Abstract
To describe the patterns of discontinuation and reinitiation in new users of metformin monotherapy in New Zealand, overall and according to person- and healthcare-related factors. We created a cohort (n = 85,066) of all patients in New Zealand with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 from the national data collections, and followed them until the earlier of their death or 31 December 2015. Discontinuation was defined as a gap in possession of metformin monotherapy of ≥90 days. We explored patterns of discontinuation and reinitiation using competing risks methods. After 1 year of follow-up, 28% of cohort members had discontinued metformin monotherapy at least once; the corresponding figures after 2 and 5 years were 37% and 46%. The proportions who reinitiated metformin monotherapy within 1, 2, and 5 years of their first discontinuation were 23%, 49%, and 73%. Discontinuation after the first reinitiation was common (48% after 1 year). Discontinuation and reinitiation varied by age, ethnicity, and other person- and healthcare-related factors. Our findings highlight the dynamic nature of metformin monotherapy use, show that substantial periods of non-use are common, and identify priority populations for interventions to facilitate adherence.
Highlights
Type 2 diabetes mellitus (T2DM) is a growing threat to health globally; in 2019 there were an estimated 463 million adults living with diabetes, an estimated 90% of whom had T2DM [1]
Our findings highlight the dynamic nature of metformin monotherapy use, show that substantial periods of non-use are common, and identify priority populations for interventions to facilitate adherence
We reported that there were important differences in long-term adherence to metformin monotherapy (measured using the medication possession ratio (MPR)) among population groups in New Zealand, with Māori, Pacific, and younger people with T2DM having lower adherence [10]
Summary
Type 2 diabetes mellitus (T2DM) is a growing threat to health globally; in 2019 there were an estimated 463 million adults living with diabetes, an estimated 90% of whom had T2DM [1]. We reported that there were important differences in long-term adherence to metformin monotherapy (measured using the medication possession ratio (MPR)) among population groups in New Zealand, with Māori, Pacific, and younger people with T2DM having lower adherence [10]. While the MPR provides a useful populationlevel indicator for identifying differences in adherence between population groups, an important limitation is that it does not adequately address the dynamic nature of medication use. It does not readily distinguish between people who continue to take metformin sporadically over a defined period of time and those who have repeated extended gaps in metformin possession. These are two quite different patterns of use with different implications for glycaemic control and potentially different approaches to improving adherence
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