Jelle M Beernink1, Milou M Oosterwijk2, Kamlesh Khunti3,4, Pankaj Gupta5,6, Prashanth Patel5,6, Job F M van Boven7,8, Hiddo J Lambers Heerspink7, Stephan J L Bakker8,9, Gerjan Navis9, Roos M Nijboer2, Gozewijn D Laverman2,10. 1. Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands j.m.beernink@students.uu.nl. 2. Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands. 3. Leicester Diabetes Centre, Leicester General Hospital, Leicester, U.K. 4. Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K. 5. Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, Leicester, U.K. 6. Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K. 7. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 8. Medication Adherence Expertise Center of the Northern Netherlands, Groningen, the Netherlands. 9. Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 10. Biomedical Signals and Systems, University of Twente, Enschede, the Netherlands.
Abstract
OBJECTIVE: To assess adherence to the three main drug classes in real-world patients with type 2 diabetes using biochemical urine testing, and to determine the association of nonadherence with baseline demographics, treatment targets, and complications. RESEARCH DESIGN AND METHODS: Analyses were performed of baseline data on 457 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Adherence to oral antidiabetics (OADs), antihypertensives, and statins was determined by analyzing baseline urine samples using liquid chromatography-tandem mass spectrometry. Primary outcomes were microvascular and macrovascular complications and treatment targets of LDL cholesterol, HbA1c, and blood pressure. These were assessed cross-sectionally at baseline. RESULTS: Overall, 89.3% of patients were identified as adherent. Adherence rates to OADs, antihypertensives, and statins were 95.7%, 92.0%, and 95.5%, respectively. The prevalence of microvascular (81.6% vs. 66.2%; P = 0.029) and macrovascular complications (55.1% vs. 37.0%; P = 0.014) was significantly higher in nonadherent patients. The percentage of patients who reached an LDL cholesterol target of ≤2.5 mmol/L was lower (67.4% vs. 81.1%; P = 0.029) in nonadherent patients. Binary logistic regression indicated that higher BMI, current smoking, elevated serum LDL cholesterol, high HbA1c, presence of diabetic kidney disease, and presence of macrovascular disease were associated with nonadherence. CONCLUSIONS: Although medication adherence of real-world type 2 diabetes patients managed in specialist care was relatively high, the prevalence of microvascular and macrovascular complications was significantly higher in nonadherent patients, and treatment targets were reached less frequently. This emphasizes the importance of objective detection and tailored interventions to improve adherence.
OBJECTIVE: To assess adherence to the three main drug classes in real-world patients with type 2 diabetes using biochemical urine testing, and to determine the association of nonadherence with baseline demographics, treatment targets, and complications. RESEARCH DESIGN AND METHODS: Analyses were performed of baseline data on 457 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Adherence to oral antidiabetics (OADs), antihypertensives, and statins was determined by analyzing baseline urine samples using liquid chromatography-tandem mass spectrometry. Primary outcomes were microvascular and macrovascular complications and treatment targets of LDL cholesterol, HbA1c, and blood pressure. These were assessed cross-sectionally at baseline. RESULTS: Overall, 89.3% of patients were identified as adherent. Adherence rates to OADs, antihypertensives, and statins were 95.7%, 92.0%, and 95.5%, respectively. The prevalence of microvascular (81.6% vs. 66.2%; P = 0.029) and macrovascular complications (55.1% vs. 37.0%; P = 0.014) was significantly higher in nonadherent patients. The percentage of patients who reached an LDL cholesterol target of ≤2.5 mmol/L was lower (67.4% vs. 81.1%; P = 0.029) in nonadherent patients. Binary logistic regression indicated that higher BMI, current smoking, elevated serum LDL cholesterol, high HbA1c, presence of diabetic kidney disease, and presence of macrovascular disease were associated with nonadherence. CONCLUSIONS: Although medication adherence of real-world type 2 diabetes patients managed in specialist care was relatively high, the prevalence of microvascular and macrovascular complications was significantly higher in nonadherent patients, and treatment targets were reached less frequently. This emphasizes the importance of objective detection and tailored interventions to improve adherence.
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