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Kolars B, Minakovic I, Grabovac B, Zivanovic D, Mijatovic Jovin V. Treatment adherence and the contemporary approach to treating type 2 diabetes mellitus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:97-104. [PMID: 38511473 DOI: 10.5507/bp.2024.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
The rising burden of type 2 diabetes mellitus (T2D) poses a significant healthcare challenge on a global scale. The economic impact is also substantial and continually increasing. In Serbia, even though the prevalence is officially around 12 percent, nearly 40 percent of the adult population is estimated to be living with undiagnosed diabetes and more than half the population is obese or overweight. This review comprehensively addresses the present approach to treating T2D, emphasizing the critical role of treatment adherence. We review the various components of T2D treatment, underlining the significance of lifestyle modifications. The pros and cons of medications used in treatment are discussed and factors influencing adherence are analysed. A healthy lifestyle remains the foundation of the treatment, and if not sufficient, early pharmacotherapy is initiated. Medications have been developed to lower blood sugar levels with cardiorenal protection, however, due to their still high cost, metformin remains the drug of first choice for most patients. Adherence to the treatment regimen is often poor. Factors associated with this are diverse and often multiple in a particular patient. Poor adherence is associated with poor glycaemic control, increased risk of disease complications, higher cardiovascular risk, increased mortality, hospitalizations, and healthcare costs. In addition to reducing the complexity of drug therapy and better informing the patient, improved education and motivation could lead to greater adherence. Enhanced communication between the patient and the physician and reduced treatment costs could also have a positive impact. The review concludes that addressing factors affecting adherence can significantly improve T2D outcomes and reduce costs. Further research is needed to identify region-specific risk factors for poor adherence.
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Affiliation(s)
- Bela Kolars
- Department of General Medicine and Geriatrics, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Health Center "Novi Sad", Novi Sad, Serbia
| | - Ivana Minakovic
- Department of General Medicine and Geriatrics, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Health Center "Novi Sad", Novi Sad, Serbia
| | - Beata Grabovac
- Department of Social Sciences and Humanities, Hungarian Language Teacher Training Faculty in Subotica, University of Novi Sad, Subotica, Serbia
| | - Dejan Zivanovic
- Department of Psychology, College of Human Development, Belgrade, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vesna Mijatovic Jovin
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Sperl-Hillen JM, Haapala JL, Dehmer SP, Chumba LN, Ekstrom HL, Truitt AR, Asche SE, Werner AM, Rehrauer DJ, Pankonin MA, Pawloski PA, O'Connor PJ. Protocol of a patient randomized clinical trial to improve medication adherence in primary care. Contemp Clin Trials 2024; 136:107385. [PMID: 37956792 PMCID: PMC10922408 DOI: 10.1016/j.cct.2023.107385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Enhanced awareness of poor medication adherence could improve patient care. This article describes the original and adapted protocols of a randomized trial to improve medication adherence for cardiometabolic conditions. METHODS The original protocol entailed a cluster randomized trial of 28 primary care clinics allocated to either (i) medication adherence enhanced chronic disease care clinical decision support (eCDC-CDS) integrated within the electronic health record (EHR) or (ii) usual care (non-enhanced CDC-CDS). Enhancements comprised (a) electronic interfaces printed for patients and clinicians at primary care encounters that encouraged discussion about specific medication adherence issues that were identified, and (b) pharmacist phone outreach. Study subjects were individuals who at an index visit were aged 18-74 years and not at evidence-based care goals for hypertension (HTN), diabetes mellitus (DM), or lipid management, along with low medication adherence (proportion of days covered [PDC] <80%) for a corresponding medication. The primary study outcomes were improved medication adherence and clinical outcomes (BP and A1C) at 12 months. Protocol adaptation became imperative in response to major implementation challenges: (a) the availability of EHR system-wide PDC calculations that superseded our ability to limit PDC adherence information solely to intervention clinics; (b) the unforeseen closure of pharmacies committed to conducting the pharmacist outreach; and (c) disruptions and clinic closures due to the Covid-19 pandemic. CONCLUSION This manuscript details the protocol of a study to assess whether enhanced awareness of medication adherence issues in primary care settings could improve patient outcomes. The need for protocol adaptation arose in response to multiple implementation challenges.
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Affiliation(s)
| | | | | | | | | | | | | | - Ann M Werner
- HealthPartners Institute, Bloomington, MN, United States
| | - Dan J Rehrauer
- HealthPartners Health Plan, Bloomington, MN, United States; HealthPartners Medical Group, Bloomington, MN, United States
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Yağar F, Sungur C, Dökme Yağar S. The Relationship among Patient Satisfaction, Patient Loyalty, and Compliance with Treatment. Hosp Top 2023:1-10. [PMID: 37811638 DOI: 10.1080/00185868.2023.2266551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
This study examined the relationship between patient loyalty and adherence to treatment and evaluated the mediating role of patient satisfaction in this relationship. This study consisted of 386 participants. Correlation and regression analyses were used. A low level of positive correlation was found between loyalty and compliance scores. It was determined that satisfaction did not mediate the relationship between loyalty and compliance. In addition, a moderately positive relationship was found between loyalty and satisfaction. It has been observed that patient loyalty can play a critical role in important health outcomes such as adherence to treatment and increasing satisfaction.
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Affiliation(s)
- Fedayi Yağar
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Kahramanmaras Sütcü Imam University, Kahramanmaras, Turkey
| | - Cuma Sungur
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Kahramanmaras Sütcü Imam University, Kahramanmaras, Turkey
| | - Sema Dökme Yağar
- Department of Health Care Management, Faculty of Health Sciences, Başkent University, Ankara, Turkey
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Ory MG, Han G, Jani SN, Zhong L, Andreyeva E, Carpenter K, Towne SD, Preston VA, Smith ML. Factors associated with higher hemoglobin A1c and type 2 diabetes-related costs: Secondary data analysis of adults 18 to 64 in Texas with commercial insurance. PLoS One 2023; 18:e0289491. [PMID: 37682942 PMCID: PMC10490838 DOI: 10.1371/journal.pone.0289491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/20/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE This study will identify factors associated with higher hemoglobin A1c (A1c) values and diabetes-related costs among commercially insured adults in Texas diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS This secondary data analysis was based on claims data from commercially insured individuals 18-64 years of age residing in Texas with diagnosed type 2 diabetes during the 2018-2019 study period. The final analysis sample after all the exclusions consisted of 34,992 individuals. Measures included hemoglobin A1c, diabetes-related costs, Charlson Comorbidity Index, diabetes-related complications, rurality and other socioeconomic characteristics. Longitudinal A1c measurements were modeled using age, sex, rurality, comorbidity, and diabetes-related complications in generalized linear longitudinal regression models adjusting the observation time, which was one of the 8 quarters in 2018 and 2019. The diabetes-related costs were similarly modeled in both univariable and multivariable generalized linear longitudinal regression models adjusting the observation time by calendar quarters and covariates. RESULTS The median A1c value was 7, and the median quarterly diabetes-related cost was $120. A positive statistically significant relationship (p = < .0001) was found between A1c levels and diabetes-related costs, although this trend slowed down as A1c levels exceeded 8.0%. Higher A1c values were associated with being male, having diabetes-related complications, and living in rural areas. Higher costs were associated with higher A1c values, older age, and higher Charlson Comorbidity Index scores. CONCLUSION The study adds updated analyses of the interrelationships among demographic and geographic factors, clinical indicators, and health-related costs, reinforcing the role of higher A1c values and complications as diabetes-related cost drivers.
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Affiliation(s)
- Marcia G. Ory
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Gang Han
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Sagar N. Jani
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
| | - Lixian Zhong
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- College of Pharmacy, Texas A&M University, College Station, Texas, United States of America
| | - Elena Andreyeva
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Keri Carpenter
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
| | - Samuel D. Towne
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
- School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, United States of America
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida, United States of America
- Southwest Rural Health Research Center, Texas A&M University, College Station, Texas, United States of America
| | - Veronica Averhart Preston
- Blue Cross Blue Shield of Texas, a subsidiary of Health Care Service Corporation, Richardson, Texas, United States of America
| | - Matthew Lee Smith
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
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Cho SJ, Oh IS, Jeong HE, Cho YM, Hwangbo Y, Yu OHY, Shin JY. Long-term clinical outcomes of oral antidiabetic drugs as fixed-dose combinations: A nationwide retrospective cohort study. Diabetes Obes Metab 2022; 24:2051-2060. [PMID: 35670650 DOI: 10.1111/dom.14792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
AIM To compare treatment patterns and clinical outcomes of single-pill fixed-dose combination (FDC) and two-pill combination (TPC) therapies using real-world data. METHODS We conducted a nationwide retrospective cohort study using South Korea's healthcare database (2002-2015). We identified two cohorts of incident patients with type 2 diabetes who initiated FDC or TPC therapy within 4 months of their first prescription for metformin or sulphonylurea. We examined persistence and adherence patterns and the clinical outcome of a composite endpoint of death or hospitalization for acute myocardial infarction, heart failure or stroke and compared the differences in treatment patterns and clinical outcomes using Cox models. RESULTS Of 5143 and 10 973 patients who initiated FDC and TPC therapy, respectively, we identified 5143 patient pairs after propensity score matching. The FDC group exhibited greater median time to treatment discontinuation (163 vs. 146 days), and proportion of days covered at 12 months (mean 0.60 vs. 0.57, P < .0001) and at 24 months (0.53 vs. 0.51, P = .014) than the TPC group. The FDC group, compared with the TPC group, had reduced risks of the composite clinical outcome (hazard ratio 0.86, 95% confidence intervals 0.77-0.97) and hospitalization for stroke (0.80, 0.67-0.96). CONCLUSION FDC therapy may provide favourable cardiovascular benefits, especially reducing the risk of hospitalization for stroke, and has better medication adherence among patients with type 2 diabetes.
