Donnelly L A, Doney A S F, Morris A D, Palmer C N A, Donnan P T
Division of Medicine and Therapeutics, University of Dundee, Dundee, UK.
Diabet Med. 2008 Jul;25(7):850-5. doi: 10.1111/j.1464-5491.2008.02476.x.
To determine the patterns and predictors of long-term adherence to statin therapy in all patients with diabetes in the community setting.
We retrospectively studied patients with diabetes who were resident in Tayside, Scotland from 1 January 1989 to 31 May 2003 and initiated statin treatment during that time. The main outcome measure was percentage of days covered (PDC) by a statin, calculated at regular intervals. Predictors of suboptimal adherence (PDC < 80%) were identified using generalized linear models for repeated measures.
Six thousand four hundred and sixty-two patients were included in the study. In the first year, the mean PDC was 87, 61% in the first and second quarter, respectively, and 65% after 13 years. Less than 50% of patients maintained a PDC of > 80% after 13 years. Predictors of poor long-term adherence were younger age, higher HbA(1c), no history of smoking, no cardiovascular morbidity at baseline and occurrence of cardiovascular disease after statin commencement.
This study suggests that barriers to long-term adherence to statins tend to arise early on in the therapeutic course. In general, long-term adherence is poor in patients with diabetes, especially among those with few other cardiovascular risk factors.
确定社区环境中所有糖尿病患者长期坚持他汀类药物治疗的模式及预测因素。
我们回顾性研究了1989年1月1日至2003年5月31日居住在苏格兰泰赛德地区且在此期间开始他汀类药物治疗的糖尿病患者。主要结局指标是定期计算的他汀类药物覆盖天数百分比（PDC）。使用重复测量的广义线性模型确定依从性欠佳（PDC < 80%）的预测因素。
6462名患者纳入研究。第一年，平均PDC为87，第一和第二季度分别为61%，13年后为65%。13年后，不到50%的患者维持PDC > 80%。长期依从性差的预测因素为年龄较小、糖化血红蛋白（HbA1c）较高、无吸烟史、基线时无心血管疾病且开始他汀类药物治疗后发生心血管疾病。
本研究表明，他汀类药物长期治疗依从性的障碍往往在治疗过程早期出现。总体而言，糖尿病患者长期依从性较差，尤其是在其他心血管危险因素较少的患者中。
