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Treatment choice, medication adherence and glycemic efficacy in people with type 2 diabetes: a UK clinical practice database study
  1. Jason Gordon1,2,3,
  2. Phil McEwan1,4,
  3. Iskandar Idris2,
  4. Marc Evans5,
  5. Jorge Puelles6
  1. 1 Health Economics & Outcomes Research Ltd, Cardiff, UK
  2. 2 School of Medicine, University of Nottingham, Nottingham, UK
  3. 3 Department of Public Health, University of Adelaide, Adelaide, Australia
  4. 4 Swansea Centre for Health Economics, Swansea University, Swansea, UK
  5. 5 Diabetes Resource Centre, Llandough Hospital, Cardiff, UK
  6. 6 Global Outcomes Research, Takeda Development Centre Europe Ltd, London, UK
  1. Correspondence to Dr Jason Gordon; jason.gordon{at}heor.co.uk

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.

  • OHA (oral Hypoglycemic Agent)
  • type 2 diabetes
  • medication adherence
  • clinical outcome(s)

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JG and PM were involved in the design, analysis, interpretation and writing of the manuscript. II, ME and JP were involved in the design, interpretation and writing of the manuscript. All authors take responsibility for the integrity of the work as a whole and have given final approval to the version to be published. As guarantor and corresponding author, JG takes full responsibility for the work as a whole, including the study design, access to data and the decision to submit and publish the manuscript.

  • Funding Sponsorship for this study and article processing charges were funded by Takeda Development Centre Europe Ltd. Support for this assistance was funded by HEOR Ltd.

  • Competing interests JG, PM, II and ME have served as consultants to and received research funding from Takeda Development Centre Europe Ltd in relation to this study. JP is an employee of Takeda Development Centre Europe Ltd.

  • Patient consent Not required.

  • Ethics approval The CPRD Independent Scientific Advisory Committee approved the use of the CPRD database for the purposes of this study (protocol number 17_ 025R).

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

  • Data sharing statement No additional data are available.

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