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Affiliation(s)
- Sang-Jun Cho
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - In-Sun Oh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yul Hwangbo
- Division of Endocrinology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Oriana Hoi Yun Yu
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, South Korea
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Sendekie AK, Netere AK, Kasahun AE, Belachew EA. Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. PLoS One 2022; 17:e0274971. [PMID: 36130160 PMCID: PMC9491880 DOI: 10.1371/journal.pone.0274971] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background
Medication nonadherence in patients with chronic diseases, particularly in type 2 diabetes mellitus (T2DM) with comorbidity, has continued to be the cause of treatment failure. The current study assessed medication adherence and its impact on glycemic control in T2DM patients with comorbidity.
Methods
An institutional-based multicenter cross-sectional study was conducted among T2DM patients with comorbidity at the selected hospitals in Northwest Ethiopia. Medication adherence was measured using a structured questionnaire of the General Medication Adherence Scale (GMAS). A logistic regression model was used to identify predictors of the level of medication adherence and glycemic control. P < 0.05 at 95% confidence interval (CI) was statistically significant.
Results
A total of 403 samples were included in the final study. This study showed that more than three-fourths (76.9%) of the participants were under a low level of medication adherence. Source of medication cost coverage [AOR = 10.593, 95% CI (2.628–41.835; P = 0.003], monthly income (P < 0.00), self-monitoring of blood glucose (SMBG) practice [AOR = 0.266, 95% CI (0.117–0.604); P = 0.002], number of medications [AOR = 0.068, 95% CI (0.004–0.813); P = 0.014] and medical conditions [AOR = 0.307, 95% CI (0.026–0.437); P = 0.018] were found to be significant predictors of medication adherence. Significantly, majority (74.7%) of participants had poor levels of glycemic control. Patients who had a high level of medication adherence [AOR = 0.003, 95% CI (0.000–0.113); P = 0.002] were found less likely to have poor glycemic control compared with patients who were low adherent to their medications.
Conclusion
The current study concluded that medication adherence was low and significantly associated with poor glycemic control. Number of medical conditions and medications were found to be associated with medication adherence. Management interventions of T2DM patients with comorbidity should focus on the improvement of medication adherence.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- * E-mail: ,
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Ayele BA, Tiruneh SA, Ayele AA, Engidaw MT, Yitbarek GY, Gebremariam AD. Medication adherence and its associated factors among type 2 diabetic patients in Ethiopian General Hospital, 2019: Institutional based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000099. [PMID: 36962151 PMCID: PMC10021151 DOI: 10.1371/journal.pgph.0000099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/06/2022] [Indexed: 11/19/2022]
Abstract
Introduction Globally, diabetes mellitus is becoming a major public health problem in developing countries. Diabetic medication has a major role in glycemic control. However, poor adherence to diabetes medication leads to increased morbidity and morbidity. This study aimed to determine diabetes medication adherence and its associated factors among type two diabetes (T2DM) patients from December 01, 2019 to December 31, 2019, at Debre Tabor General Hospital, Northwest Ethiopia. Methods An institutional-based cross-sectional survey was conducted with a sample of 422 T2DM at Debre Tabor General Hospital diabetic clinic, Ethiopia. The study was conducted from December 01-31/2019. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale. The data were analyzed using STATA version 15.1 software. Logistic regressions were carried out to identify independent predictors for T2DM adherence. P-value less than 0.05 was used to declare statistical significance. Results A total of 408 T2DM patients were recruited for this study with a response rate of 96.7%. Overall, 58.33% (95% Confidence Interval (CI): 53.47–63.03) T2DM patients had good medication adherence.T2DM patients who were taking both oral and injectable anti-diabetic medications (Adjusted odds ratio (AOR) = 1.98, 95% CI: 1.16–3.39), got the prescribed anti-diabetic medication from the hospital (AOR = 0.51, 95% CI: 0.32–0.80), having own glucometer at home (AOR = 0.30, 95% CI: 0.16–0.54), and having good diabetes-related knowledge (AOR = 0.50, 95% CI: 0.27–0.90) were a significant determinant factors for anti-diabetic medication adherence. Conclusion Overall, more than half of T2DM patients had good medication adherence. Medication type, access to anti-diabetic medication, having own glucometer at home, diabetes-related knowledge were independent predictors of medication adherence. T2DM patients should have own glucometer at home and health promotion should provide about diabetic Mellitus for T2DM patients.
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Affiliation(s)
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health (Epidemiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- School of Health, University of New England, Armidale, Australia
| | - Melaku Tadege Engidaw
- Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbarek
- Department of Biomedical Sciences (Medical Physiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemayehu Digssie Gebremariam
- Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Jalilian H, Heydari S, Mir N, Fehresti S, Khodayari-Zarnaq R. Forgone care in patients with type 2 diabetes: a cross-sectional study. BMC Public Health 2021; 21:1588. [PMID: 34429093 PMCID: PMC8386068 DOI: 10.1186/s12889-021-11639-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Diabetes mellitus is a complex chronic disease requiring appropriate continuous medical care and delayed, or forgone care may exacerbate the severity of the disease. This study aimed to investigate the factors affecting forgone care in patients with type2 diabetes. MATERIALS AND METHODS This was a cross-sectional study involving 1139 patients with type 2 diabetes aged> 18 years in 2019 in Tabriz, Iran. The researcher-made questionnaire was used for data collection. Data were analyzed using IBM SPSS software version 22 and IBM AMOS 22. Exploratory Factor Analysis (EFA) was performed for dimension reduction of the questionnaire, and Confirmatory Factor Analysis (CFA) used to verify the result of EFA. We applied the binary logistic regression model to assess the factors affecting forgone care. RESULTS Of the 1139 patients, 510 patients (45%) reported forgone care during the last year. The percentage of forgoing care was higher in patients without supplementary insurance coverage (P = 0.01), those with complications (P = 0.01) and those with a history of hospitalization (P = 0.006). The majority of patients (41.5%) reported that the most important reason for forgoing care is financial barriers resulting from disease treatment costs. Of the main four factors affecting, quality of care had the highest impact on forgone care at 61.28 (of 100), followed by accessibility (37.01 of 100), awareness and attitude towards disease (18.52 of 100) and social support (17.22 of 100). CONCLUSION The results showed that, despite the implementation of the Islamic Republic of Iran on a fast-track to beating non-communicable diseases (IraPEN), a considerable number of patients with type2 diabetes had a history of forgoing care, and the most important reasons for forgoing care were related to the financial pressure and dissatisfaction with the quality of care. Therefore, not only more financial support programs should be carried out, but the quality of care should be improved.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Somayeh Heydari
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Mir
- Student Research Committee, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Fehresti
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Munshi KD, Amelung K, Carter CS, James R, Shah BR, Henderson RR. Impact of a diabetes remote monitoring program on medication adherence. J Manag Care Spec Pharm 2021; 27:724-731. [PMID: 34057390 PMCID: PMC10391223 DOI: 10.18553/jmcp.2021.27.6.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Medication nonadherence in diabetes is well documented to be associated with inadequate glycemic control. Through remote blood glucose (BG) monitoring, unlimited test strip and lancet supplies, personal coaching, and online access to clinical information and educational resources, diabetes remote monitoring (DRM) programs may provide a solution. OBJECTIVE: To examine the relationship between patient participation in a DRM solution and adherence to oral antidiabetic drugs (OAD). METHODS: A retrospective, propensity score-matched cohort study was conducted using deidentified administrative claims data from a large pharmacy benefit manager. Commercially insured patients aged 18 years or older and having 2 or more 30-day adjusted OAD claims comprised the target sample. Patients enrolled in insurance plans that implemented DRM, who had at least 1 BG check (ever engaged) between April 1, 2015, and March 31, 2018 (exposure) were matched to patients enrolled in insurance plans that did not implement DRM (nonexposure). After a 1:2 matching on baseline demographics, disease burden proxy, total pharmacy out-of-pocket costs, previous adherence and insulin use, nonexposure group participants were assigned the same first BG check date as their matched DRM participants. Medication adherence measured as proportion of days covered (PDC) in the 365 days following first BG check was examined as a continuous and binary outcome measure (PDC > 80% or adherent vs < 80% or nonadherent). Multivariable linear and logistic regression were conducted to examine differential magnitude in adherence and likelihood of being adherent, respectively. RESULTS: The final sample consisted of 6,002 exposure and 12,004 nonexposure group patients. DRM participants who were ever engaged had a 4.5% higher adherence rate (P < 0.001) and 42% higher odds of being adherent (P < 0.001) in the period after engagement compared with non-DRM participants. Sensitivity analyses showed that patients engaged continuously (> 1 BG check per week) for 3, 6, and 12 months had 5.1%, 5.2%, and 6.4% higher adherence rates, respectively (P < 0.001), and 52%, 64%, and 98% higher odds of being adherent, respectively (P < 0.001), compared with non-DRM participants. CONCLUSIONS: The study findings offer evidence that DRM engagement is associated with higher odds of medication adherence. DRM solutions that provide access to glucose test results, personalized coaching, educational resources, and lower testing supply cost can also influence adherence. Our findings have important implications for payers and patients related to improved health outcomes due to higher medication adherence. DISCLOSURES: Funding for this study was provided by Express Scripts. Munshi, Amelung, Carter, and Henderson are employed by Express Scripts. James and Shah are employed by Livongo, which provided the DRM solution.
