J Clin Outcomes Manage
Impact of treatment complexity on adherence and glycemic control: an analysis of oral antidiabetic agents
Pollack M, Chastek B, Williams SA, Moran J
Abstract Objective: To evaluate the impact of treatment com-plexity on adherence and subsequent glycemic control among patients with type 2 diabetes mellitus. Methods: This was a retrospective evaluation of patients enrolled in a national health plan during the period 2000 to 2007. Patients diagnosed with diabetes, naive to oral antidiabetic agents (OADs), and not using insulin were included. A treatment complexity score was assigned based on treatment characteristics. First-year adherence was calculated as a medication possession ratio (MPR) weighted by duration of OAD treatment. HbA1c values were obtained for those with available laboratory data. Multivariate analyses were conducted, controlling for patient demographics, baseline HbA1c, and comorbidities. Results: A total of 94,860 patients were identified, 16,198 with HbA1c values. Mean age was 52.6 years; 78% initiated monotherapy, 20% initiated dual therapy, and the remaining 2% were on 3 or more therapies. Mean treatment complexity score was 3.33 (range, 0–14), with 29%, 57%, and 14% in low-, medium-, and high-complexity categories. Mean 1-year adherence was 58%, 51%, and 43% for low-, medium-, and high-complexity treatments, respectively. Probability of adherence (MPR ? 80%) was significantly lower for medium- and high-complexity versus low-complexity regimens in all multivariate analyses (P < 0.05). More patients with low-complexity regimens were at or below the HbA1c goal (< 7%) during the baseline and follow-up periods. The probability of reaching and maintaining goal was significantly higher for adherent patients (P < 0.01). Conclusion: Treatment complexity has negative effects on adherence and glycemic control. Appropriate choice of therapy based on each individual’s need may overcome these limitations.
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