GSB 7.1 Standardlösung

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Diabetes in Germany - adults

Use of ACEI and ARB

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People with diabetes are at an increased risk of cardiovascular disease and benefit from antihypertensive therapy with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), which have been shown to reduce the risk of cardiovascular disease and mortality (Hao et al., 2014). According to the National Health Care Guideline (NVL) for the treatment of type 2 diabetes, ACEI or ARB should be used in people with diabetes with known hypertension and in people with diabetes with increased albumin excretion (NVL 2004).

Key messages

  • More than 70 % of 45- to 79-year-old people with type 2 diabetes and known hypertension use ACEI or ARB.
  • Among people with type 2 diabetes as well as known hypertension, men are more likely to use ACEI or ARB than women.
  • Over time, an increase in the use of ACEI or ARB can be seen among people with type 2 diabetes and known hypertension.

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trend

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cross-section

By state

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  • By gender

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  • By age

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  • By education group

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Results

In 2010, 71.0% of 45- to 79-year-olds with known type 2 diabetes as well as known hypertension are treated with ACEI or ARB. Men (78.5%) are more likely to take ACEI or ARB than women (63.2%). No differences in ACEI or ARB use were seen with respect to age, education, and region. ACEI or ARB use increases among people with known type 2 diabetes and hypertension overall from 1998 (49.2%) to 2010 (71.0%), with pronounced increases being observed among men, in western federal states, and among those in the middle and upper education groups.

Conclusion

The majority of 45- to 79-year-olds with known type 2 diabetes as well as known hypertension used ACEI or ARB in 2010. Men are significantly more likely to use ACEI or ARB than women. The use of ACEI or ARB among individuals with type 2 diabetes as well as known hypertension in Germany increased substantially from 1998 to 2010 (Du et al., 2015). The sex difference in ACEI or ARB use and in the increase from 1998 to 2010 is likely due to the side effect of dry cough with ACEI, which occurs particularly in women and can lead to discontinuation of the drug (Israili et al. 1992).

Show more information on methodology and data sources

Definition

The indicator use of ACEI and ARB is defined as the proportion of people with type 2 diabetes using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) to lower blood pressure.

Operationalisation

Use of ACEI/ARB within the last seven days recorded by the automated medication registration via the ATC codes C09A/C09B or C09C/C09D.

Reference population

Resident population in Germany with known type 2 diabetes, aged 45 to 79 years

Data source

Nationwide RKI interview and examination surveys 1997-1999 (GNHIES98) and 2008-2011 (DEGS1) based on a population registry sample and self-completed questionnaire, medical interview, automated medicine registration and examination.

Number of cases

  • GNHIES98: n = 7,124
  • DEGS1: n = 7,115 (of which n = 2,923 had also participated in GNHIES98)

For the indicator use of ACEI and ARB, data from the 45-to-79 age group with known type 2 diabetes are evaluated:

  • GNHIES98: n = 333
  • DEGS1: n = 526

People with type 1 diabetes were excluded.

Calculation

  • Description: For the indicator, the figures for total, women and men are provided and are stratified by age group, residential area and education as far as the number of cases available for the figure is ≥ 5 and the statistical uncertainty in the estimate of the indicator is not considered too large (a coefficient variation ≤ 33.5%).
  • Stratification: The geographical classification of the residence of the participating person was carried out by east and west (east = former East Germany, including all of Berlin; west = former West Germany, not including West Berlin). Educational status was determined using the CASMIN index, which takes information on both school and vocational training into account and allows a categorisation into a low, medium and high education group.
  • Weighting: In order to correct for deviations from the underlying reference population due to different participation rates or sampling probabilities, weighting factors were used when calculating the indicator. These adjust the surveys to the population structure of the reference population with regard to sex, age, federal state, German citizenship (yes / no), community type and education as of 31 December 1997 (GNHIES98) and 31 December 2010 (DEGS1). In DEGS1, the different participation probability of re-participants from GNHIES98 was also taken into account in the weighting.
  • Age standardization: Age standardization and trend weighting was carried out by calculating the weighting factor in GNHIES98 using the age, sex and federal state structure of the reference population as of 31 December 2010.

Data quality

RKI interview and examination surveys provide representative results for the 18- to 79-year-old resident population of Germany. The population aged 80 years and over will only be included in future survey waves. As is the case in all population-based studies, underrepresentation of the seriously ill and those living in institutions must be assumed.

Data download

References and links

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