Abstract
The World Health Organization considers the non-adherence to medication a significant issue with global impact, especially in chronic conditions such as type 2 diabetes. We aim to study antidiabetic treatment initiation, add-on, treatment switching, and medication persistence. We conducted an observational study on 4247 individuals initiating antidiabetic treatment between 2013 and 2014 in the EpiChron Cohort (Spain). We used Cox regression models to estimate the likelihood of non-persistence after a one-year follow-up, expressed as hazard ratios (HRs). Metformin was the most frequently used first-line antidiabetic (80% of cases); combination treatment was the second most common treatment in adults aged 40–79 years, while dipeptidyl peptidase-4 inhibitors were the second most common in individuals in their 80s and over, and in patients with renal disease. Individuals initiated on metformin were less likely to present addition and switching events compared with any other antidiabetic. Almost 70% of individuals initiated on monotherapy were persistent. Subjects aged 40 and over (HR 0.53–0.63), living in rural (HR 0.79) or more deprived areas (HR 0.77–0.82), or receiving polypharmacy (HR 0.84), were less likely to show discontinuation. Our findings could help identify the population at risk of discontinuation, and offer them closer monitoring for proper integrated management to improve prognosis and health outcomes.
Highlights
The term diabetes encompasses a major group of chronic diseases with some of the highest prevalence rates and associated mortality risks, as reported by the World Health Organization (WHO) [1]
Diabetes is a disease with a high clinical and social impact; its proper management and control is a priority for health systems
This study provides real-world evidence that the utilization pattern of oral antidiabetic drugs in type 2 diabetes (T2D) patients in Spain is consistent with the recommendations of international clinical guidelines
Summary
The term diabetes encompasses a major group of chronic diseases with some of the highest prevalence rates and associated mortality risks, as reported by the World Health Organization (WHO) [1]. Various studies report that the incidence of type 2 diabetes (T2D) increased in most populations until the early 2000s, tending to be more stable or even decreasing after approximately. Its prevalence in adults (85–95% T2D) has almost doubled between 1980 and 2014 worldwide [3]. The factors potentially contributing to diabetes incidence and prevalence variances are numerous, and could explain the differences among populations and over time. These factors include, but are not limited to, lifestyle behaviors (such as poor diet, insomnia, and low physical activity), obesity, higher life expectancy, and changes on the diagnostic criteria of diabetes during the last years [2,4]. Roughly 6.6–7.0% of the adult population in
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