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Treatment choice, medication adherence and glycemic efficacy in people with type 2 diabetes: a UK clinical practice database study

Gordon, Jason; McEwan, Phil; Idris, Iskandar; Evans, Marc; Puelles, Jorge

Authors

Jason Gordon

Phil McEwan

ISKANDAR IDRIS Iskandar.Idris@nottingham.ac.uk
Clinical Associate Professor & Honoraryconsultant Physician

Marc Evans

Jorge Puelles



Abstract

Objective

Using primary care data obtained from the UK Clinical Practice Research Datalink, this retrospective cohort study examined the relationships between medication adherence and clinical outcomes in patients with type 2 diabetes.

Research design and methods

Data were extracted for patients treated between 2008 and 2016, and stratified by oral antihyperglycemic agent (OHA) line of therapy (mono, dual or triple therapy). Patients were monitored for up to 365 days; associations between medication possession ratio (MPR) and outcomes at 1 year (glycated hemoglobin A1c (HbA1c), weight and hypoglycemia incidence) were assessed using linear regression modeling and descriptive analyses.

Results

In total, 33 849 patients were included in the study (n=23 925 OHA monotherapy; n=8406 OHA dual therapy; n=1518 OHA triple therapy). One-year change in HbA1c was greater among adherent (−0.90 to −1.14%; −9.8 to −12.5 mmol/mol) compared with non-adherent patients (−0.49 to −0.69%; −5.4 to −7.5 mmol/mol). On average, adherent patients had higher hypoglycemia event rates than non-adherent patients (rate ratios of 1.24, 1.10 and 2.06 for OHA mono, dual and triple therapy cohorts, respectively) and experienced greater weight change from baseline. A 10% improvement in MPR was associated with −0.09% (−1.0 mmol/mol), −0.09% (−1.0 mmol/mol) and −0.21% (−2.3 mmol/mol) changes in HbA1c for OHA mono, dual and triple therapy cohorts, respectively.

Conclusions

For patients with type 2 diabetes, increasing medication adherence can bring about meaningful improvements in HbA1c control as the requirement for treatment escalation increases. Regimens associated with weight loss and the avoidance of hypoglycemia were generally associated with better medication adherence and improved glycemic control.

Citation

Gordon, J., McEwan, P., Idris, I., Evans, M., & Puelles, J. (2018). Treatment choice, medication adherence and glycemic efficacy in people with type 2 diabetes: a UK clinical practice database study. BMJ Open Diabetes Research and Care, 6(1), https://doi.org/10.1136/bmjdrc-2018-000512

Journal Article Type Article
Acceptance Date Apr 12, 2018
Online Publication Date May 5, 2018
Publication Date Jul 31, 2018
Deposit Date Jul 13, 2018
Publicly Available Date Jul 13, 2018
Journal BMJ Open Diabetes Research & Care
Electronic ISSN 2052-4897
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 6
Issue 1
Article Number e000512
DOI https://doi.org/10.1136/bmjdrc-2018-000512
Public URL http://eprints.nottingham.ac.uk/id/eprint/52937
Publisher URL http://dx.doi.org/10.1136/bmjdrc-2018-000512
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0





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