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Affiliation(s)
| | - Kyle Amelung
- Clinical Solutions, Express Scripts, Memphis, TN
| | - Callie S Carter
- Office of Clinical Evaluation & Policy, Express Scripts, Memphis, TN
| | | | - Bimal R Shah
- Chief Medical Officer, Livongo, Mountain View, CA, and Duke University School of Medicine, Durham, NC
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Erukainure OL, Salau VF, Xiao X, Matsabisa MG, Koorbanally NA, Islam MS. Bioactive compounds of African star apple (Chrysophyllum albidum G. Don) and its modulatory effect on metabolic activities linked to type 2 diabetes in isolated rat psoas muscle. J Food Biochem 2020; 45:e13576. [PMID: 33270256 DOI: 10.1111/jfbc.13576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022]
Abstract
The infusion of Chrysophyllum albidum was investigated for its antidiabetic mechanism by studying its ability to promote glucose uptake and utilization as well as its modulatory effect on metabolic activities linked to type 2 diabetes in isolated psoas muscle. Isolated psoas muscle was incubated with different concentrations of the infusion in the presence of glucose at 37°C for 2 hr. The infusion improved muscle glucose uptake, with concomitant elevated muscular levels of glutathione, superoxide dismutase, catalase, and ectonucleotidase activities, while depleting malondialdehyde, nitric oxide, adenosine triphosphatase, acetylcholinesterase, glycogen phosphorylase, glucose 6-phosphatase, fructose-1,6-biphosphatase, and lipase activities. It also maintained muscular morphology, while increasing magnesium, calcium, and iron levels. The infusion inhibited α-glucosidase and α-amylase activities in vitro. LC-MS analysis of the infusion revealed the presence of phenolics. These results indicate that C. albidum may mediate antidiabetic activities by stimulating muscle glucose uptake and modulation of key metabolisms linked to diabetes. PRACTICAL APPLICATIONS: The African star apple is among the underutilized fruits consumed for nutritional and medicinal purposes in Western Africa. The fruits are usually wasted during its season leading to postharvest loss owing to poor utilization. The present study gives credence to its use in treating diabetes and its complications. Thus, the fruits can be utilized in the development of cheap and affordable nutraceuticals for the management of diabetes which has been reported for its high-cost treatment. Utilization of the fruits will also reduce its postharvest loss and improve its economic values.
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Affiliation(s)
- Ochuko L Erukainure
- Department of Pharmacology, School of Clinical Medicines, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Veronica F Salau
- Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Xin Xiao
- Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Motlalepula G Matsabisa
- Department of Pharmacology, School of Clinical Medicines, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Neil A Koorbanally
- School of Chemistry and Physics, University of KwaZulu-Natal, Durban, South Africa
| | - Md Shahidul Islam
- Department of Pharmacology, School of Clinical Medicines, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Factors Influencing Medication Non-Adherence among Chinese Older Adults with Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176012. [PMID: 32824886 PMCID: PMC7503473 DOI: 10.3390/ijerph17176012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/28/2022]
Abstract
Objectives: This study aimed to examine the prevalence of medication non-adherence among older adults with diabetes mellitus (DM) in Shandong province, China and to identify its influencing factors. Methods: A sample of 1002 older adults aged 60 or above with DM was analyzed. Medication adherence was measured using the Morisky–Green–Levine (MGL) Medication Adherence Scale. Descriptive statistical analysis, chi-square test, univariate and multivariate logistic regression analyses were employed. Results: The prevalence of self-reported medication non-adherence among older adults with DM was 19.9%. Female respondents (adjusted odds ratio (AOR) = 1.56, 95% CI: 1.09–2.24) and respondents who perceived medication adherence to be unimportant (AOR = 1.69, 95% CI: 1.05–2.74) were more likely to experience medication non-adherence. Respondents with 5 years of disease duration or longer were less likely (AOR = 0.63, 95% CI: 0.46–0.87) to experience medication non-adherence. Conclusions: This study showed that about one out of five older adults with DM in Shandong province, China, experienced medication non-adherence, and that gender, disease duration and perceived importance of medication adherence were associated with medication non-adherence in this population group. Provision of counseling and health education programs could be the future priority to raise patients’ awareness of the importance of medication adherence and improve patients’ self-management of DM.
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Jiang P, Babazono A, Fujita T. Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan. Popul Health Manag 2019; 23:264-270. [PMID: 31657660 PMCID: PMC7301321 DOI: 10.1089/pop.2019.0141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013–2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27–1.43) and 1.41 (95% CI: 1.30–1.54); females: 1.17 (95% CI: 1.11–1.23) and 1.24 (95% CI: 1.13–1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80–0.96) and 0.88 (95% CI: 0.79–0.99); females: 1.00 (95% CI: 0.93–1.07) and 0.95 (95% CI: 0.83–1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75–0.91) and 0.62 (95% CI: 0.54–0.70); females: 0.94 (95% CI: 0.87–1.02) and 0.77 (95% CI: 0.65–0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes).
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Affiliation(s)
- Peng Jiang
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Mroueh L, Ayoub D, El-Hajj M, Awada S, Rachidi S, Zein S, Al-Hajje A. Evaluation of medication adherence among Lebanese diabetic patients. Pharm Pract (Granada) 2019; 16:1291. [PMID: 30637030 PMCID: PMC6322979 DOI: 10.18549/pharmpract.2018.04.1291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/22/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Diabetes type 2 is considered one of the main public health concerns. Lack of
adherence to treatment leads to poor therapeutic outcome, poor glycemic
control, and high risk for developing diabetes complications. Objectives: The aim of this study is to evaluate adherence to oral antidiabetic
medication in Diabetes type 2 Lebanese patients, and to evaluate factors
leading to low adherence. Methods: A cross-sectional study was conducted in outpatients endocrinology clinics of
two hospitals and four private clinics located in Beirut-Lebanon. Data was
collected using a well-structured questionnaire by trained pharmacists.
Adherence level was measured by the Lebanese Medication Adherence Scale
(LMAS-14). Bivariate and multivariate analyses were conducted using SPSS
version 20. Results: Overall, 245 patients were included in the study with the majority being
females (54.3%) and obese (47.8%). Only 29% of the
participants had controlled glycemia (HbA1c <7%) with
31.8% of subjects had high adherence to their medication compared to
68.2% with low adherence. Increased working hours/day was associated
with a decrease in adherence to oral antidiabetic medication (OR=0.31;
95% CI 0.11:0.88; p=0.029). Other factors significantly associated
with decreased adherence to treatment were forgetfulness, high drug costs,
complex treatment regimens, experiencing side effects, and perception of
treatment inefficacy. Postponing physician office visits also decreased the
probability of being adherent to oral antidiabetic medication (OR=0.36;
95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of
hypo/hyperglycemia and the sensation of treatment burden also decreased
medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and
OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively). Conclusions: Adherence to oral antidiabetic medication is low for Lebanese patients, which
leads to a poor glycemic control and increases the diabetes complications.
Intervention programs including patient education strategies are essential
to improve medication adherence.
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Affiliation(s)
- Lara Mroueh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Dana Ayoub
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Maya El-Hajj
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Sanaa Awada
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Salam Zein
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
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Chen X, Yu S, Li C, Zhan X, Yan W. Text message–based intervention to improve treatment adherence among rural patients with type 2 diabetes mellitus: a qualitative study. Public Health 2018; 163:46-53. [DOI: 10.1016/j.puhe.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/20/2018] [Accepted: 06/22/2018] [Indexed: 01/15/2023]
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Rosenstock J, Buse JB, Azeem R, Prabhakar P, Kjems L, Huang H, Baron MA. Efficacy and Safety of ITCA 650, a Novel Drug-Device GLP-1 Receptor Agonist, in Type 2 Diabetes Uncontrolled With Oral Antidiabetes Drugs: The FREEDOM-1 Trial. Diabetes Care 2018; 41:333-340. [PMID: 29242349 DOI: 10.2337/dc17-1306] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/19/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE ITCA 650 (exenatide in osmotic mini-pump) continuously delivers exenatide subcutaneously for 3-6 months. Two doses of ITCA 650 were compared with placebo in patients with uncontrolled type 2 diabetes. RESEARCH DESIGN AND METHODS This 39-week, phase 3, double-blind, placebo-controlled trial randomized 460 patients aged 18-80 years with glycated hemoglobin (HbA1c) 7.5-10% [58-86 mmol/mol] 1:1:1 to placebo, ITCA 650 40 μg/day, or ITCA 650 60 μg/day. Primary end point was change in HbA1c at 39 weeks. RESULTS Least squares (LS) mean change from baseline HbA1c was -1.1% [-12.2 mmol/mol] and -1.2% [-13.2 mmol/mol] for ITCA 650 40 and 60 μg/day, respectively (P < 0.001 vs. placebo -0.1% [-1.3 mmol/mol]). In a prespecified analysis, greater HbA1c reductions occurred in patients not receiving sulfonylureas (SUs) versus those receiving SUs (-1.7% vs. -1.2% [-18.6 and -13.1 mmol/mol]). At week 39, HbA1c <7% [53 mmol/mol] was attained in 37%, 44%, and 9% of ITCA 650 40 μg/day, ITCA 650 60 μg/day, and placebo groups, respectively (P < 0.001 each dose vs. placebo). LS mean change from baseline body weight was -2.3 kg and -3.0 kg for ITCA 650 40 and 60 μg/day, respectively (P ≤ 0.015 vs. placebo -1.0 kg). Nausea was the most common adverse event (AE) and subsided over time. Discontinuation for gastrointestinal AEs occurred in 7.2% with ITCA and 1.3% with placebo. Most AEs associated with procedures to place and remove ITCA 650 were mild and transient. CONCLUSIONS ITCA 650 significantly reduced HbA1c and weight compared with placebo and was well tolerated in patients with uncontrolled type 2 diabetes on oral antidiabetes medications.
