Refill compliance in type 2 diabetes mellitus: a predictor of switching to insulin therapy?

Abstract

SUMMARYObjective To assess whether switching to insulin therapy in patients with type 2 diabetes mellitus is associated with medication refill compliance of oral hypoglycemic agents. Research Design and Methods The PHARMO Record Linkage System was used as data source for this study. Patients with newly treated type 2 diabetes mellitus were defined as subjects in whom oral hypoglycemic therapy was initiated between 1991 and 1998. We performed a matched case-control study in this cohort. Cases were patients who switched to insulin therapy. Date of switching in the case was defined as the index date. Controls were subjects still on oral therapy on the index date, matched on duration of diabetes and calendar time. We measured the medication refill compliance in the year starting 18 months before the index date and calculated various compliance indices. Results In total, 411 cases and 411 matched controls were identified. Cases suffered more often from more severe comorbidity and used a higher number of oral hypoglycemic agents and concomitant non-diabetic drugs. The overall compliance rate did not differ significantly between cases and controls, the adjusted odds ratio (OR) was 1.3 (CI 95% 0.6-2.8). After performing multivariate logistic regression modeling, age at onset of diabetes, gender, comedication, combination therapy, and daily dosage frequency, were independently related to switching. Conclusions We were unable to confirm the hypothesis that noncompliance with treatment is more prevalent in patients with secondary failure. Other variables, like comorbidity and disease-related factors seem to play a more important role in switching to insulin therapy.

Adherence of Diabetic Patients to the Recommendations on Diabetes in Kayseri

“…15 A study on the systematic review of adherence to medication for diabetes reported that the adherence rate in three retrospective studies ranged from 36 to 93%. [16][17][18] In the present study, 59.5% of the patients reported adherence to an appropriate diet, whereas other studies stated adherence to an appropriate diet as 37-52%. 19,20 Effective self-management is considered the cornerstone of successful diabetes control, and monitoring of blood glucose may have a role in this situation.…”

The Influence of Insulin Use on Glycemic Control

“…This could be the result of disease progression or patients' belief that the OHA will cover their insulin lapses. Although Spoelstra et al (27) hypothesized that poor compliance with OHA dosing might lead to use of insulin, the natural progression of the disease complicates that association. Pugh et al (1) noted that generalists and specialists differed in their implementation of practice guidelines.…”

Initiation of insulin therapy in elderly patients taking oral antidiabetes drugs

“…A younger age, 7 a low body mass index, 7 being a woman, 24 taking more than 1 oral antidiabetes drug, 24 an increase in daily dosage frequency or in the number of comedications, 24 and having a history of myocardial infarction, dyslipidemia, depression and atrial fibrillation 25 have all been reported to be predictors of insulin initiation. Researchers in these studies 7,24,25 did not observe factors similar to those that we have identified. These discrepencies may be explained by differences in methodology.…”

“…We asked the Régie de l'assurance maladie du Québec to identify all beneficiaries of the drug plan who had received at least 1 prescription of an oral antidiabetes drug between Jan. 1, 1998, and Dec. 24,2004. We defined the index date as the date of the first claim for any oral antidiabetes drug during this period.…”