Abstract
AimsThis study assesses the attributable impact of adherence to oral glucose medications as a risk factor for poor glycemic control in population subgroups of a large general population, using an objective medication adherence measure.MethodsUsing electronic health records data, adherence to diabetes medications over a two-year period was calculated by prescription-based Medication Possession Ratios for adults with diabetes diagnosed before January 1, 2010. Glycemic control was determined by the HbA1c test closest to the last drug prescription during 2010–2012. Poor control was defined as HbA1c>75 mmol/mol (9.0%). Medication adherence was categorized as “good” (>80%), “moderate” (50–80%), or “poor” (<50%). Logistic regression models assessed the role medication adherence plays in the association between disease duration, age, and poor glycemic control. We calculated the change in the attributable fraction of glucose control if the non-adherent diabetic medication population would become adherent by age-groups.ResultsAmong 228,846 diabetes patients treated by oral antiglycemic medication, 46.4% had good, 28.8% had moderate, and 24.8% had poor adherence. Good adherence rates increased with increasing disease duration, while glycemic control became worse. There was a strong inverse association between adherence level and poor control (OR = 2.50; CI = 2.43–2.58), and adherence was a significant mediator between age and poor control.ConclusionsA large portion of the diabetes population is reported to have poor adherence to oral diabetes medications, which is strongly associated with poor glycemic control in all disease durations. While poor adherence does not mediate the poorer glycemic control seen in patients with longer-standing disease, it is a significant mediator of poor glycemic control among younger diabetes patients. A greater fraction of poorly controlled younger patients, compared to older patients, could be prevented if at least 80% adherence to their medications was achieved. Therefore, our results suggest that interventions to improve adherence should focus on this younger sub-group.
Highlights
Diabetes and its complications remain a major concern in health care management and clinical practice, with many patients unable to achieve target glycemic levels [1]
The present study aimed to retrospectively assess the importance of adherence to multiple diabetes medications in a large, general population of individuals with diabetes using an objective medication adherence measure that accounts for these multi-drug regimens. We evaluated this by testing whether medication adherence is an intermediary factor leading to poor glycemic control in different sub-segments of the general diabetes population
There were a higher proportion of members of low SES, ethnic minorities, insulin users, and those with a long duration of diabetes in the poorly controlled group (Table 1). The percentage of those with poor glucose control increased over disease duration, and nearly 80% of those with poor control had long duration diabetes (.5 years) as opposed to 70% in the entire study population
Summary
Diabetes and its complications remain a major concern in health care management and clinical practice, with many patients unable to achieve target glycemic levels [1]. Current recommendations for glycemic control targets, as assessed by HbA1c levels, are dependent on age and duration of illness [7]. Despite evidence of the efficacy of hypoglycemic medications to help diabetes patients regulate and control their glucose levels, great variation in adherence to these medications has been reported, with studies often indicating poor or low average levels of adherence [9,10,11,12,13,14,15]. The clinical focus of therapeutic interventions for improving glycemic control is often on oral medication adherence, and, at later disease stages, on adherence with recommended parenteral insulin treatment
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