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Affiliation(s)
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
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Choi YJ, Smaldone AM. Factors Associated With Medication Engagement Among Older Adults With Diabetes: Systematic Review and Meta-Analysis. DIABETES EDUCATOR 2017; 44:15-30. [DOI: 10.1177/0145721717747880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this systematic review and meta-analysis is to explore the factors associated with medication engagement among older adults (≥60 years) with diabetes. Methods Five databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus) were systematically searched to identify studies examining the association between factors and medication engagement among older diabetes patients. A study met inclusion for meta-analysis if the prevalence of medication engagement or factor was reported in ≥2 studies and the frequency or strength of association was either reported or able to be computed. Quality appraisal was performed with the Downs and Black tool. Results Of 538 retrieved studies, 33 (20 cohort and 13 cross-sectional) were included for systematic review; of these, 22 met criteria for meta-analysis. Findings from meta-analysis show that women (odds ratio [OR], 0.92; 95% CI, 0.86-0.97), those with depression (OR, 0.73; 95% CI, 0.62-0.87), and those with higher out-of-pocket spending for prescription drugs (OR, 0.87; 95% CI, 0.80-0.94) were less likely to take diabetes medication when compared with men, those without depression, and those with lower out-of-pocket costs, respectively. Older age (OR, 1.13; 95% CI, 1.00-1.27) was associated with better engagement to diabetes medication. Conclusions Of 4 identified factors, 2 are modifiable. Recent policy efforts to decrease the cost burden of prescribed medication for older adults, such as Medicare Part D, may remove this barrier to medication engagement. Routine screening for depression among older adults with diabetes should be included as part of usual care to facilitate an integrated treatment approach.
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Affiliation(s)
- Yoon Jeong Choi
- Research Institute of Nursing Science, Seoul National University College of Nursing, Seoul, South Korea
| | - Arlene M. Smaldone
- School of Nursing and College of Dental Medicine, Columbia University Medical Center, New York, New York, USA
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Bloomgarden ZT, Tunceli K, Liu J, Brodovicz KG, Mavros P, Engel SS, Radican L, Chen Y, Rajpathak S, Qiu Y, Brudi P, Fonseca V. Adherence, persistence, and treatment discontinuation with sitagliptin compared with sulfonylureas as add-ons to metformin: A retrospective cohort database study. J Diabetes 2017; 9:677-688. [PMID: 27531167 DOI: 10.1111/1753-0407.12461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/22/2016] [Accepted: 08/14/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Data are limited regarding adherence to dipeptidyl peptidase-4 inhibitors. METHODS The present retrospective cohort study of a claims database involved adults with type 2 diabetes mellitus, continuous enrollment for 12 months before the first prescription of add-on sitagliptin (SITA) or a sulfonylurea (SU) to metformin (MET) monotherapy (index date), and ≥45 days of MET coverage ≤90 days before the index date. The SITA and SU users were matched on duration of follow-up and propensity score (PS). Logistic regression analysis incorporated age, gender, comorbidities, and concomitant medications as independent variables. RESULTS Approximately 99 % of SITA patients were PS matched, resulting in 14 807 well-balanced PS-matched SITA/SU pairs. Mean proportion of days covered (PDC) was significantly higher for SITA (vs SU) + MET after 1 year (P < 0.001). Adherence (PDC ≥80 %) to SITA (vs SU) + MET was 59.1 % (vs 55.9 %; P < 0.001) at 1 year and 52.6 % (vs 49.9 %; P = 0.007) at 2 years. Using logistic regression models including out-of-pocket expense (OPE) as a covariate, we found improved mean PDC and adherence for SITA (vs SU) + MET. Numbers of patients who continued to use SITA (vs SU) + MET were significantly higher after Years 1, 2, and 3 (all P < 0.05). CONCLUSIONS Users of SITA + MET had significantly higher mean PDC, adherence, and persistence than those on SU + MET. These trends were robust to model alterations and were more marked when accommodating OPEs.
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Affiliation(s)
- Zachary T Bloomgarden
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | | | - Jinan Liu
- Merck & Co. Inc., Kenilworth, New Jersey, USA
| | | | | | | | | | - Yong Chen
- Merck & Co. Inc., Kenilworth, New Jersey, USA
| | | | - Ying Qiu
- Merck & Co. Inc., Kenilworth, New Jersey, USA
| | | | - Vivian Fonseca
- Tulane University Health Sciences Center, New Orleans, Louisiana, USA
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Kennedy-Martin T, Boye KS, Peng X. Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review. Patient Prefer Adherence 2017; 11:1103-1117. [PMID: 28721024 PMCID: PMC5501621 DOI: 10.2147/ppa.s136639] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To explore published evidence on health care costs associated with adherence or persistence to antidiabetes medications in adults with type 2 diabetes mellitus (T2DM). METHODS Primary 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. RESULTS A 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. CONCLUSIONS Few 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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Affiliation(s)
| | - Kristina S Boye
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiaomei Peng
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
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19
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Fukuda H, Mizobe M. Impact of nonadherence on complication risks and healthcare costs in patients newly-diagnosed with diabetes. Diabetes Res Clin Pract 2017; 123:55-62. [PMID: 27940390 DOI: 10.1016/j.diabres.2016.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/25/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
AIMS To investigate the association between nonadherence to diabetes treatment and the occurrence of diabetes complications. METHODS Our study retrospectively identified adherence and nonadherence to diabetes treatment in patients during the first year of observation after new diagnoses of type 2 diabetes enrolled in commercial database from 52 health insurers in Japan. Participants were insurance enrollees with type 2 diabetes who received healthcare between 2005 and 2013, and who could be tracked for more than 12months from the initiation of diabetes treatment. We compared the occurrence of diabetes-related complications (retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion) and all-cause healthcare expenditure during the second to eighth years. RESULTS We identified 1784 nonadherent patients and 9547 adherent patients. Cox proportional hazard models showed that the occurrence of microvascular complications was significantly higher in the nonadherent group: the hazard ratios (95% confidence intervals) for retinopathy, nephropathy, and neuropathy were 2.04 (1.57-2.66), 1.91 (1.35-2.72), and 1.83 (1.02-3.27), respectively. However, no significant differences were observed between the adherent and nonadherent groups for the macrovascular complications (ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion). In addition, the nonadherent group had a significantly higher cumulative healthcare expenditure than the adherent group during the second-to-fifth-year period (p=0.029) and the second-to-sixth-year period (p=0.009) after treatment initiation. CONCLUSIONS Nonadherence in the first year of diabetes may increase the incidence of complications and result in higher expenditures for patients and payers.
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Affiliation(s)
- Haruhisa Fukuda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Miki Mizobe
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Sutton D, Higdon C, Carmon M, Abbott S. Regular Insulin Administered With the V-Go Disposable Insulin Delivery Device in a Clinical Diabetes Setting: A Retrospective Analysis of Efficacy and Cost. Clin Diabetes 2016; 34:201-205. [PMID: 27766012 PMCID: PMC5070587 DOI: 10.2337/cd16-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- David Sutton
- Northeast Florida Endocrine and Diabetes Associates, Jacksonville, FL
| | - Charissa Higdon
- Northeast Florida Endocrine and Diabetes Associates, Jacksonville, FL
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Wei W, Pan C, Xie L, Baser O. Real-world insulin treatment persistence among patients with type 2 diabetes. Endocr Pract 2016; 20:52-61. [PMID: 24013990 DOI: 10.4158/ep13159.or] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate real-world treatment persistence among patients with type 2 diabetes mellitus (T2DM) initiating treatment with insulin. METHODS Patient-level data were pooled from 3 previously published observational retrospective studies evaluating patients with T2DM who were previously on oral antidiabetic drugs (OADs) and initiated with a basal analog insulin (insulin glargine or insulin detemir). Treatment persistence was defined as remaining on the study drug during the 1-year follow-up period without discontinuation or switching after study drug initiation. Analyses were conducted to identify baseline factors associated with persistence with insulin therapy and to estimate the association between insulin treatment persistence and patients' clinical and economic outcomes during the follow-up period. RESULTS A total of 4,804 patients with T2DM (insulin glargine: n = 4,172, insulin detemir: n = 632) were included. The average insulin persistence rate over the 1-year follow-up period was 65.0%. A significantly higher persistence rate was associated with older age, initiation with insulin glargine using either disposable pens or vial-and-syringe, and with baseline exenatide or sitagliptin use. Higher insulin treatment persistence was also associated with lower hemoglobin A1c (A1C) at follow-up, a greater reduction in A1C from baseline, and lower health care utilization. CONCLUSION In real-world settings, treatment persistence among patients with T2DM initiating basal insulin is influenced by the type of insulin and patient factors. Greater insulin treatment persistence is linked to improved clinical outcomes and reduced health care utilization.
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Affiliation(s)
- Wenhui Wei
- Sanofi U.S., Inc., Bridgewater, New Jersey
| | | | - Lin Xie
- STATinMED Research, Inc., Ann Arbor, Michigan
| | - Onur Baser
- University of Michigan, Ann Arbor, Michigan
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The Clinical and Economic Impact of the V-Go ® Disposable Insulin Delivery Device for Insulin Delivery in Patients with Poorly Controlled Diabetes at High Risk. Drugs Real World Outcomes 2016; 3:191-199. [PMID: 27398298 PMCID: PMC4914539 DOI: 10.1007/s40801-016-0075-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Diabetes is a chronic condition and when poorly controlled can lead to complications and death. Patients with glycated hemoglobin (A1C) measures >9 % are at significant risk for diabetes-related complications impacting the patient's quality of life and imposing higher costs on the healthcare system. A1C reductions of 1 % or greater in this population have demonstrated substantial health and economic benefits. Reducing the percent of patients at risk is an essential component of quality-care measures established for patients with diabetes. OBJECTIVE To evaluate if switching patients prescribed subcutaneous insulin injections to V-Go for insulin delivery would impact clinical and economic parameters in patients with poorly controlled diabetes (A1C > 9 %). METHODS The study was a retrospective analysis using data extracted from the electronic medical records database of a multicenter diabetes system. Outcome measures included mean change in A1C from baseline, the percent of patients achieving a reduction in A1C ≥1 % while on V-Go therapy, and the impact to quality measures. In addition, economic analyses were conducted to assess the pharmacy budget impact and projected implication to total healthcare cost. RESULTS Ninety-seven patients were evaluated after a mean duration of 13.6 ± 6.9 weeks of insulin delivery with V-Go. Switching to V-Go resulted in an overall mean change (95 % CI) in A1C of -2.0 % (-1.7 to -2.3; p < 0.001) from a baseline of 10.5 %. Seventy-three percent of patients achieved an A1C reduction ≥1 %. Cost analysis supported a direct pharmacy savings of $119.30 (18.80-219.60, p = 0.020) per patient per month compared with baseline. CONCLUSION Switching to V-Go for insulin delivery resulted in significant glycemic improvement and proved cost effective. This real-world assessment could be applied more broadly at the health system and plan level.
