Department of Clinical Pharmacology, Faculty of Medical Science, University Medical Center Groningen, University of Groningen, The Netherlands.
Clin Ther. 2011 Jan;33(1):121-34. doi: 10.1016/j.clinthera.2011.01.024.
Low rates of treatment modification in patients with insufficiently controlled risk factors are common in type 2 diabetes. Although adherence problems are often mentioned in surveys as a reason for not intensifying treatment, observational studies have shown inconclusive results.
To assess how medication adherence affects treatment modifications for hypertension and hyperglycemia in patients with type 2 diabetes.
This was a cohort study of 11,268 primary care patients with type 2 diabetes in the Netherlands. Inclusion criteria were diagnosis before 2007, ≥1 prescription to antihypertensive or glucose-regulating medication in the preceding 6 months, and a systolic blood pressure level ≥140 mm Hg or glycosylated hemoglobin ≥7% in 2007. Patients on maximal treatment were excluded. Treatment modifications as observed from prescriptions were classified as none, dose increase, dose decrease, class switch, class addition, or class discontinuation. Refill adherence was assessed as medication possession ratio or length of last gap between refills. We performed multilevel multinomial regression analysis to test for associations.
We included 4980 diabetic patients with elevated blood pressure and 2945 diabetic patients with elevated glycosylated hemoglobin levels. Patients with lower adherence for antihypertensive drugs were more likely to have those medications discontinued (odds ratio [OR] for every 10% lower medication possession ratio =1.22; 95% CI, 1.11-1.33) or the dose decreased (OR = 1.14; CI 1.01-1.28). For glucose-regulating medication, dose increases (OR = 0.92; 95% CI, 0.85-0.98) and medication additions (OR = 0.90; 95% CI, 0.82-0.99) were less likely in patients with lower adherence levels.
Low adherence inhibits the intensification of glucose-regulating but not antihypertensive medication in type 2 diabetic patients with insufficiently controlled risk factors in the Netherlands. Adherence problems may lead to diminished or even discontinued antihypertensive treatment.
在 2 型糖尿病患者中，风险因素控制不佳的治疗调整率较低较为常见。尽管在调查中经常提到依从性问题是不加强治疗的原因，但观察性研究结果尚无定论。
评估药物依从性如何影响 2 型糖尿病患者高血压和高血糖的治疗调整。
这是一项在荷兰的 11268 名 2 型糖尿病患者的队列研究。纳入标准为 2007 年前诊断，在过去 6 个月内至少有一次降压或血糖调节药物处方，且 2007 年收缩压≥140mmHg 或糖化血红蛋白≥7%。排除已接受最大剂量治疗的患者。从处方中观察到的治疗调整被分类为无、剂量增加、剂量减少、类别转换、类别添加或类别停用。 refill 依从性评估为药物占有比或最后一次 refill 之间的间隔长度。我们进行了多层次多项回归分析来检验相关性。
我们纳入了 4980 名血压升高的糖尿病患者和 2945 名糖化血红蛋白水平升高的糖尿病患者。降压药物依从性较低的患者更有可能停止服用这些药物（每降低 10%药物占有比的比值比 [OR] =1.22；95%CI，1.11-1.33）或减少剂量（OR = 1.14；CI 1.01-1.28）。对于血糖调节药物，依从性较低的患者更不可能增加剂量（OR = 0.92；95%CI，0.85-0.98）或添加药物（OR = 0.90；95%CI，0.82-0.99）。
在荷兰，风险因素控制不佳的 2 型糖尿病患者中，低依从性会抑制血糖调节药物的强化，但不会抑制降压药物的强化。依从性问题可能导致降压治疗减少甚至停止。
