A study on the impact of poor medication adherence on health status and medical expense for diabetes mellitus patients in Taiwan

Lin, Chin–Shien; Khan, Haider; Chang, Ruei-Yuan; Liao, Wei‐Chih; Chen, Yi-Hsin; Siao, Sih-Yin; Hsieh, Tsung-Cheng

doi:10.1097/md.0000000000020800

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…Socioeconomic and health-related factors are important to consider as we identified low educational attainment in Egyptians and multimorbidity in Germans to be associated with nonadherence to antithrombotic agents. These results are supported by previous investigations on predictors of medication adherence, reporting a higher likelihood of nonadherence comparing those with low educational level to those with high [33], and those with higher comorbidity scores to those with lower [34]. The identification of disparities in medication adherence between Egyptians and Germans has important implications because lower adherence may contribute to significant disparities in recurrent ischemic stroke outcomes.…”

Section: Discussionsupporting

confidence: 80%

Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis

et al. 2021

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Background: The burden of stroke weighs heavily in developing countries where recurrence rates clearly exceed that of developed countries. The impact of nonadherence to antithrombotic treatment within this context has been poorly investigated. Objective: The objective of this study was to evaluate patients with recurrent ischemic stroke in Egypt and Germany with focus on stroke subtype distribution and adherence to antithrombotic therapy. Methods: We conducted a comparative cross-sectional retrospective cohort study enrolling consecutive patients hospitalized for recurrent ischemic stroke in 2017 in 2 academic centers. Data were collected on demographics, risk factors, stroke subtypes, and medication adherence. Nonadherence to antithrombotic agents was analyzed at the time point of index stroke (recurrent stroke). Predictors of nonadherence were analyzed using logistic regression. Results: A total of 373 Egyptian and 468 German patients with ischemic stroke were included. The proportion of recurrent ischemic stroke among all patients was higher in the Egyptian cohort compared to the German cohort (33 vs. 10%, p < 0.05). Small-vessel occlusion stroke was the most frequent subtype in Egyptians, with a significantly greater proportion than in Germans (45 vs. 26%, p < 0.05). Nonadherence to antiplatelets at the time point of the recurrent stroke was higher in Egyptians than in Germans (82 vs. 19%, p < 0.001). Low educational attainment among Egyptians (OR 0.14, 95% CI [0.00–0.19], p < 0.01) and high comorbidity scores among Germans (OR 2.45, 95% CI [1.06–5.66], p < 0.05) were found to be predictors of nonadherence to antithrombotic treatment. Conclusions: The large stroke recurrence burden in Egypt may be partly explained by differing adherence to secondary preventative antithrombotic pharmacotherapy. Predictors of medication nonadherence have to be addressed to reduce stroke recurrence disparities.

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Section: Discussionsupporting

confidence: 80%

Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis

et al. 2021

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“…This is likely explained by low levels of HbA1c at baseline (7.3±1.2% in the no-DPN group and 7.6±1.7% in the incident-DPN group) compared with the levels usually found in previous studies. These data possibly re ect better medication adherence among Taiwanese DM patients [31] compared with worldwide [32]. Our study also showed equally high numbers of hypoglycemic medication prescriptions in both groups.…”

Section: Other Risk Factors Of Future Dpnsupporting

confidence: 61%

Is renal impairment predictor of future diabetic peripheral neuropathy? A 6-year follow-up cohort study

Wang¹,

Pai²,

Lin³

et al. 2021

Preprint

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The relationship between renal impairment and diabetic peripheral neuropathy (DPN) remains inconclusive. We aim to investigate the risk factors for the occurrence of DPN in Taiwanese adults with type 2 diabetes mellitus (T2DM) and focus on renal impairment. A hospital-based cohort study was conducted from 2013 to 2019 and 552 Taiwanese people who had T2DM without DPN at baseline were enrolled. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Potential risk factors were recorded, including patient’s sociodemographic factors, current medication usage and biochemical markers. As of 2019, 73 developed DPN and 479 had no DPN. The cumulative incidence during the 6-year period was 13.22%. A multivariate logistic regression analysis revealed that lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.98, p=0.008), higher serum creatinine concentration in people under the age of 65 (OR 5.25, p=0.013), advanced age (OR 1.06, p=0.001), increased body weight (OR 1.04, p=0.018), duration of DM (OR 1.05, p=0.036) and male gender (OR 3.69, p=0.011) were significantly associated with future DPN. In conclusion, this is the first large scaled cohort study to investigate risk factors for DPN in Taiwanese. Lower eGFR, higher serum creatinine concentration, particularly in people under the age of 65, advanced age, increased body weight, duration of DM and male gender are predictors of future DPN. Our study not only confirms the association between renal impairment and future DPN but also provides a commonly available assessment to predict the future DPN.

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“…However, our findings showed that men were more likely to forget taking medication. Lin et al [ 17 ] found that compared to female patients, male patients with diabetes were associated with poorer medication adherence, and another study found that the male patients in Taiwan had lower adherence to daily food guides [ 18 ]. Additionally, measurements of medication nonadherence in previous studies consisted of pill counts or scores in scales, which are different from our assessments.…”

Section: Discussionmentioning

confidence: 99%

Behavioral Factors Associated with Medication Nonadherence in Patients with Hypertension

Chen

et al. 2021

IJERPH

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Medication nonadherence is associated with an increased risk of complications in hypertensive patients. We investigated behavioral factors associated with medication nonadherence in hypertensive patients in southern Taiwan. Using questionnaires, we collected data regarding clinicodemographic characteristics and nonadherence behaviors from 238 hypertensive patients. We assessed the self-reported prevalence of specific behaviors of medication nonadherence and investigated factors associated with each behavior using multivariable logistic regression analysis. The most common behavior of medication nonadherence was forgetting to take medication (28.6%), followed by discontinuing medication (9.2%) and reducing the medication dose (8.8%). Age ≥ 65 years (adjusted odds ratio [aOR] = 0.32, 95% confidence interval [CI] = 0.15–0.69) and male sex (aOR = 2.61, CI = 1.31–5.19) were associated with forgetting to take medication. The presence of comorbidities (diabetes, kidney disease, or both) and insomnia (aOR = 3.97, 95% CI = 1.30–12.1) was associated with reducing the medication dose. The use of diet supplements was associated with discontinuing the medication (aOR = 4.82, 95% CI = 1.50–15.5). Compliance with a low oil/sugar/sodium diet was a protective factor against discontinuing medication (aOR = 0.14; 95% CI = 0.03–0.75). The most pervasive behavior associated with medication nonadherence among hypertensive patients was forgetting to take medication. Age <65 years, male sex, comorbidities, insomnia, noncompliance with diet, and the use of dietary supplements were specifically associated with medication nonadherence.

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A study on the impact of poor medication adherence on health status and medical expense for diabetes mellitus patients in Taiwan

Cited by 14 publications

References 21 publications

Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis

Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis

Is renal impairment predictor of future diabetic peripheral neuropathy? A 6-year follow-up cohort study

Behavioral Factors Associated with Medication Nonadherence in Patients with Hypertension

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