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Medication adherence and glycemic control among newly diagnosed diabetes patients
  1. Lee-Kai Lin1,
  2. Yan Sun1,
  3. Bee Hoon Heng1,
  4. Daniel Ek Kwang Chew2,3,4,
  5. Phui-Nah Chong5
  1. 1 Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore
  2. 2 Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
  3. 3 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
  4. 4 Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
  5. 5 National Healthcare Group Polyclinics, Singapore, Singapore
  1. Correspondence to Dr Yan Sun; yan_sun{at}


Background Poor medication adherence can have negative consequences for the patients, the provider, the physician, and the sustainability of the healthcare system. To our knowledge, the association between medication adherence and glycemic control among newly diagnosed diabetes patients has not been studied. This study aims to bridge the gap.

Method This is a retrospective cohort study of 2463 patients managed in the National Healthcare Group in Singapore with newly diagnosed diabetes. Patients were followed up for the first two years from their first medication dispensed for measuring medication adherence, proportion of days covered (PDC); and for another three years for investigating outcomes of glycemic control, emergency department visit, and hospitalization. Multivariable regressions were performed to study the association between medication adherence and the outcomes as well as the risk factors of poor adherence.

Results The prevalence of medication adherence (PDC≥80%) was 65.0% (95% CI 63.1% to 66.9%) among newly diagnosed diabetes patients in Singapore. Male, Indian, or patients without hypertension or dyslipidemia were associated with poorer medication adherence. The HbA1c level of poor adherent patients (PDC <40%) increased by 0.4 (95% CI 0.2 to 0.5) over the two years, and they were also more likely to have hospitalization (OR 2.6,95% CI 1.7 to 3.8) or emergency department visit (OR 2.4,95% CI 1.7 to 3.4) compared with the fully adherent patients (PDC=100%).

Conclusions The medication adherence in the early stage of diabetes is important for maximizing the effectiveness of pharmaceutical therapy. Health policies or interventions targeting the improvement of medication adherence among newly diagnosed diabetes patients are in need.

  • adherence to medications
  • adult diabetes
  • hospitalization
  • glycemic control

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  • Contributors L-KL designed the study, performed the analyses, drafted the initial and revised manuscript. YS conceptualized the study, assisted in study design and data analysis, drafted the initial and revised manuscript, and had final responsibility for the decision to submit for publication. BHH provided guidance on study design and critically reviewed the manuscript. DEKC and P-NC critically reviewed the manuscript. All authors approved the final manuscript as submitted. YS is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Ethics approval NHG's ethics reviewing board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.