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Ayadurai S, Hattingh HL, Tee LBG, Md Said SN. A Narrative Review of Diabetes Intervention Studies to Explore Diabetes Care Opportunities for Pharmacists. J Diabetes Res 2016; 2016:5897452. [PMID: 27247949 PMCID: PMC4877480 DOI: 10.1155/2016/5897452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/14/2016] [Indexed: 01/19/2023] Open
Abstract
Background. We conducted a review of current diabetes intervention studies in type 2 diabetes and identified opportunities for pharmacists to deliver quality diabetes care. Methods. A search on randomised controlled trials (RCT) on diabetes management by healthcare professionals including pharmacists published between 2010 and 2015 was conducted. Results and Discussion. Diabetes management includes multifactorial intervention which includes seven factors as outlined in diabetes guidelines, namely, glycaemic, cholesterol and blood pressure control, medication, lifestyle, education, and cardiovascular risk factors. Most studies do not provide evidence that the intervention methods used included all seven factors with exception of three RCT which indicated HbA1c (glycated hemoglobin) reduction range of 0.5% to 1.8%. The varied HbA1C reduction suggests a lack of standardised and consistent approach to diabetes care. Furthermore, the duration of most studies was from one month to two years; therefore long term outcomes could not be established. Conclusion. Although pharmacists' contribution towards improving clinical outcomes of diabetes patients was well documented, the methods used to deliver structured, consistent evidence-based care were not clearly stipulated. Therefore, approaches to achieving long term continuity of care are uncertain. An intervention strategy that encompass all seven evidence-based factors will be useful.
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Affiliation(s)
- Shamala Ayadurai
- Curtin University, School of Pharmacy, Kent Road, Bentley, Perth, WA 6102, Australia
| | - H. Laetitia Hattingh
- Curtin University, School of Pharmacy, Kent Road, Bentley, Perth, WA 6102, Australia
| | - Lisa B. G. Tee
- Curtin University, School of Pharmacy, Kent Road, Bentley, Perth, WA 6102, Australia
| | - Siti Norlina Md Said
- Ministry of Health, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor, Malaysia
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McGovern A, Tippu Z, Hinton W, Munro N, Whyte M, de Lusignan S. Systematic review of adherence rates by medication class in type 2 diabetes: a study protocol. BMJ Open 2016; 6:e010469. [PMID: 26928029 PMCID: PMC4780063 DOI: 10.1136/bmjopen-2015-010469] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Treatment options for type 2 diabetes are becoming increasingly complex with people often prescribed multiple medications, and may include both oral and injectable therapies. There is ongoing debate about which drug classes provide the optimum second-line and third-line treatment options. In the real world, patient adherence and persistence determines medication effectiveness. A better understanding of adherence may help inform the choice of second-line and third-line drug classes. METHODS AND ANALYSIS This systematic review will compare adherence and persistence rates across the different classes of medication available to people with type 2 diabetes. It will include all identified studies comparing medication adherence or persistence between two or more glucose-lowering medications in people with type 2 diabetes. Research databases (MEDLINE, EMBASE, The Cochrane Library, The Register of Controlled Trials, PsychINFO and CINAHL) will be searched for relevant articles, using a comprehensive search strategy. All identified medication trials and observational studies will be included which compare adherence or persistence across classes of diabetes medication. The characteristics and outcomes of all the included studies will be reported along with a study quality grade, assessed using the Cochrane Risk Assessment Tool. The quality of adjustment for confounders of adherence or persistence will be reported for each study. Where multiple (n ≥ 3) studies provide compare adherence or persistence across the same 2 medication classes, a meta-analysis will be performed. ETHICS AND DISSEMINATION No ethics approval is required. This review and meta-analysis (where possible) will provide important information on the relative patient adherence and persistence, with the different classes of diabetes therapies. Once complete, the results will be made available by peer-reviewed publication. TRIAL REGISTRATION NUMBER CRD42015027865.
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Affiliation(s)
- Andrew McGovern
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Zayd Tippu
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - William Hinton
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Neil Munro
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Martin Whyte
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
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Fadare J, Olamoyegun M, Gbadegesin BA. Medication adherence and direct treatment cost among diabetes patients attending a tertiary healthcare facility in Ogbomosho, Nigeria. Malawi Med J 2016; 27:65-70. [PMID: 26405515 DOI: 10.4314/mmj.v27i2.7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is now prevalent in many countries in sub-Saharan Africa, with associated health and socioeconomic consequences. Adherence to antidiabetic medications has been shown to improve glycaemic control, which subsequently improves both the short- and long-term prognosis of the disease. The main objective of this study was to assess the level of adherence to antidiabetic drugs among outpatients in a teaching hospital in southwestern Nigeria. METHODS A cross-sectional study was carried out using the eight-item Morisky Medication Adherence Scale (MMAS-8) among diabetic patients attending the medical outpatients' diabetes clinic of Ladoke Akintola University Teaching Hospital, in Ogbomosho, Oyo State in southwestern Nigeria, during a three-month period (October to December 2013). RESULTS A total of 129 patients participated in the study with a male-to-female ratio of 1:1.5. Seventy-eight (60.5%) patients had systemic hypertension as a comorbid condition while the remaining were being managed for diabetes mellitus alone. Only 6 (4.7%) of the patients had type 1 DM while the remaining 123 (95.3%) were diagnosed with type 2 DM. Metformin was the most prescribed oral hypoglycaemic agent (n = 111, 58.7%) followed by glibenclamide (n = 49, 25.9%). Medication adherence was classified as good, medium, and poor for 52 (40.6%), 42 (32.8%), and 34 (26.6%) patients, respectively. Medication costs accounted for 72.3% of the total direct cost of DM in this study, followed by the cost of laboratory investigations (17.6%). CONCLUSION Adherence of diabetes patients in the study sample to their medications was satisfactory. There is a need for the integration of generic medicines into routine care as a way of further reducing the burden of healthcare expenditure on the patients.
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Affiliation(s)
- J Fadare
- Department of Pharmacology, Ekiti State University, Ado-Ekiti, Nigeria
| | - M Olamoyegun
- Department of Medicine, Ladoke Akintola University of Technology (LAUTECH) and LAUTECH Teaching Hospital, Ogbomosho, Nigeria
| | - B A Gbadegesin
- Department of Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomosho, Nigeria
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Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016; 10:1299-307. [PMID: 27524885 PMCID: PMC4966497 DOI: 10.2147/ppa.s106821] [Citation(s) in RCA: 408] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
At least 45% of patients with type 2 diabetes (T2D) fail to achieve adequate glycemic control (HbA1c <7%). One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals), patient demographic factors (eg, young age, low education level, and low income level), critical patient beliefs about their medications (eg, perceived treatment inefficacy), and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia). Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative medication beliefs of patients. Solutions to these problems would require behavioral innovations as well as new methods and modes of drug delivery.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego
- University of California, San Diego
- Correspondence: William H Polonsky, Behavioral Diabetes Institute, PO Box 2148, Del Mar, CA 92014, USA, Tel +1 760 525 5256, Email
| | - Robert R Henry
- University of California, San Diego
- Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA, USA
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Farr AM, Sheehan JJ, Davis BM, Smith DM. Comparison of adherence and persistence among adults with type 2 diabetes mellitus initiating saxagliptin or linagliptin. Patient Prefer Adherence 2016; 10:1471-9. [PMID: 27540280 PMCID: PMC4979597 DOI: 10.2147/ppa.s112598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adherence and persistence to antidiabetes medications are important to control blood glucose levels among individuals with type 2 diabetes mellitus (T2D). OBJECTIVES The objective of this study was to compare adherence and persistence over a 12-month period between patients initiating saxagliptin and patients initiating linagliptin, two dipeptidyl peptidase-4 inhibitors. METHODS This retrospective cohort study was conducted in MarketScan(®) Commercial and Medicare Supplemental claims databases. Patients with T2D initiating saxagliptin or linagliptin between January 1, 2009, and June 30, 2013, were selected. Patients were required to be at least 18 years old and have 12 months of continuous enrollment prior to and following initiation. Adherence and persistence to initiated medication were measured over the 12 months after initiation using outpatient pharmacy claims. Patients were considered adherent if the proportion of days covered was ≥0.80. Patients were considered nonpersistent (or to have discontinued) if there was a gap of >60 days without initiated medication on hand. Multivariable logistic regression and multivariable Cox proportional hazard models were fit to compare adherence and persistence, respectively, between the two cohorts. RESULTS There were 21,599 saxagliptin initiators (mean age 55 years; 53% male) and 5,786 linagliptin initiators (mean age 57 years; 54% male) included in the study sample. Over the 12-month follow-up, 46% of saxagliptin initiators and 42% of linagliptin initiators were considered adherent and 47% of saxagliptin initiators and 51% of linagliptin initiators discontinued their initiated medication. After controlling for patient characteristics, saxagliptin initiation was associated with significantly greater odds of being adherent (adjusted odds ratio =1.212, 95% CI 1.140-1.289) and significantly lower hazards of discontinuation (adjusted hazard ratio =0.887, 95% CI 0.850-0.926) compared with linagliptin initiation. CONCLUSION Compared with patients with T2D who initiated linagliptin, patients with T2D who initiated saxagliptin had significantly better adherence and persistence.
