Treatment choice and medication adherence in T2DM patients

  • Gordon J & al.
  • BMJ Open Diabetes Res Care
  • 1 Jan 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Across all oral anti-hyperglycaemic agent (OHA) lines of therapy (mono, dual or triple therapy), increasing adherence to medication can bring about meaningful improvements in HbA1c control as the requirement to escalate therapy increases.
  • Regimens typically associated with weight loss and lower incidence of hypoglycaemia were generally associated with better medication adherence and improved glycaemic control.

Why this matters

  • Study helps identify important determinants of optimal medication adherence and glycaemic management for patients with type 2 diabetes mellitus (T2DM) requiring therapy escalation across the OHA treatment paradigm.

Study design

  • Retrospective study investigated the association between medication adherence and clinical outcomes in 33,849 patients with T2DM (n=23,925 OHA monotherapy; n=8406 OHA dual therapy; n=1518 OHA triple therapy). 
  • Funding: Takeda Development Centre Europe Ltd.

Key results

  • Over the course of 1 year, patients adherent to therapy had significant reduction in HbA1c vs those considered non-adherent (−0.90 to −1.14% [−9.8 to −12.5 mmol/mol] vs −0.49 to −0.69% [−5.4 to −7.5 mmol/mol]).
  • On average, hypoglycaemia was more frequent among adherent patients vs non-adherent patients with rate ratios of 1.24 (P=.303), 1.10 (P=.757) and 2.06 (P=.096) associated with OHA mono, dual and triple therapy cohorts, respectively.
  • Weight change was also greater in adherent patients vs non-adherent patients.
  • 10% improvement in medication possession ratio showed −0.09% (−1.0 mmol/mol), −0.09% (−1.0 mmol/mol) and −0.21% (−2.3 mmol/mol) change in HbA1c for OHA mono, dual therapy, and triple therapy, respectively).

Limitations

  • Risk for confounding.

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