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A class comparison of medication persistence in people with type 2 diabetes: a retrospective observational study

Mcgovern, Andrew, Hinton, W, Calderara, S, Munro, N, Whyte, Martin and de Lusignan, Simon (2018) A class comparison of medication persistence in people with type 2 diabetes: a retrospective observational study Diabetes Therapy, 9 (1). pp. 229-242.

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Abstract

Background:

Longer medication persistence in type 2 diabetes (T2D) is associated with improved glycaemic control. It is not clear which oral therapies have the best persistence.

Objective:

To compare medication persistence across different oral therapies in people with T2D.

Methods:

We performed a retrospective cohort analysis using a primary care based population, the Royal College of General Practitioners Research and Surveillance Centre cohort. We identified new prescriptions for oral diabetes medication in people with type 2 diabetes between 1st January 2004 and 31st July 2015. We compared median persistence across each class (non-persistence defined as prescription gap of ≥ 90 days). We also compared non-persistence between classes, adjusting for confounders, using Cox regression. Confounders included: age, gender, ethnicity, socioeconomic status, alcohol use, smoking status, glycaemic control, diabetes duration, diabetes complications, comorbidities, and number of previous and concurrent diabetes medications.

Results:

We identified 60,327 adults with T2D. The majority 42,810 (70.9%) of people had one or more oral medications prescribed. In these patients we measured persistence with 55,728 oral medications. Metformin had the longest median persistence (3.04 years; 95% CI 2.94 to 3.12). The adjusted hazard ratios for non-persistence compared with metformin were: sulfonylureas HR 1.20 (1.16 to 1.24), DPP-4 inhibitors HR 1.43 (1.38 to 1.49), thiazolidinediones HR 1.71 (95% CI 1.64-1.77), SGLT2 inhibitors HR 1.04 (0.93 to 1.17), meglitinides HR 2.25 (1.97 to 2.58), and alpha-glucosidase inhibitors HR 2.45 (1.98 to 3.02). The analysis of SGLT2 inhibitors was limited by the short duration of follow-up for this new class. Other factors associated with reduced medication persistence are female gender, younger age, and non-white ethnicity.

Conclusions:

Persistence is strongly influenced by medication class and should be considered when initiating treatments.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Mcgovern, Andrewa.p.mcgovern@surrey.ac.uk
Hinton, W
Calderara, S
Munro, N
Whyte, Martinm.b.whyte@surrey.ac.uk
de Lusignan, SimonS.Lusignan@surrey.ac.uk
Date : 4 January 2018
Identification Number : 10.1007/s13300-017-0361-5
Copyright Disclaimer : This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Uncontrolled Keywords : Medication Compliance, Medication Adherence, Medication Persistence, Type 2 diabetes
Related URLs :
Depositing User : Melanie Hughes
Date Deposited : 05 Jan 2018 14:06
Last Modified : 15 May 2018 15:50
URI: http://epubs.surrey.ac.uk/id/eprint/845546

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