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Affiliation(s)
- Amanda M Farr
- Life Sciences, Truven Health Analytics, an IBM Company, Cambridge, MA
- Correspondence: Amanda M Farr, Life Sciences, Truven Health Analytics, an IBM Company, 150 Cambridgepark Drive, Cambridge, MA 02140, USA, Tel +1 603 801 5193, Email
| | - John J Sheehan
- Health Economics and Outcomes Research – Diabetes, AstraZeneca, Fort Washington, PA, USA
| | - Brian M Davis
- Life Sciences, Truven Health Analytics, an IBM Company, Cambridge, MA
| | - David M Smith
- Life Sciences, Truven Health Analytics, an IBM Company, Cambridge, MA
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Boye KS, Curtis SE, Lage MJ, Garcia-Perez LE. Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database. Patient Prefer Adherence 2016; 10:1573-81. [PMID: 27574406 PMCID: PMC4993402 DOI: 10.2147/ppa.s107543] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the association between adherence to glucose-lowering agents and patient outcomes, including costs, acute-care resource utilization, and complications, in an older, type 2 diabetic population. DATA AND METHODS The study used Truven's Medicare Supplemental database from July 1, 2009 to June 30, 2014. Patients aged 65 years or older were included if they had at least two type 2 diabetes diagnoses and received a glucose-lowering agent from July 1, 2010 through June 30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and levels of adherence, proxied by the proportion of days covered. Outcomes included all-cause medical costs, diabetes-related medical costs, acute-care resource utilization, and acute complications. RESULTS In this study (N=123,235), higher adherence was linked to reduced costs and improved health outcomes. For example, comparing an individual with adherence of proportion of days covered <20% to one with proportion of days covered ≥80% illustrates an average saving of $28,824 in total 3-year costs. Furthermore, a 1% increase in adherence among 1,000 patients was associated with all-cause savings of $65,464 over 3 years. The probability of a hospitalization, an emergency room (ER) visit, or an acute complication decreased monotonically as adherence levels got higher, as did the number of hospitalizations, ER visits, and days hospitalized (P<0.005). CONCLUSION Higher adherence was associated with substantially less need for acute care, as indicated by a lowered probability of hospitalization or ER use, a reduced risk of an acute complication, and a decreased number of hospitalizations, ER visits, and days hospitalized. Higher adherence was also generally associated with lower all-cause and diabetes-related total costs, despite higher drug costs. These lower total costs were driven by the diminished acute care and outpatient costs. Results suggest that higher glucose-lowering agent adherence is associated with significant benefits for payers and older patients with type 2 diabetes.
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Affiliation(s)
- Kristina Secnik Boye
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | - Sarah E Curtis
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | - Maureen J Lage
- HealthMetrics Outcomes Research, LLC, Bonita Springs, FL
- Correspondence: Maureen J Lage, HealthMetrics, Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL 34134, USA, Tel +1 860 245 0685, Email,
| | - Luis-Emilio Garcia-Perez
- Global Medical Affairs, Lilly Diabetes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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Gentil L, Vasiliadis HM, Préville M, Berbiche D. Adherence to Oral Antihyperglycemic Agents Among Older Adults With Mental Disorders and Its Effect on Health Care Costs, Quebec, Canada, 2005-2008. Prev Chronic Dis 2015; 12:E230. [PMID: 26719900 PMCID: PMC4699743 DOI: 10.5888/pcd12.150412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Nonadherence to oral antihyperglycemic agents (OHAs) leads to an increase in use of health care resources and overall expenditures due to type 2 diabetes and its complications. People with type 2 diabetes are almost twice as likely to have anxiety and depression as the general population. Our aim was to examine health care costs associated with adherence to OHAs and the effect of depression and anxiety disorders on these in older adults with type 2 diabetes. Methods We used data from a representative sample (N = 2,811) of community-dwelling adults in Quebec aged 65 years or older who participated in the Étude sur la Santé des Aînés survey. The final sample consisted of 301 participants who were diagnosed with type 2 diabetes and who were taking OHAs. Total health care costs were calculated as the sum of the costs of hospitalizations and outpatient clinic services. Adherence to OHAs was measured using the medication possession ratio. Depression and anxiety disorders were assessed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. We also analyzed data by the Charlson Comorbidity Index, age, sex, education, and marital status, using generalized linear models. Results Nonadherence among people without depression or anxiety was associated with higher total health care costs ($4,477; 95% confidence interval [CI], $3,754–$5,201; P < .001), as was nonadherence among people with depression or anxiety ($11,124; 95% CI, $9,685–$12,562; P < .001). Conclusion Improving adherence to OHAs among people with type 2 diabetes, particularly those with underlying mental disorders such as depression or anxiety, can decrease health care costs.
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Affiliation(s)
- Lia Gentil
- 150 Place Charles-LeMoyne, Suite 200, PO Box 11, Longueuil, Quebec J4K 0A8, Canada.
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, University of Sherbrooke, and Charles LeMoyne Hospital Research Center, Longueuil, Quebec, Canada
| | - Michel Préville
- Faculty of Medicine and Health Sciences, University of Sherbrooke, and Charles LeMoyne Hospital Research Center, Longueuil, Quebec, Canada
| | - Djamal Berbiche
- Charles LeMoyne Hospital Research Center, Longueuil, Quebec, Canada
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Herron C, Brueckner C, Chism J, Kemp D, Prescott J, Smith G, Melich D, Oleas N, Polli J. Toxicokinetics and toxicity of atorvastatin in dogs. Toxicol Appl Pharmacol 2015; 289:117-23. [DOI: 10.1016/j.taap.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 01/12/2023]
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Tunceli K, Iglay K, Zhao C, Brodovicz KG, Radican L. Factors associated with adherence to oral antihyperglycemic monotherapy in patients with type 2 diabetes mellitus in the United Kingdom. Diabetes Res Clin Pract 2015; 109:e27-31. [PMID: 26233933 DOI: 10.1016/j.diabres.2015.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/23/2022]
Abstract
To evaluate adherence to oral antihyperglycemic monotherapy, we conducted a retrospective cohort study of a UK clinical database. The mean proportion of days covered was 73.5%, and 60.1% of patients were adherent. Younger age and fewer concomitant medications were negatively associated with the likelihood of being adherent.
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Jecht M. Die Therapietreue beeinflussenden Faktoren bei der Einnahme von Diabetesmedikamenten. DIABETOLOGE 2015. [DOI: 10.1007/s11428-015-1399-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kirkman MS, Rowan-Martin MT, Levin R, Fonseca VA, Schmittdiel JA, Herman WH, Aubert RE. Determinants of adherence to diabetes medications: findings from a large pharmacy claims database. Diabetes Care 2015; 38:604-9. [PMID: 25573883 PMCID: PMC4370331 DOI: 10.2337/dc14-2098] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Adults with diabetes typically take multiple medications for hyperglycemia, diabetes-associated conditions, and other comorbidities. Medication adherence is associated with improved outcomes, including reduced health care costs, hospitalization, and mortality. We conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to antidiabetic medications. RESEARCH DESIGN AND METHODS We extracted data on a cohort of >200,000 patients who were treated for diabetes with noninsulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011. Adherence was defined as a medication possession ratio ≥ 0.8. We used a modified adherence measure that accounted for switching therapies. Logistic regression analysis was performed to determine factors independently associated with adherence. RESULTS Sixty-nine percent of patients were adherent. Adherence was independently associated with older age, male sex, higher education, higher income, use of mail order versus retail pharmacies, primary care versus nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. Patients who were new to diabetes therapy were significantly less likely to be adherent. CONCLUSIONS Several demographic, clinical, and potentially modifiable system-level factors were associated with adherence to antidiabetic medications. Patients typically perceived to be healthy (those who are younger, new to diabetes, and on few other medications) may be at risk for nonadherence. For all patients, efforts to reduce out-of-pocket costs and encourage use of mail order pharmacies may result in higher adherence.
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Affiliation(s)
- M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC
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Sicras-Mainar A, Navarro-Artieda R. Economic impact of combining metformin with dipeptidyl peptidase-4 inhibitors in diabetic patients with renal impairment in spanish patients. Diabetes Metab J 2015; 39:74-81. [PMID: 25729716 PMCID: PMC4342540 DOI: 10.4093/dmj.2015.39.1.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/19/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To evaluate resource use and health costs due to the combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with diabetes and renal impairment in routine clinical practice. METHODS An observational, retrospective study was performed. Patients aged ≥30 years treated with metformin who initiated a second oral antidiabetic treatment in 2009 to 2010 were included. Two groups of patients were analysed: metformin+DPP-4 inhibitors and other oral antidiabetics. The main measures were: compliance, persistence, metabolic control (glycosylated hemoglobin< 7%) and complications (hypoglycemia, cardiovascular events) and total costs. Patients were followed up for 2 years. RESULTS We included 395 patients, mean age 70.2 years, 56.5% male: 135 patients received metformin+DPP-4 inhibitors and 260 patients received metformin+other oral antidiabetics. Patients receiving DPP-4 inhibitors showed better compliance (66.0% vs. 60.1%), persistence (57.6% vs. 50.0%), and metabolic control (63.9% vs. 57.3%), respectively, compared with those receiving other oral antidiabetics (P<0.05), and also had a lower rate of hypoglycemia (20.0% vs. 47.7%) and lower total costs (€ 2,486 vs. € 3,002), P=0.001. CONCLUSION Despite the limitations of the study, patients with renal impairment treated with DPP-4 inhibitors had better metabolic control, lower rates (association) of hypoglycaemia, and lower health costs for the Spanish national health system.
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Haak T. Combination of linagliptin and metformin for the treatment of patients with type 2 diabetes. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2015; 8:1-6. [PMID: 25628514 PMCID: PMC4284079 DOI: 10.4137/cmed.s10360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/16/2014] [Accepted: 11/18/2014] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive condition requiring long-term treatment. Most patients with T2DM are unable to maintain normoglycemia using metformin alone; thus, combination therapy is a pivotal part of disease management. Addition of the dipeptidyl peptidase-4 inhibitor linagliptin, with its proven efficacy, low propensity for hypoglycemia, and weight neutrality, has been shown to improve glycemic control for patients who are not well controlled with metformin. As patients often have other comorbidities requiring pharmacotherapy, an increase in pill number, different prescribing frequencies, and timing of medications may adversely impact patients’ adherence. Studies have shown that treatment nonadherence contributes to increased morbidity, mortality, and healthcare cost. In the United States, the single-pill combination (SPC) of linagliptin/metformin is available in three strengths approved for twice-daily administration: 2.5/500 mg, 2.5/850 mg, and 2.5/1000 mg. The SPC has the potential to reduce pill burden and simplify patients’ treatment regimens, thereby promoting improved adherence and efficacy.
