Diabetes: ACEi or ARBs

Indicator type

General practice indicator suitable for use in the Quality and Outcomes Framework.

Rationale

This indicator measures the percentage of people with diabetes and kidney disease treated with ACE inhibitors or ARBs. NICE guidelines recommend the use of ACE-I (or ARBs) to slow the progression of renal disease in people with type 1 or type 2 diabetes and with urine albumin:creatinine ratio (ACR) ≥3 mg/mmol.

There is strong clinical evidence that the progression of kidney disease in people with diabetes is slowed by treatment with ACE inhibitors. Although trial evidence is based largely on ACE inhibitors, it is believed that similar benefits occur with ARB treatment in people who have intolerable side effects with ACE inhibitors. The SIGN guideline for diabetes recommends that all people with diabetes and a diagnosis of microalbuminuria are offered ACE inhibitors or ARB treatment, irrespective of blood pressure. This is in agreement with the NICE guidelines for type 1 diabetes, type 2 diabetes and chronic kidney disease.

This indicator aligns with the guidance by providing an incentive for ACE inhibitor or ARB treatment for all people with type 1 or type 2 diabetes who have a diagnosis of microalbuminuria or confirmed nephropathy (urine albumin:creatinine ratio (ACR) ≥3 mg/mmol).

Source guidance

Specification

Numerator: The number of patients in the denominator who are currently treated with an ACE-I (or ARBs).

Denominator: The number of patients on the diabetes register with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria.

Calculation: (Numerator/denominator)*100.

Exclusions:

Minimum population: The indicator would be appropriate to assess performance at individual general practice level.

ISBN: 978-1-4731-6104-7