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Abstract
Background: Although medication adherence is one of the most important aspects of the management
of diabetes mellitus, low rates of adherence have been documented.
Objective: This study sought to examine medication adherence among patients with diabetes mellitus
in a managed care organization who were receiving antidiabetic monotherapy (metformin
or glyburide), combination therapy (metformin and glyburide), or fixed-dose combination
therapy (glyburide/metformin).
Methods: Medication adherence was evaluated through a retrospective database analysis of pharmacy
claims. The adherence rate was defined as the sum of the days' supply of oral antidiabetic
medication obtained by the patient during the follow-up period divided by the total
number of days in the designated follow-up period (180 days). Health plan members
were included in the analysis if they had an index pharmacy claim for an oral antidiabetic
medication between August 1 and December 31, 2000, were continuously enrolled in the
health plan, and were aged ≥18 years. A 6-month pre-index period was used to classify
patients as newly treated or previously treated. Patients were grouped according to
their medication-use patterns.
Results: After adjustment for potential confounding factors, including overall medication
burden at index, there were no significant differences in adherence rates among 6502
newly treated patients receiving monotherapy, combination therapy, or fixed-dose combination
therapy. Among the 1815 previously treated patients receiving glyburide or metformin
monotherapy who required the addition of the alternative agent, resulting in combination
therapy, adherence rates were significantly lower (54.0%; 95% CI, 0.52–0.55) than
in the 105 patients receiving monotherapy who were switched to fixed-dose combination
therapy (77.0%; 95% CI, 0.72–0.82). The 59 previously treated patients receiving combination
therapy who were switched to fixed-dose combination therapy had a significant improvement
in adherence after the switch (71.0% vs 87.0%; P < 0.001).
Conclusions: In a managed care organization, previously treated patients receiving monotherapy
with an oral antidiabetic medication who required additional therapy exhibited significantly
greater adherence when they were switched to fixed-dose combination therapy compared
with combination therapy. Patients receiving combination therapy who were switched
to fixed-dose combination therapy exhibited significantly greater adherence after
the switch.
Keywords
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References
Centers for Disease Control and Prevention Web site. Available at: http://www.cdc.gov/diabetes/pub/glance/htm#dcp. Accessed December 18, 2000.
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Article info
Publication history
Accepted:
February 5,
2002
Identification
Copyright
© 2002 Published by Elsevier Inc.