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Affiliation(s)
- Thomas Haak
- Diabetes Klinik Bad Mergentheim GmbH & Co. KG, Bad Mergentheim, Germany
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Farr AM, Sheehan JJ, Curkendall SM, Smith DM, Johnston SS, Kalsekar I. Retrospective analysis of long-term adherence to and persistence with DPP-4 inhibitors in US adults with type 2 diabetes mellitus. Adv Ther 2014; 31:1287-305. [PMID: 25504156 PMCID: PMC4271133 DOI: 10.1007/s12325-014-0171-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Indexed: 02/08/2023]
Abstract
Introduction Patients with type 2 diabetes mellitus (T2DM) must remain adherent and persistent on antidiabetic medications to optimize clinical benefits. This analysis compared adherence and persistence among adults initiating dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), and thiazolidinediones (TZDs) and between patients initiating saxagliptin or sitagliptin, two DPP-4is. Methods This retrospective cohort study utilized the US MarketScan® (Truven Health Analytics, Ann Arbor, MI, USA) Commercial and Medicare Supplemental health insurance claims databases. Adults aged ≥18 years with T2DM who initiated a DPP-4i, SU, or TZD from January 1, 2009 to January 31, 2012 were included. Patients must have been continuously enrolled for ≥1 year prior to and ≥1 year following initiation. Adherence was measured using proportion of days covered (PDC), with PDC ≥ 0.80 considered adherent. Persistence was measured as time to discontinuation, defined as last day with drug prior to a 60+ days gap in therapy. Multivariable logistic regression and Cox proportional hazards models compared the outcomes between cohorts, controlling for baseline differences. Results The sample included 238,372 patients (61,399 DPP-4i, 134,961 SU, 42,012 TZD). During 1-year follow-up, 47.3% of DPP-4i initiators, 41.2% of SU initiators, and 36.7% of TZD initiators were adherent. Adjusted odds of adherence were significantly greater among DPP-4i initiators than SU (adjusted odds ratio [AOR] = 1.678, P < 0.001) and TZD initiators (AOR = 1.605, P < 0.001). During 1-year follow-up, 55.0% of DPP-4i initiators, 47.8% of SU initiators, and 42.9% of TZD initiators did not discontinue therapy. Adjusted hazards of discontinuation were significantly greater for SU (adjusted hazard ratio [AHR] = 1.390, P < 0.001) and TZD initiators (AHR = 1.402, P < 0.001) compared with DPP-4i initiators. Saxagliptin initiators had significantly better adherence (AOR = 1.213, P < 0.001) compared with sitagliptin initiators, and sitagliptin initiators had significantly greater hazard of discontinuation (AHR = 1.159, P < 0.001). Results were similar over a 2-year follow-up. Conclusions US adults with T2DM who initiated DPP-4i therapy, particularly saxagliptin, had significantly better adherence and persistence compared with patients who initiated SUs or TZDs. Electronic supplementary material The online version of this article (doi:10.1007/s12325-014-0171-3) contains supplementary material, which is available to authorized users.
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Sicras-Mainar A, Navarro-Artieda R. Healthcare costs of the combination of metformin/dipeptidyl peptidase-4 inhibitors compared with metformin/other oral antidiabetes agents in patients with type 2 diabetes and metabolic syndrome. Diabetes Technol Ther 2014; 16:722-7. [PMID: 25089916 DOI: 10.1089/dia.2014.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study assessed the health costs resulting from the combination of metformin/dipeptidyl peptidase-4 (DPP-4) inhibitors compared with metformin/oral antidiabetes drugs in patients with type 2 diabetes and metabolic syndrome (MS). PATIENTS AND METHODS An observational retrospective study was performed. Patients ≥30 years of age who were receiving treatment with metformin who started a second oral antidiabetes therapy in 2008 and 2009 were included. Patients were divided into two groups: (a) metformin plus DPP-4 inhibitors and (b) metformin plus other oral antidiabetes drugs. The main measures were compliance, persistence, metabolic control (glycosylated hemoglobin level of <7%), and complications (hypoglycemia and cardiovascular events). Healthcare and non-healthcare costs were calculated. Patients were followed up for 2 years. An analysis of covariance was carried out (P<0.05 was considered significant). RESULTS Of the 1,435 patients (mean age, 67.3 years; 53.1% male) who were enrolled, 442 (30.8%) were receiving metformin plus DPP-4 inhibitors, and 993 (69.2%) were receiving metformin plus other oral antidiabetes drugs. The prevalence of MS was 72.2% (95% confidence interval, 71.1-73.3%). Patients treated with DPP-4 inhibitors had better compliance (69.1% vs. 63.8%), persistence (63.8% vs. 53.1%), and metabolic control (69.9% vs. 64.3%) (P<0.01) compared with those receiving other antidiabetes drugs, lower rates of hypoglycemia (14.3% vs. 41.1%) and cardiovascular events (2.9% vs. 5.7%) (P<0.01), and a lower mean adjusted unit cost (€2,278 vs. €2,631; P=0.003). CONCLUSIONS Despite the limitations of this observational study, diabetes patients with MS who were treated with metformin plus DPP-4 inhibitors had better compliance, greater metabolic control, and lower rates of hypoglycemia, causing lower costs for the Spanish national health system than patients receiving metformin plus other antidiabetes drugs.
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Affiliation(s)
- Antoni Sicras-Mainar
- 1 Management Planning, Badalona Healthcare Services SA , Badalona, Barcelona, Spain
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Sicras-Mainar A, Navarro-Artieda R. Use of metformin and vildagliptin for treatment of type 2 diabetes in the elderly. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:811-8. [PMID: 24970999 PMCID: PMC4069049 DOI: 10.2147/dddt.s65327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to describe the clinical (treatment adherence, metabolic control, hypoglycemia, and macrovascular complications) and economic (resource use and costs) consequences of using a combination of metformin + vildagliptin to treat type 2 diabetes in elderly patients seen in daily clinical practice. METHODS We conducted a multicenter, retrospective, observational study that included patients aged ≥65 years treated with metformin who started a second oral antidiabetic therapy during the years 2008-2009. There were two groups of patients: a study group receiving metformin + vildagliptin and a reference group receiving metformin + other oral antidiabetics (sulfonylureas or glitazones). The main measures were comorbidity, compliance/persistence, metabolic control (glycosylated hemoglobin <7%), complications (hypoglycemic, macrovascular), and total costs. The patients were followed for 2 years. RESULTS We recruited 987 patients (49.1% male) of mean age 74.2 years. There were 270 (27.4%) patients in the metformin + vildagliptin group and 717 (72.6%) in the reference group. Vildagliptin-treated patients had significantly (P<0.05) improved compliance (68.3% versus 62.5%, respectively), persistence (61.5% versus 55.1%), and metabolic control (63.3% versus 57.6%). They also had lower rates of hypoglycemia (17.4% versus 42.8%) and cardiovascular events (4.4% versus 8.6%) and lower total costs (€2,544 versus €2,699, P<0.05). CONCLUSION Patients treated with metformin and vildagliptin showed better adherence and metabolic control and lower rates of hypoglycemia, resulting in lower health care costs for the national health system.
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Affiliation(s)
| | - Ruth Navarro-Artieda
- Documentación Médica, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Ascher-Svanum H, Lage MJ, Perez-Nieves M, Reaney MD, Lorraine J, Rodriguez A, Treglia M. Early discontinuation and restart of insulin in the treatment of type 2 diabetes mellitus. Diabetes Ther 2014; 5:225-42. [PMID: 24782063 PMCID: PMC4065305 DOI: 10.1007/s13300-014-0065-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Although the largest improvement in glycemic control occurs within the first 90 days of insulin therapy, little is known about early persistence on insulin therapy. This research aimed to identify predictors of early discontinuation and of subsequent restart of basal or mixture insulin among patients with type 2 diabetes mellitus (T2DM) and to assess the economic cost associated with such behaviors over a 1-year period. METHODS Truven's Health Analytics Commercial Claims and Encounters database was utilized for the study. Logistic regressions were used to examine factors associated with early discontinuation of insulin (basal or mixture) and, among patients who discontinued early, the factors associated with restarting. Cost regressions were estimated using generalized linear models with a gamma distribution and logistic link. Kaplan-Meier survival curves were used to examine time to discontinuation and time to restart among those who discontinued. RESULTS Multivariate analyses revealed that patient characteristics, prior healthcare resource utilization, comorbid diagnoses, and type of initiated insulin were associated with early discontinuation of insulin and of restarting among patients who discontinued early. Acute care (hospitalization and emergency room) costs were 9.6% higher among patients who discontinued early (P < 0.001), although outpatient, drug, and total costs were significantly lower among individuals who discontinued early. Among the early discontinuation subgroup, restarting insulin was associated with higher costs. Specifically: 11.3% higher acute care costs (P < 0.001), 24.0% higher outpatient costs (P < 0.001), 80.2% higher drug costs (P < 0.001), and 30.3% higher total costs (P < 0.001), compared to patients who discontinued early but did not restart insulin therapy in the 1-year post-period. CONCLUSION Among patients with T2DM who were initiated on insulin therapy, early discontinuation of insulin and its subsequent restart were associated with significantly higher acute care costs, which may signal a more complex and challenging subgroup of patients who tend to be less engaged in outpatient care and may have poorer long-term outcomes.
