Oral Antihyperglycemic Medication Nonadherence and Subsequent Hospitalization Among Individuals With Type 2 Diabetes

College of Pharmacy, University of Michigan, Ann Arbor, Michigan, United States
Diabetes Care (Impact Factor: 8.42). 10/2004; 27(9):2149-53. DOI: 10.2337/diacare.27.9.2149
Source: PubMed


This study examines the association between oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes.
Using administrative claims data (2000-2001) from a managed care organization in the Midwestern U.S., this study analyzed 900 enrollees, aged 18 years and over, with type 2 diabetes who were taking oral antihyperglycemic agents both years but who did not use insulin. Nonadherence was defined as a medication possession ratio (MPR) <80%. Multivariate logistic regression analyses were performed where hospitalization in 2001 was regressed on nonadherence to the oral antihyperglycemic drug regimen in 2000, while controlling for nonadherence to drugs for hypertension and dyslipidemia and for hospitalization in 2000, age, sex, intensity of the diabetes drug regimen, and comorbidities.
The proportion of enrollees who were nonadherent to the antihyperglycemic drug regimen in 2001 was 28.9%, whereas 18.8 and 26.9% were nonadherent to antihypertensive and lipid-modifying drugs, respectively. The increase in the hospitalization rate for 2001 was most apparent where the antihyperglycemic MPR for 2000 dropped to <80%. Enrollees who were nonadherent to oral diabetes medications in 2000 were at higher risk of hospitalization in 2001 (odds ratio 2.53; 95% CI 1.38-4.64), whereas nonadherence to drugs for hypertension and dyslipidemia were not significantly associated with hospitalization.
Patients with type 2 diabetes who do not obtain at least 80% of their oral antihyperglycemic medications across 1 year are at a higher risk of hospitalization in the following year.

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    • "In a recently published population-based study on people newly treated for type 2 diabetes in Quebec province, Canada, 38% did not adhere to their antidiabetes treatment during the year following initiation [4]. Such poor adherence is a barrier to reaching clinical targets [5] and can, therefore, lead to increased diabetes complications and hospitalization [2] [6]. Moreover, poor adherence is likely to be associated with an increase in healthcare costs [7]. "

    • "Even though insulin can be used alone or in combination with OADs, nearly 60% of the individuals with type 2 diabetes use only OADs to control their diabetes [7]. Unfortunately, patient adherence to OAD treatment is often poor [8] [9], which contributes to suboptimal metabolic control [10] [11], increased diabetes complications and hospitalizations [12] [13], and increased health care expenditures [14]. Adherence to OAD treatment could be optimized by exposing patients to effective behavior change interventions. "
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    ABSTRACT: Objectives: To estimate the pooled effect size of oral antidiabetic drug (OAD) adherence-enhancing interventions and to explore which of the behavior change techniques (BCTs) applied in the intervention groups modified this pooled intervention effect size. Methods: We searched relevant studies published until September 3, 2013, on MEDLINE, Embase, PsycInfo, the Cochrane Library, CINAHL, Current Contents Connect, and Web of Science. Selected studies were qualitatively synthesized, and those of at least medium quality were included in the meta-analysis. A random-effects model was used to pool effectiveness (Hedges’s g) and to examine heterogeneity (Higgins I2). We also explored the influence on the pooled effectiveness of unique intervention BCTs (those delivered to the intervention groups but not control groups in a trial) by estimating their modifying effects. Results: Fourteen studies were selected for the qualitative synthesis and 10 were included in the meta-analysis. The pooled effectiveness of the interventions was 0.21 (95% confidence interval −0.05 to 0.47; I2 = 82%). Eight unique BCTs were analyzed. “Cope with side effects” (P = 0.003) and “general intention formation” (P = 0.006) had a modifying effect on the pooled effectiveness. The pooled effectiveness of the interventions in which “cope with side effects” was applied was moderate (0.64; 95% confidence interval 0.31–0.96; I2 = 56%). Conclusions: The overall effectiveness of OAD adherence-enhancing interventions that have been tested is small. Helping patients cope with side effects or formulate desired treatment outcomes could have an impact on the effectiveness of OAD adherence-enhancing interventions. Only those interventions that include helping patients to cope with side effects appear to be particularly effective in improving OAD adherence.
    Value in Health 05/2015; 18(4). DOI:10.1016/j.jval.2015.02.017 · 3.28 Impact Factor
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    • "However , lack of standard measurements and use of different definitions make comparison challenging. It is important for health care providers to consider low medication adherence as a factor contributing to poor glycemic control (Lau and Nau 2004). Thus, designing strategies to improve medication adherence might improve glycemic control and there-by decrease the rate of chronic complications related to diabetes. "
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    ABSTRACT: Low adherence to prescribed diabetes medications is one of the major reasons to poor glycemic control in developing countries. Therefore, this study attempted to assess the magnitude of medication adherence and factors associated with it among adult persons with diabetes in northwest Ethiopia. This study utilized a cross sectional study design with internal comparison. The study population was adult persons with diabetes attending the Diabetes Referral Clinic of Gondar University Hospital. Adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). In addition laboratory tests and chart reviews were carried out to collect relevant data. Ordinary logistic regression was used to identify factors associated with adherence. A total of 391 patients were studied. Based on the MMAS-8 scale, the self-reported adherence to diabetic medication was low for 25.4% [95% CI: 21, 29] of the patients, medium for 28.7% [95% CI: 24, 33], and high for 45.9% [95% CI: 41, 50] of the patients. The Mean (±SD) of glycosylated hemoglobin for the low adherence group was 8.2% (±2.1). It was 8.1% (±2.0), for the medium, and 7.4% (±1.6) for the high adherence group. In the multivariate analysis poor wealth status (AOR = 1.99; 1.15, 3.43), using traditional treatment (AOR = 2.90; 1.03, 8.15), and service dissatisfaction (AOR = 2.23; 1.04, 4.80) were significantly associated with low adherence to prescribed diabetic medications. Over half of the persons with diabetes did not adhere to medications. Adherence was poor among users of traditional treatment and those dissatisfied with services. Developing a more intensive communication strategies and improving the quality of services could improve the level of adherence.
    SpringerPlus 04/2014; 3(1):195. DOI:10.1186/2193-1801-3-195
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