2 型糖尿病儿科患者口服抗糖尿病药物的依从性：回顾性数据库分析。

Adherence to oral antidiabetic medications in the pediatric population with type 2 diabetes: a retrospective database analysis.

机构信息

Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.

出版信息

Clin Ther. 2012 Mar;34(3):712-9. doi: 10.1016/j.clinthera.2012.01.028. Epub 2012 Feb 28.

DOI:10.1016/j.clinthera.2012.01.028

PMID:22381712

Abstract

BACKGROUND

Little has been done in assessing adherence to oral antidiabetic (OAD) medications in the pediatric population presenting with type 2 diabetes. This study provided information on adherence rates in the Texas Medicaid pediatric population with type 2 diabetes, which is rare in the literature. The knowledge of adherence rates in the pediatric population with type 2 diabetes might help improve the care given to pediatric patients with type 2 diabetes.

OBJECTIVE

To describe OAD medication use, and assess trends in medication adherence and persistence among Texas pediatric Medicaid patients.

METHODS

Texas Medicaid prescription claims data of patients between 10 and 18 years of age, with at least 2 prescriptions of the same OAD medication from January 1, 2006 to December 31, 2009, were analyzed. Adherence was assessed using the medication possession ratio (MPR) as a proxy.

RESULTS

A total of 3109 patients met the study's inclusion criteria. The mean (SD) age of the 3109 eligible patients was 14.2 (2.3) years; 60% were Hispanics, 14% were blacks, 13% were whites, and another 13% were other minority races; 67% of the population were females; and 91% were on metformin of the 6 OAD medications included in the study The overall mean (SD) MPR for patients was 44.69% (27.06%). Adherence differed by gender (P < 0.0001), race (P < 0.0001), and age category (P < 0.0001). Males had higher mean (SD) MPR (47.47% [27.42%]) compared with females (43.29% [26.78%]). Mean MPR for whites (50.04% [29.65%]) was significantly higher compared with blacks (44.24% [26.16%]) and Hispanics (42.50% [26.10%]). Patients ≤12 years of age had significantly higher mean MPR (48.82% [27.37%]) compared with those in older age categories. Logistic regression analysis suggested that age was significantly related (odds ratio [OR] = 0.91; 95% CI, 0.87-0.95) to being adherent (MPR ≥80%). Males were 25% (OR = 1.25; 95% CI, 1.02-1.53; P = 0.034) more likely to be adherent (MPR ≥80%) compared with females, and whites were twice as likely to be adherent (MPR ≥80%) compared with Hispanics (OR = 2.02; 95% CI, 1.54-2.66; P = 0.0012). Overall, mean (SD) days to nonpersistence was 108 (86) days. Persistence was significantly and negatively associated with age (P < 0.0001). White race was significantly related to longer persistence.

CONCLUSION

Adherence and persistence to OAD medications in the selected Texas Medicaid pediatric population between 10 and 18 years was generally suboptimal, especially in adolescents.

摘要

背景

针对患有 2 型糖尿病的儿科人群，评估他们对口服抗糖尿病药物（OAD）的依从性方面做得很少。本研究提供了德克萨斯州医疗补助计划中患有 2 型糖尿病的儿科人群的用药依从率信息，这在文献中很少见。了解儿科人群中 2 型糖尿病的用药依从率可能有助于改善对儿科 2 型糖尿病患者的护理。

目的

描述 OAD 药物的使用情况，并评估德克萨斯州医疗补助计划中儿科患者的药物依从性和持久性趋势。

方法

分析了 2006 年 1 月 1 日至 2009 年 12 月 31 日期间年龄在 10 至 18 岁之间、至少有 2 次相同 OAD 药物处方的德克萨斯州医疗补助计划患者的处方数据。使用药物持有率（MPR）作为替代指标来评估依从性。

结果

共有 3109 名患者符合研究纳入标准。3109 名合格患者的平均（SD）年龄为 14.2（2.3）岁；60%为西班牙裔，14%为黑人，13%为白人，另外 13%为其他少数民族；67%为女性；在所研究的 6 种 OAD 药物中，有 91%的患者使用二甲双胍。患者的总体平均（SD）MPR 为 44.69%（27.06%）。依从性因性别（P < 0.0001）、种族（P < 0.0001）和年龄类别（P < 0.0001）而异。男性的平均（SD）MPR（47.47%[27.42%]）明显高于女性（43.29%[26.78%]）。白人的平均 MPR（50.04%[29.65%]）明显高于黑人（44.24%[26.16%]）和西班牙裔（42.50%[26.10%]）。≤12 岁的患者的平均 MPR（48.82%[27.37%]）明显高于年龄较大的患者。逻辑回归分析表明，年龄与依从性（MPR≥80%）显著相关（比值比[OR] = 0.91；95%置信区间，0.87-0.95）。与女性相比，男性（OR = 1.25；95%置信区间，1.02-1.53；P = 0.034）更有可能达到依从性（MPR≥80%），而白人达到依从性（MPR≥80%）的可能性是西班牙裔的两倍（OR = 2.02；95%置信区间，1.54-2.66；P = 0.0012）。总体而言，非持续用药的平均（SD）天数为 108（86）天。持续性与年龄呈显著负相关（P < 0.0001）。白种人种族与更长的持续性显著相关。