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Affiliation(s)
- Haya Ascher-Svanum
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN USA
| | | | - Magaly Perez-Nieves
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN USA
| | - Matthew D. Reaney
- Eli Lilly and Company, Windlesham, Surrey, UK
- Present Address: ERT, Peterborough Business Park, Lynch Wood, Peterborough, PE2 6FZ UK
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Henry RR, Rosenstock J, Logan D, Alessi T, Luskey K, Baron MA. Continuous subcutaneous delivery of exenatide via ITCA 650 leads to sustained glycemic control and weight loss for 48 weeks in metformin-treated subjects with type 2 diabetes. J Diabetes Complications 2014; 28:393-8. [PMID: 24631129 DOI: 10.1016/j.jdiacomp.2013.12.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/20/2013] [Accepted: 12/22/2013] [Indexed: 11/30/2022]
Abstract
AIMS Evaluate the efficacy and tolerability of ITCA 650 in subjects with type 2 diabetes treated for up to 48 weeks. METHODS This was a 24-week extension to a randomized, 24-week, open-label, phase 2 study in subjects with type 2 diabetes inadequately controlled with metformin. Subjects received ITCA 650 mg (20, 40, 60 or 80 μg/day). Mean changes for HbA1c, weight, and fasting plasma glucose (FPG) were evaluated. RESULTS Mean changes in HbA1c from baseline to week 48 ranged from -0.85% to -1.51%. At week 48, ≥64% of subjects with an HbA1c ≤7% at week 24 maintained an HbA1c ≤7%. The incidence of adverse events (AEs) was dose-related and ranged from 13.3% with 20 μg/day to 37.5% with 80 μg/day. Most AEs were mild and transient; the incidence of nausea declined from 12.9% to 9.5% over the 24-week extension. One subject on ITCA 650 80 μg/day experienced mild intermittent vomiting. Three (3.5%) subjects experienced severe AEs, but none were considered related to study drug. CONCLUSION Significant changes in HbA1c, body weight, and FPG attained with ITCA 650 were maintained to 48 weeks. The incidence of AEs was lower in the 24-week extension than in the initial 24-week treatment phase.
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Affiliation(s)
- Robert R Henry
- VA San Diego Healthcare System, San Diego, CA and University of California, San Diego, La Jolla, CA.
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX
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Sicras-Mainar A, Navarro-Artieda R, Ibáñez-Nolla J. Clinical and economic characteristics associated with type 2 diabetes. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Principales factores asociados al coste de la diabetes mellitus tipo 2: revisión de la literatura. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.avdiab.2014.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e)-prescribing.
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Affiliation(s)
- Aurel O Iuga
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; Johns Hopkins University, Baltimore, MD, USA
| | - Maura J McGuire
- Johns Hopkins Community Physicians, Baltimore, MD, USA ; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hiligsmann M, Boonen A, Rabenda V, Reginster JY. The importance of integrating medication adherence into pharmacoeconomic analyses: the example of osteoporosis. Expert Rev Pharmacoecon Outcomes Res 2014; 12:159-66. [DOI: 10.1586/erp.12.8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Pihau-Tulo ST, Parsons RW, Hughes JD. An evaluation of patients' adherence with hypoglycemic medications among Papua New Guineans with type 2 diabetes: influencing factors. Patient Prefer Adherence 2014; 8:1229-37. [PMID: 25258517 PMCID: PMC4172082 DOI: 10.2147/ppa.s66655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aims of this study were to evaluate the extent of adherence to hypoglycemic medications, assess the relationship between adherence and glycemic control, and evaluate factors affecting adherence. RESEARCH DESIGN AND METHODS This was a cross-sectional study of patients with established type 2 diabetes attending the Port Moresby General Hospital Diabetes Clinic. Face-to-face interviews were conducted using a questionnaire designed for the study and data were collected concerning the 3 months prior to interview. The questionnaire covered demographic details, lifestyle, biochemical and physical measurements, and medication management. Glycemic control was investigated among patients adhering to their medications (not missing doses) to different degrees (100%, 95%, 90%, and 80%). RESULTS Of a total of 356 participants who were prescribed hypoglycemic medications, 59.6% omitted some of their doses. Age appeared to have a significant impact on adherence at some levels of adherence, with those aged >60 years being more likely to be adherent (logistic regression). Those who were 95%-99% and those who were <80% adherent had a statistically significant risk of a high glycated hemoglobin of >10% (85.5 mmol/mol). Multiple factors were identified as contributors to nonadherence, with patient-based issues (86.0%) and the health care system (21.7%) being the most common. CONCLUSION This study showed a significant level of nonadherence among patients with type 2 diabetes in Papua New Guinea. Nonadherence to medication appeared to be associated with poor glycemic control and was due to a variety of reasons. Future interventions aimed at improving adherence will need to take these into account.
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Affiliation(s)
| | - Richard W Parsons
- CHIRI and School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Jeffery D Hughes
- CHIRI and School of Pharmacy, Curtin University, Perth, WA, Australia
- Correspondence: Jeffery D Hughes, School of Pharmacy, Curtin University, GPO Box U1987, Perth, WA 6845, Australia, Tel +61 8 9266 7367, Fax +61 8 9266 2769, Email
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Clinical and economic characteristics associated with type 2 diabetes. Rev Clin Esp 2013; 214:121-30. [PMID: 24359793 DOI: 10.1016/j.rce.2013.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (DM2) is usually accompanied by various comorbidities that can increase the cost of treatment. We are not aware of studies that have determined the costs associated with treating DM2 patients with co-morbidities such as overweight (OW), obesity (OBE) or arterial hypertension (AHT). The aim of the study was to examine the health-related costs and the incidence of cardiovascular disease (CVD) in these patients. PATIENTS AND METHODS Multicenter, observational retrospective design. We included patients 40-99 years of age who requested medical attention in 2010 in Badalona (Barcelona, Spain). There were two study groups: those with DM2 and without DM2 (reference group/control), and six subgroups: DM2-only, DM2-AHT, DM2-OW, DM2-OBE; DM2-AHT-OW and DM2-AHT-OBE. The main outcome measures were: co-morbidity, metabolic syndrome (MS), complications (hypoglycemia, CVD) and costs (health and non-health). Follow-up was carried out for two years. RESULTS A total of 26,845 patients were recruited. The prevalence of DM2 was 14.0%. Subjects with DM2 were older (67.8 vs. 59.7 years) and more were men (51.3 vs. 43.0%), P<.001. DM2 status was associated primarily with OBE (OR=2.8, CI=2.4-3.1), AHT (OR=2.4, CI=2.2-2.6) and OW (OR=1.9, CI=1.7-2.2). The distribution by subgroups was: 6.7% of patients had only DM2, 26.1% had DM2, AHT and OW, and 34.1% had DM2, AHT, and OBE. Some 75.4% had MS and 37.5% reported an episode of hypoglycemia. The total cost/patient with DM2 was €4,458. By subgroups the costs were as follows: DM2: €3,431; DM2-AHT: €4,075; DM2-OW: €4,057; DM2-OBE: €4,915; DM2-AHT-OW: €4,203 and DM2-AHT-OBE: €5,021, P<.001. The CVD rate among patients with DM2 was 4.7 vs. 1.7% in those without DM2 P<.001. CONCLUSIONS Obesity is a comorbidity associated with DM2 that leads to greater healthcare costs than AHT. The presence of these comorbidities causes increased rates of CVD.
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Sicras-Mainar A, Font-Ramos B, Roldán-Suárez C, Navarro-Artieda R, Ibáñez-Nolla J. Caracterización y costes asociados al perfil del paciente con diabetes tipo 2 en tratamiento con metformina al que se le añade un segundo fármaco antidiabético oral: estudio de base poblacional. ACTA ACUST UNITED AC 2013; 60:557-69. [DOI: 10.1016/j.endonu.2013.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 01/21/2023]
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García-Pérez LE, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther 2013; 4:175-94. [PMID: 23990497 PMCID: PMC3889324 DOI: 10.1007/s13300-013-0034-y] [Citation(s) in RCA: 437] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Indexed: 12/12/2022] Open
Abstract
Adherence to therapy is defined as the extent to which a person's behavior in taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider. Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a healthy diet and exercise regimen, followed by early medication that generally includes one or more oral hypoglycemic agents and later may include an injectable treatment. To prevent the complications associated with type 2 diabetes, therapy frequently also includes medications for control of blood pressure, dyslipidemia and other disorders, since patients often have more than three or four chronic conditions. Despite the benefits of therapy, studies have indicated that recommended glycemic goals are achieved by less than 50% of patients, which may be associated with decreased adherence to therapies. As a result, hyperglycemia and long-term complications increase morbidity and premature mortality, and lead to increased costs to health services. Reasons for nonadherence are multifactorial and difficult to identify. They include age, information, perception and duration of disease, complexity of dosing regimen, polytherapy, psychological factors, safety, tolerability and cost. Various measures to increase patient satisfaction and increase adherence in type 2 diabetes have been investigated. These include reducing the complexity of therapy by fixed-dose combination pills and less frequent dosing regimens, using medications that are associated with fewer adverse events (hypoglycemia or weight gain), educational initiatives with improved patient-healthcare provider communication, reminder systems and social support to help reduce costs. In the current narrative review, factors that influence adherence to different therapies for type 2 diabetes are discussed, along with outcomes of poor adherence, the economic impact of nonadherence, and strategies aimed at improving adherence.
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Affiliation(s)
- Luis-Emilio García-Pérez
- Global Medical Affairs, Medical Department, Lilly, S.A., Avda. de la Industria 30, 28108, Alcobendas, Madrid, Spain,
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Sicras Mainar A, Roldán Suárez C, Font Ramos B, Navarro Artieda R, Ibáñez Nolla J. Consecuencias clínicas y económicas de la combinación de metformina con inhibidores de la dipeptidilpeptidasa en pacientes con diabetes tipo 2. Rev Clin Esp 2013; 213:377-84. [DOI: 10.1016/j.rce.2013.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/28/2013] [Accepted: 06/02/2013] [Indexed: 10/26/2022]
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Sicras Mainar A, Roldán Suárez C, Font Ramos B, Navarro Artieda R, Ibáñez Nolla J. Clinical and economical consequences of the combination of metformin with dipeptidyl peptidase inhibitors in type 2 diabetes patients. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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