Meta-analysis of studies examining medication adherence, persistence, and discontinuation of oral antihyperglycemic agents in type 2 diabetes

Iglay, Kristy; Cartier, Shannon; Rosen, Virginia M.; Zarotsky, Victoria; Rajpathak, Swapnil; Radican, Larry; Tunceli, Kaan

doi:10.1185/03007995.2015.1053048

Cited by 125 publications

(114 citation statements)

References 44 publications

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“…For instance, a recent meta-analysis conducted by Iglay et al (2015) found that daily diabetes medication adherence (MPR) was 75.3% in the general population (Iglay et al, 2015); which is only slightly less than the 77.3% adherence we observed in the schizophrenia population. This is also the case when comparing these findings to other reviews of diabetes medication adherence in the general population.…”

Section: Diabetes Medication Adherence In Schizophrenia 23contrasting

confidence: 57%

Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis

Gorczynski

Firth

Stubbs

et al. 2017

Psychiatry Research

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. Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis. Psychiatry Research, 250,[17][18][19][20][21][22][23][24] https://doi.org/10.1016/j.psychres.2017.01.049Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rightsCopyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights.•Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research.•You may not further distribute the material or use it for any profit-making activity or commercial gain •You may freely distribute the URL identifying the publication in the Research Portal Take down policy If you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access to the work immediately and investigate your claim. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. AbstractIndividuals living with schizophrenia are 2-3 times more likely to experience type 2 diabetes mellitus. Diabetes medication adherence is essential to reduce morbidity and mortality in this population. We conducted a meta-analysis of diabetes medication adherence among people with schizophrenia, and compared this to those without schizophrenia. A systematic search strategy was used to identify all articles reporting adherence to diabetes medications among patients with schizophrenia. In total, 10 unique studies reporting data from 33,910 people with schizophrenia were included. Random effects meta-analysis showed people with schizophrenia adhered to medication on 77.3% of days prescribed (n=32080, 95%CI=73.6%-81%, I²=99.2%,), and adhered on 4.6% more days per year than those without schizophrenia (p<0.01, 95%CI=2.4%-6.7%, I²=92.5%, schizophrenia n=19367, controls=170,853).Furthermore, 56% of individuals with schizophrenia (n=33680) were considered "adherent"(i.e. >80% adherence over 12-24 month) to diabetes medication, which was signifi...

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Section: Diabetes Medication Adherence In Schizophrenia 23contrasting

confidence: 57%

Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis

Gorczynski

Firth

Stubbs

et al. 2017

Psychiatry Research

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“…This could explain the higher MPR across all groups in our study as compared with that in previous studies. [17,19,23] …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the chronic disease management program for appropriateness of medication adherence and persistence in hypertension and type-2 diabetes patients in Korea

Kim

Kim²,

Lee³

2017

Medicine

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The chronic disease management program (CDMP), a multilevel intervention including copayment reduction and physician incentives, was introduced in 2012 in Korea to improve blood pressure and glycemic control by strengthening the function of clinic as primary care institutions in managing hypertension and diabetes. This study, therefore, aimed to evaluate the effect of CDMP on the appropriateness of medication adherence and persistence in hypertension or type-2 diabetes patients.A pre-post retrospective study was conducted using claims cohort data from 2010 to 2013. Hypertension or type-2 diabetes patients were selected as the CDMP group, while dyslipidemia patients were the control group. Study groups were further categorized as clinic shifters or non-shifters on the basis of whether hospital use changed to clinic use during the study period. Prepost changes in adherence and persistence were assessed. Adherence was measured by medication possession ratio (MPR) and categorized as under (<0.8), appropriate (0.8-1.1), and over-adherence (>1.1). Persistence was measured by 12-month cumulative persistence rate.The pre-post change was significantly improved for appropriate-adherence (hypertension, +6.0%p; diabetes, +6.1%p), 12-month cumulative persistence (hypertension, +6.5%p; diabetes, +10.8%p), and over-adherence (hypertension, À5.3%p; diabetes, À2.8% p) only among the shifters in the CDMP group. Among these, patients visiting the same, single clinic showed a significant increase in appropriate-adherence, whereas those who changed their clinics showed a nonsignificant increase. No significant improvement was verified among the non-shifters in the CDMP group.CDMP improved medication adherence and persistence by significantly increasing appropriate-adherence and 12-month cumulative persistence rate in hypertension and type-2 diabetes patients. Particularly, CDMP significantly improved over-adherence, which was associated with increasing healthcare costs and hospitalization risk.Abbreviations: AHDs = antihypertensive drugs, BP = blood pressure, CDMP = chronic disease management program, COC = continuity of care, COCI = continuity of care index, CVD = cardiovascular disease, HbA1c = hemoglobin A1c, KNHIS-NSC = Korea National Health Insurance Service-National Sample Cohort, LLDs = lipid-lowering drugs, MPR = medication possession ratio, OADs = oral antidiabetes drugs, PDC = proportion of days covered, UPI = usual provider continuity index.

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“…For example, a meta-analysis of 27 studies that evaluated adherence rates to T2DM medications found that only 22% of studies reported ≥80% adherence among patients 6. A systematic review of observational studies reporting persistence with oral antidiabetes drugs (OADs) in patients with T2DM revealed a mean rate of 56.2%, with discontinuation estimates of 31.4% 7. Similarly, using claims data, rates of insulin glargine persistence in the first year after initiation of ~55.0% were reported 8,9.…”

Section: Introductionmentioning

confidence: 99%

Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review

Kennedy-Martin¹,

Boye²,

Peng³

2017

PPA

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PurposeTo explore published evidence on health care costs associated with adherence or persistence to antidiabetes medications in adults with type 2 diabetes mellitus (T2DM).MethodsPrimary research studies published between January 2006 and December 2015 on compliance, adherence, or persistence and treatment in patients with T2DM that document a link with health care costs were identified through literature searches in bibliographic databases and 2015 abstract books for relevant DM congresses. Results were assessed for relevance by two reviewers. The review was part of a larger overview evaluating the impact of adherence and persistence on a range of clinical and economic outcomes; only findings from the cost element are reported herein.ResultsA total of 4,662 de-duplicated abstracts were identified and 110 studies included in the wider review. Of these, 19 reported an association between adherence (n=13), persistence (n=5), or adherence and persistence (n=1), and health care costs. All studies were retrospective, with sample sizes ranging from 301 to 740,195. Medication possession ratio was the most commonly employed adherence measure (n=11). The majority of adherence studies (n=9) reported that medication adherence was associated with lower total health care costs. Pharmacy costs were often increased in adherent patients but this was offset by beneficial effects on other costs. Findings were more variable in persistence studies; three reported that higher pharmacy costs in persistent patients were not sufficiently offset by savings in other areas to result in a reduction in total health care costs.ConclusionsFew studies have evaluated the relationship between adherence, persistence, and health care costs in T2DM. However, it has been consistently shown that medication nonadherence increases health care costs, suggesting that cost savings from better adherence could be substantial. Available data support the economic case for identification of strategies that facilitate improved medication adherence in patients with T2DM.

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Meta-analysis of studies examining medication adherence, persistence, and discontinuation of oral antihyperglycemic agents in type 2 diabetes

Abstract: The results of the analysis demonstrate that medication adherence, persistence, and discontinuation rates are suboptimal in patients with T2DM prescribed OAHAs.

Cited by 125 publications

References 44 publications

Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis

Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis

Evaluation of the chronic disease management program for appropriateness of medication adherence and persistence in hypertension and type-2 diabetes patients in Korea

Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review

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