Treatment choice, medication adherence and glycemic efficacy in people with type 2 diabetes: a UK clinical practice database study

Abstract

ObjectiveUsing primary care data obtained from the UK Clinical Practice Research Datalink, this retrospective cohort study examined the relationships between medication adherence and clinical outcomes in patients with type 2 diabetes.Research design and methodsData were extracted for patients treated between 2008 and 2016, and stratified by oral antihyperglycemic agent (OHA) line of therapy (mono, dual or triple therapy). Patients were monitored for up to 365 days; associations between medication possession ratio (MPR) and outcomes at 1 year (glycated hemoglobin A1c (HbA1c), weight and hypoglycemia incidence) were assessed using linear regression modeling and descriptive analyses.ResultsIn total, 33 849 patients were included in the study (n=23 925 OHA monotherapy; n=8406 OHA dual therapy; n=1518 OHA triple therapy). One-year change in HbA1c was greater among adherent (−0.90 to −1.14%; −9.8 to −12.5 mmol/mol) compared with non-adherent patients (−0.49 to −0.69%; −5.4 to −7.5 mmol/mol). On average, adherent patients had higher hypoglycemia event rates than non-adherent patients (rate ratios of 1.24, 1.10 and 2.06 for OHA mono, dual and triple therapy cohorts, respectively) and experienced greater weight change from baseline. A 10% improvement in MPR was associated with −0.09% (−1.0 mmol/mol), −0.09% (−1.0 mmol/mol) and −0.21% (−2.3 mmol/mol) changes in HbA1c for OHA mono, dual and triple therapy cohorts, respectively.ConclusionsFor patients with type 2 diabetes, increasing medication adherence can bring about meaningful improvements in HbA1c control as the requirement for treatment escalation increases. Regimens associated with weight loss and the avoidance of hypoglycemia were generally associated with better medication adherence and improved glycemic control.

Predictive models of medication non-adherence risks of patients with T2D based on multiple machine learning algorithms

“…Although studies related to medication adherence predictive models are found in tuberculosis14 and heart failure,15 few studies have been retrieved that established and examined the predictive models in patients with type 2 diabetes mellitus (T2DM), for whom medication adherence is a key factor to treatment outcomes 5 21 22. Kumamaru H et al 23 established a logistic regression model for the prediction of future drug compliance.…”

“…Type 2 diabetes (T2D), one of the most popular disorders all over the world,1 is a chronic condition that requires long-term treatment to improve life quality and reduce the probability of related disability and death 2–4. Studies have confirmed that good medication adherence is important for patients with T2D to improve glycemic control, avoid complications, and reduce overall health expenditure 5 6. Interventions such as integrative health coaching can significantly improve medication adherence 7–9.…”

“…Studies found that numerous factors may be associated with medication adherence in patients with T2D, including the duration of the disease, mental state, anxiety, depression, irritability, smoking, cost, and so on 5 10 11. These factors vary with study designs and regions.…”

Psychosocial aspects and contributions of behavioural science to medication‐taking for adults with type 2 diabetes

“…Other specific issues related to people with type 2 diabetes include the fears and worries about side effects of treatment, specifically hypoglycaemia and weight gain. A recent retrospective cohort of 33 000 people with type 2 diabetes in the UK demonstrated greater optimal medication‐taking behaviour for those taking medications associated with weight loss, and fewer hypoglycaemia concerns . It was demonstrated that, as people intensify from monotherapy to dual and triple OAD therapy, treatment choice becomes more important as drugs associated with weight gain and hypoglycaemia such as sulfonylureas and thiazolidinediones are more likely to conflate the issue of medication‐taking behaviour and glycaemic control.…”

Adherence and diabetes

“…For glucose‐lowering treatment, there is some evidence that adherence to metformin is less than that to sulfonylureas and thiazolidinediones, which, in turn, show lower adherence than that to dipeptidyl peptidase 4 inhibitors (DPP‐4i) . Indeed, an important caveat from a large pharmacy database study of people given second‐line treatment after metformin showed that fewer than 10% had definite evidence of having taken metformin in the recommended dosage, and that 28% had no prior claim evidence of having received the medicine at all! Certainly, one would expect that greater levels of adherence would lead to greater degrees of improvement in glycemia, and there is evidence that this is true for oral hypoglycemic agents, with a report from the UK Clinical Practice Database Study showing nearly twice as great an improvement in HbA1c in adherent people receiving oral hypoglycemic treatment, but the mechanism of this association may not simply reflect the pharmacologic action of the medication, with evidence that psychological factors associated with greater medication adherence may track with glycemic improvement . Issues of adherence are particularly great with injected diabetes treatments.…”