College of Pharmacy, The University of Texas at Austin, Austin, Texas 78712-0127, USA.
Clin Ther. 2012 Mar;34(3):605-13. doi: 10.1016/j.clinthera.2012.02.007. Epub 2012 Mar 3.
Adherence to oral antidiabetic (OAD) medications is essential in achieving glycemic control and slowing the progression of diabeties-related complications such as neuropathic pain. OAD medication adherence has been suboptimal and adding neuropathic pain medications may negatively affect adherence. However, little is known about adherence to neuropathic pain medications by patients with diabetes and how this may be related to OAD medication adherence.
The objectives of our study were to: (1) describe painful diabetic peripheral neuropathy (PDPN) and OAD medication use, (2) determine if PDPN medication adherence differs among individual PDPN medications (ie, tricyclic antidepressants, gabapentin, pregabalin, and duloxetine); and (3) determine if PDPN medication adherence is related to post-index OAD medication adherence while controlling for covariates.
This retrospective prescription claims database study included continuously enrolled Texas Medicaid beneficiaries who were adult (aged 30-64 years) prescribed OAD (pre- and post-index) and PDPN (post-index) medications. Data were extracted from June 1, 2003 to October 31, 2009. The main study outcome was post-index OAD medication adherence. Primary independent variables included PDPN medication adherence and PDPN medication type. Demographic and medication use characteristics served as covariates. Adherence was measured both continuously and dichotomously (80% cut-off) using medication possession ratio (MPR).
The sample's (n = 4277) overall mean MPR (SD) for PDPN medications was 75.4% (23.9%). Mean MPR differed significantly among individual PDPN medications (P < 0.0001) and was highest for duloxetine (85.6% [18.2%]) and lowest for pregabalin (69.4% [24.9%]). Overall mean MPR (SD) for OAD medications decreased significantly (P < 0.0001) from 73.0% (24.3%) in the pre-index period to 64.5% (25.6%) in the post-index period. After controlling for covariates, nonadherers (ie, MPR <80%) to PDPN medications, compared with adherers (ie, MPR ≥80%), were significantly less likely to be adherent to OAD medications in the post-index period (odds ratio = 0.626; 95% CI, 0.545-0.719).
Overall, these data suggest that mean adherence to both PDPN and OAD medications was suboptimal (MPR <80%). Patients who were adherent to PDPN medications were more adherent to OAD medications in the post-index period, but OAD medication adherence was independent of the type of PDPN medication used. OAD adherence decreased from pre- to post-index (ie, when patients were prescribed PDPN medications), which may indicate an opportunity for practitioners to emphasize the importance of OAD adherence in reducing the progression to neuropathy.
口服抗糖尿病药物（OAD）的依从性对于控制血糖和减缓糖尿病相关并发症（如神经痛）的进展至关重要。OAD 药物的依从性并不理想，而添加神经痛药物可能会对依从性产生负面影响。然而，人们对糖尿病患者对神经痛药物的依从性知之甚少，也不知道这与 OAD 药物的依从性有何关系。
我们研究的目的是：（1）描述痛性糖尿病周围神经病变（PDPN）和 OAD 药物的使用情况；（2）确定 PDPN 药物的依从性是否因个别 PDPN 药物（即三环类抗抑郁药、加巴喷丁、普瑞巴林和度洛西汀）而异；（3）在控制了混杂因素的情况下，确定 PDPN 药物的依从性与索引后 OAD 药物的依从性是否相关。
这是一项回顾性的处方索赔数据库研究，包括连续入组的德克萨斯州医疗补助计划的成年（30-64 岁）患者，他们在入组前（入组前）和入组后（入组后）使用了 OAD（入组前和入组后）和 PDPN（入组后）药物。数据从 2003 年 6 月 1 日至 2009 年 10 月 31 日提取。主要研究结果是入组后 OAD 药物的依从性。主要的独立变量包括 PDPN 药物的依从性和 PDPN 药物的类型。人口统计学和药物使用特征作为混杂因素。依从性通过药物占有比（MPR）连续和二分法（80%的截止值）进行测量。
该样本（n=4277）的 PDPN 药物总体平均 MPR（SD）为 75.4%（23.9%）。个别 PDPN 药物的 MPR 差异显著（P<0.0001），度洛西汀的 MPR 最高（85.6%[18.2%]），普瑞巴林的 MPR 最低（69.4%[24.9%]）。OAD 药物的总体平均 MPR（SD）从入组前的 73.0%（24.3%）显著下降到入组后的 64.5%（25.6%）（P<0.0001）。在控制了混杂因素后，与依从者（MPR≥80%）相比，不依从 PDPN 药物（即 MPR<80%）的患者在入组后更不可能依从 OAD 药物（比值比=0.626；95%置信区间，0.545-0.719）。
总的来说，这些数据表明，PDPN 和 OAD 药物的平均依从性都不理想（MPR<80%）。依从 PDPN 药物的患者在入组后更依从 OAD 药物，但 OAD 药物的依从性与使用的 PDPN 药物类型无关。OAD 药物的依从性从入组前到入组后（即当患者被开处 PDPN 药物时）下降，这可能表明医生有机会强调 OAD 药物依从性在减少神经病变进展方面的重要性。
