Background
The prevalence and social burden of type 2 diabetes mellitus (T2DM) is increasing. Medication adherence is necessary for positive outcomes in patients with T2DM.Objective
This study evaluated the association between medication adherence and clinical/economic outcomes in patients with T2DM in the Republic of Korea over a 3-year period.Methods
This study used data from the Korean National Diabetes Program at 5 hospitals. Medication possession ratios of ≥90% and <90% were used to define adherent and nonadherent groups, respectively. The degree of glycemic control, changes in blood pressure and lipid profiles, and health care costs were compared.Results
Of the 608 patients, 472 were medication adherent and 136 were nonadherent. The adherent patients displayed improved fasting blood glucose and hemoglobin A1c during the study. Diastolic blood pressure and total cholesterol were lower at 36 months, and lower low-density lipoprotein cholesterol was noted at baseline and 24 months. The total health care costs were $1861, $2060, and $1924, respectively, versus $1617, $1751, and $1602 during the 3-year study period for the adherent group versus the nonadherent group, respectively (P = 0.316, 0.627, and 0.172, respectively), whereas the outpatient drug costs were $1143, $1176, and $1162 in the adherent group versus $925, $778, and $914 in the nonadherent group (P = 0.002, P < 0.001, and P = 0.001).Conclusions
The adherent patients displayed better glycemic control and lipid profiles. Medication-related expenses were higher in the adherent group, but overall health care costs, including hospitalization costs, were similar between the 2 groups. 相似文献Methods: The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal.
Results: Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00).
Conclusion: We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology. 相似文献
Methods We compared how guidelines take comprehensive care into consideration, what treatment targets and what antihyperglycemic medication was recommended. The use of glucose-lowering medication was based on the sales of diabetes drugs in these countries.
Results All guidelines stress the importance of comprehensive diabetes care. Individualized glycemic targets are emphasized especially in the Danish and Finnish guidelines. In 2013, sulfonylureas were the most common second-line treatment after metformin in Denmark, Norway and Sweden; in Finland, this position was taken by DPP-4 inhibitors. Recommended initial insulin type for patients with T2D differs between the four countries. Danish, Norwegian and Swedish guidelines also take economic aspects into account.
Conclusions All guidelines stress regular and comprehensive diabetes care. Danish and Finnish guidelines strongly underline the importance of individualized glycemic targets. All guidelines recommend metformin as the initial oral antihyperglycemic drug. In relation to recommended second line drug therapy and initial insulin type for patients with T2D, the guidelines vary largely between the four countries.
- Key messages
All Nordic guidelines for treating type 2 diabetes stress the importance of comprehensive care.
The Danish and Finnish guidelines underline the importance of individualized glycemic targets.
The first line and most commonly used oral antihyperglycemic drug is metformin in all four countries.
Recommended second line antihyperglycemic treatment differs largely between the four Nordic guidelines.
Recommended initial insulin type for patients with T2D differs between the guidelines.
