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Medication adherence affects treatment modifications in patients with type 2 diabetes.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Voorham, Jaco Haaijer-Ruskamp, Flora M. Wolffenbuttel, Bruce H. R. Stolk, Ronald P. Denig, Petra
Spatial Coverage	Netherlands
Description	Country affiliation: Netherlands Author Affiliation: Voorham J ( Department of Clinical Pharmacology, Faculty of Medical Science, University Medical Center Groningen, University of Groningen, The Netherlands. j.voorham@med.umcg.nl)
Abstract	BACKGROUND: Low rates of treatment modification in patients with insufficiently controlled risk factors are common in type 2 diabetes. Although adherence problems are often mentioned in surveys as a reason for not intensifying treatment, observational studies have shown inconclusive results. OBJECTIVE: To assess how medication adherence affects treatment modifications for hypertension and hyperglycemia in patients with type 2 diabetes. METHODS: This was a cohort study of 11,268 primary care patients with type 2 diabetes in the Netherlands. Inclusion criteria were diagnosis before 2007, ≥1 prescription to antihypertensive or glucose-regulating medication in the preceding 6 months, and a systolic blood pressure level ≥140 mm Hg or glycosylated hemoglobin ≥7% in 2007. Patients on maximal treatment were excluded. Treatment modifications as observed from prescriptions were classified as none, dose increase, dose decrease, class switch, class addition, or class discontinuation. Refill adherence was assessed as medication possession ratio or length of last gap between refills. We performed multilevel multinomial regression analysis to test for associations. RESULTS: We included 4980 diabetic patients with elevated blood pressure and 2945 diabetic patients with elevated glycosylated hemoglobin levels. Patients with lower adherence for antihypertensive drugs were more likely to have those medications discontinued (odds ratio [OR] for every 10% lower medication possession ratio =1.22; 95% CI, 1.11-1.33) or the dose decreased (OR = 1.14; CI 1.01-1.28). For glucose-regulating medication, dose increases (OR = 0.92; 95% CI, 0.85-0.98) and medication additions (OR = 0.90; 95% CI, 0.82-0.99) were less likely in patients with lower adherence levels. CONCLUSIONS: Low adherence inhibits the intensification of glucose-regulating but not antihypertensive medication in type 2 diabetic patients with insufficiently controlled risk factors in the Netherlands. Adherence problems may lead to diminished or even discontinued antihypertensive treatment.
File Format	HTM / HTML
ISSN	01492918
Issue Number	1
Volume Number	33
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2011-01-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Antihypertensive Agents Therapeutic Use Diabetes Mellitus, Type 2 Drug Therapy Hypoglycemic Agents Medication Adherence Aged Administration & Dosage Blood Pressure Drug Effects Cohort Studies Complications Dose-response Relationship, Drug Female Humans Hypertension Male Middle Aged Netherlands Regression Analysis Risk Factors Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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