Adherence, control of cardiometabolic factors and therapeutic inertia in patients with type 2 diabetes in the primary care setting

Abstract

Introduction Studies on treatment adherence to glucose‐lowering drugs among patients with type 2 diabetes (T2D) including concomitant treatment for other cardiovascular risk factors are scarce. We aimed to estimate the prevalence of good adherence to all medications used to control diabetes, hypertension and dyslipidemia and to analyse cardiometabolic control and its associated factors in T2D patients in the primary care (PC) setting. Methods Observational, retrospective study conducted in adult patients with T2D who were followed in the PC setting in Spain. Patients were classified as adherent in a particular category if the summary of the proportion of days covered (PDC) for a particular medication category was ≥80% and were considered globally adherent if the PDC was ≥80% for each of the 3 medication categories. Results A total of 457 evaluable patients were recruited, among which 321 patients (70.3%, 95% CI 65.8 to 74.4) were adherent to the three drug categories. The proportion of patients controlled for the 3 cardiometabolic risk factors was 31% according to the contemporary clinical practice guideline criteria, 58% according to investigator judgment and 36% when the objective for HbA1c was individualized. In a multivariate analysis, presenting comorbidities was associated with a lower likelihood of showing adequate control of dyslipidemia (odds ratio [OR] 0.25, 95% CI, 0.16–0.40) and the three cardiometabolic factors as a whole (OR 0.43, 95% CI 0.26–0.70). In a post hoc analysis, therapeutic inertia was found to be greater for dyslipidemia and hypertension than for T2D. Conclusions Despite a relatively high adherence to all medications for treating diabetes, hypertension and dyslipidemia in patients with T2D in the PC setting in Spain, the control of cardiometabolic risk factors as a whole is far from optimal. This could be related, at least in part, to the high frequency of comorbidity of these patients.

Disease and Economic Burden of Poor Metabolic and Weight Control in Type 2 Diabetes in Spain: A Systematic Literature Review

“…Of the nine selected observational studies, four had cross-sectional [ 23 – 26 ] and four retrospective [ 27 – 30 ] designs. Study design was not specified for one of the selected publications [ 31 ].…”

“…Regarding the correct communication of the information, two of the nine studies had 90.1% of STROBE items adequately reported [ 27 , 29 ], followed by three others with 81.8% [ 23 – 25 ] and two additional one with 77.3% [ 26 , 28 ]. Lower STROBE percentages (68.2%) were found for two of the selected publications [ 30 , 31 ] because of the absence or lack of clarity around essential study aspects, such as study design, variables, statistical methods or sample size (Table 1 ).…”

“…A total of four studies analyzed clinical outcomes in PwT2D and poor weight control compared to those of normal weight [ 25 – 27 , 30 ] (Table 5 and S4). The presence of a BMI ≥ 30 kg/m 2 in PwT2D was linked to CVD disease (OR = 1.8) and hypoglycemia (OR = 1.7) (Fig.…”

“…A higher proportion of PwT2D were found to have metabolic syndrome (75.8% vs. 31.2%) [ 27 ] and suboptimal BP control (53.0% vs. 47.6%) [ 25 ] among those with poor weight control. Accordingly, a BMI < 30 kg/m 2 was associated with a reduced risk of inadequate BP control (OR = 0.6) [ 30 ]. Contradictory findings were observed for the relationship between body weight and dyslipidemia.…”

Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022

“…Antes de intensificar un fármaco o cambiarlo hay que valorar si el paciente lo estaba tomando correctamente. Además, se ha comprobado que el médico suele sobreestimar la adherencia de sus pacientes cuando no se mide objetivamente 292 . En la tabla 15 se describen de menor a mayor complejidad, tres métodos para valorar la falta de adherencia: la pregunta de Haynes et al 293 , el cuestionario MMAS-8 de 8 items 294 y el recuento de comprimidos 231 .…”