Chronic Disease

Medications differ in their effect on risk of foot ulcers and limb amputations in patients with diabetes

Diabetes is associated with several vascular complications, such as chronic kidney disease (CKD), diabetic foot ulcers (DFU), and lower extremity amputation (LEA). Two different types of medications are used to prevent CKD in those with diabetes: angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).

In this new study, researchers evaluated whether the risk of developing DFU or LEA in those with diabetes was different in users of ACEIs versus ARBs. This study examined 40,343 individuals from the United Kingdom with diabetes who were first prescribed an ACEI or ARB between 1995 and 2006. Users of ACEIs were about 50 percent more likely than users of ARBs to develop foot ulcers and about 28 percent more likely to suffer limb amputations. The patients who had lower extremity peripheral arterial disease and were taking ACEIs had a 50 percent increased risk of LEA.

The researchers noted that although both ACEIs and ARBs show similar clinical benefits for prevention of CKD and treatment of hypertension, they have different mechanisms of action that could result in the different safety profiles. The study was partly supported by the Agency for Healthcare Research and Quality (HS16946).

See "The differential effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers with respect to foot ulcer and limb amputation in those with diabetes," by David J. Margolis, M.D., Ph.D., Ole Hoffstad, M.A., Stephen Thom, M.D., Ph.D., and others in the September/October 2010 Wound Repair and Regeneration 18, pp. 445-451.

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