DiBonaventura Marco, Wintfeld Neil, Huang Joanna, Goren Amir
Health Outcomes Practice, Kantar Health, New York, NY.
Health Economics and Outcomes Research, Novo Nordisk, Princeton, NJ, USA.
Patient Prefer Adherence. 2014 Jun 19;8:873-82. doi: 10.2147/PPA.S55550. eCollection 2014.
The main objective of this study was to investigate the relationship between adherence and both clinical (ie, glycated hemoglobin [HbA1c]) and nonclinical (ie, health status, work impairment, and health care-resource use) health outcomes among type 2 diabetes (T2D) patients using basal insulin.
The 2012 US National Health and Wellness Survey dataset was used for this study (n=71,141). A total of 1,198 respondents who reported a diagnosis of T2D, were currently using basal insulin, and reported both their HbA1c and level of nonadherence were included in the analyses. Classical test theory and item response theory (IRT) analyses were used to provide evidence for the Morisky Medication Adherence Scale (MMAS) in this population. Adherence was then used as a predictor of HbA1c and nonclinical outcomes using regression modeling, controlling for demographics and health history.
A total of 61.44% of respondents were male, and the mean age was 60.65 (standard deviation 10.74) years. Internal consistency of the eight-item MMAS (MMAS-8) was adequate (Cronbach's α =0.68), and one factor was retained (eigenvalue =1.80). IRT analyses suggested that the MMAS-8 was most precise for those with high levels of nonadherence. A significant relationship between variables emerged, whereby each point increase in the level of nonadherence was associated with a 0.21 increase in HbA1c (B=0.212, P<0.05). A modest quadratic trend was also observed (B=0.026, P<0.05), indicating that the benefit to HbA1c may taper off at high adherence. Each point of nonadherence was associated with a 4.6%, 20.4%, and 20.9% increase in the number of physician visits, emergency room visits, and hospitalizations, respectively.
This study provides evidence that adherence rates are high among patients with T2D using basal insulin, and the MMAS-8 is a reliable and valid tool to assess adherence. Further, the results suggest that HbA1c increases concomitantly with nonadherence, as do poorer health status and health care-resource use.
本研究的主要目的是调查使用基础胰岛素的2型糖尿病（T2D）患者的依从性与临床（即糖化血红蛋白[HbA1c]）和非临床（即健康状况、工作障碍和医疗资源使用）健康结局之间的关系。
本研究使用了2012年美国国家健康与 Wellness 调查数据集（n = 71,141）。共有1198名报告患有T2D、目前正在使用基础胰岛素且报告了其HbA1c和不依从水平的受访者纳入分析。采用经典测试理论和项目反应理论（IRT）分析为该人群中的Morisky药物依从性量表（MMAS）提供证据。然后，使用回归模型，将依从性作为HbA1c和非临床结局的预测因子，并对人口统计学和健康史进行控制。
共有61.44%的受访者为男性，平均年龄为60.65（标准差10.74）岁。八项MMAS（MMAS - 8）的内部一致性良好（Cronbach's α = 0.68），并保留了一个因子（特征值 = 1.80）。IRT分析表明，MMAS - 8对不依从水平高的患者最为精确。变量之间出现了显著关系，即不依从水平每增加1分，HbA1c增加0.21（B = 0.212，P < 0.05）。还观察到适度的二次趋势（B = 0.026，P < 0.05），表明在高依从性时对HbA1c的益处可能会逐渐减少。不依从的每1分分别与医生就诊次数、急诊就诊次数和住院次数增加4.6%、20.4%和20.9%相关。
本研究提供的证据表明，使用基础胰岛素的T2D患者的依从率较高，并且MMAS - 8是评估依从性的可靠有效工具。此外，结果表明，HbA1c随着不依从性的增加而升高，健康状况较差和医疗资源使用情况也是如此。
