown, M.D., Ph.D., of the University of California, Los Angeles.

In a study that was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00132 and HS09424), Dr. Brown and her colleagues analyzed the influence of income on recommended medication use among a random sample of 301 community-dwelling elderly Medicare beneficiaries who had diabetes and were covered by the same managed prescription drug benefit. They used telephone interviews and clinical examinations to review medication use.

Annual household income (above or below $20,000) was the primary predictor of receipt of recommended therapies. After adjustment for other patient characteristics, statin use was observed in 57 percent of higher income versus 30 percent of lower income respondents with a history of high blood lipid levels (hyperlipidemia) and 66 percent of higher income versus 29 percent of lower income respondents with a history of heart attack.

There were no differences by income in the rates of aspirin or ACE inhibitor use. Thus, overall use of recommended medications among elderly people with diabetes was low. This, plus the even lower use of more expensive medications by poorer elders with diabetes underscores the need for additional prescription drug coverage for elders who have chronic conditions, particularly low-income individuals, conclude the researchers.

See "Income-related differences in the use of evidence-based therapies in older persons with diabetes mellitus in for-profit managed care," by Dr. Brown, Amy G. Gross, Peter R. Gutierrez, M.S., and others, in the May 2003 Journal of the American Geriatrics Society 51, pp. 665-670.

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