Objective
To determine how effective angiotensinconverting enzyme (ACE) inhibitors must be in
preventing diabetic nephropathy to warrant early and routine therapy in all Pima Indians
with type 2 diabetes mellitus.
Design
A computerized medical decision analysis model was used to compare strategy 1, screening
for microalbuminuria and treatment of incipient nephropathy as currently recommended
with ACE inhibitor therapy, with strategy 2, a protocol wherein all patients were
routinely administered an ACE inhibitor 1 year after diagnosis of type 2 diabetes
mellitus. The model assumed that ACE inhibitors can block, at least in part, the pathogenic
mechanisms responsible for early diabetic nephropathy (microalbuminuria).
Results
The model predicted that strategy 2 would produce more life-years at less cost than
strategy 1, if routine drug therapy reduced the rate of development of microalbuminuria
by 21% in all patients. Only a 9% reduction in the rate of development of microalbuminuria
was cost-effective at $15,000 per additional life-year gained, and only a 2.4% reduction
was cost-effective at $75,000 per additional life-year gained for strategy 2 over
strategy 1.
Conclusions
Routine ACE inhibitor therapy in Pima Indians with type 2 diabetes mellitus could
prove more effective and even cost saving than the currently recommended approach
of microalbuminuria screening. A prospective trial examining this goal should be considered.
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© 1999 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
