Abstract
BackgroundGuideline-adherent prescribing for treatment of multiple risk factors in type 2 diabetes (T2D) patients is expected to improve clinical outcomes. However, the relationship to Health-Related Quality of Life (HRQoL) is not straightforward since guideline-adherent prescribing can increase medication burden.ObjectivesTo test whether guideline-adherent prescribing and disease-specific medication burden are associated with HRQoL in patients with T2D.MethodsCross-sectional study including 1,044 T2D patients from the e-VitaDM/ZODIAC study in 2012 in the Netherlands. Data from the diabetes visit, such as laboratory and physical examinations and prescribed medication, and from two HRQoL questionnaires, the EuroQol 5 Dimensions 3 Levels (EQ5D-3L) and the World Health Organization Well-Being Index (WHO-5) were collected. Twenty indicators assessing prescribing of recommended glucose lowering drugs, statins, antihypertensives and renin-angiotensin-aldosterone system (RAAS)-inhibitors and potentially inappropriate drugs from a validated diabetes indicator set were included. Disease-specific medication burden was assessed using a modified version of the Medication Regimen Complexity Index (MRCI). Associations were tested with regression models, adjusting for age, gender, diabetes duration, comorbidity, body mass index and smoking.ResultsThe mean MRCI was 7.1, the median EQ5D-3L-score was 0.86 and the mean WHO-5 score was 72. Seven indicators included too few patients and were excluded from the analysis. The remaining thirteen indicators focusing on recommended start, intensification, current and preferred use of glucose lowering drugs, statins, antihypertensives, RAAS inhibitors, and on inappropriate prescribing of glibenclamide and dual RAAS blockade were not significantly associated with HRQoL. Finally, also the MRCI was not associated with HRQoL.ConclusionsWe found no evidence for associations between guideline-adherent prescribing or disease-specific medication burden and HRQoL in T2D patients. This gives no rise to refrain from prescribing intensive treatment in T2D patients as recommended, but the interpretation of these results is limited by the cross-sectional study design and the selection of patients included in some indicators.
Highlights
Clinical guidelines for managing patients with type 2 diabetes (T2D) recommend pharmacotherapy to reduce levels of risk factors such as glycated hemoglobin (HbA1c), blood pressure, low-density lipoprotein (LDL)-cholesterol and albuminuria [1, 2]
The remaining thirteen indicators focusing on recommended start, intensification, current and preferred use of glucose lowering drugs, statins, antihypertensives, renin-angiotensin-aldosterone system (RAAS) inhibitors, and on inappropriate prescribing of glibenclamide and dual RAAS blockade were not significantly associated with health-related quality of life (HRQoL)
We found no evidence for associations between guideline-adherent prescribing or diseasespecific medication burden and HRQoL in T2D patients
Summary
Clinical guidelines for managing patients with type 2 diabetes (T2D) recommend pharmacotherapy to reduce levels of risk factors such as glycated hemoglobin (HbA1c), blood pressure, low-density lipoprotein (LDL)-cholesterol and albuminuria [1, 2]. These recommendations are based on clinical trials assessing the efficacy and safety of these treatments. Following treatment recommendations may have a negative effect on HRQoL by increasing medication burden and inducing an increased risk for adverse drug events [6]. Guideline-adherent prescribing for treatment of multiple risk factors in type 2 diabetes (T2D) patients is expected to improve clinical outcomes. The relationship to HealthRelated Quality of Life (HRQoL) is not straightforward since guideline-adherent prescribing can increase medication burden.
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