Sun Peter, Lian Jean
a Health Economics and Outcomes Research Division, Kailo Research Group , Fishers , IN , USA.
b Formerly Health Economics and Outcomes Research Division, Novo Nordisk , Plainsboro , NJ , USA.
Postgrad Med. 2016 May;128(4):338-45. doi: 10.1080/00325481.2016.1151326. Epub 2016 Feb 23.
The purpose of this study was to evaluate the impact of antidiabetic medication adherence on hospital utilization in patients with newly diagnosed type 2 diabetes mellitus (T2D). This study specifically analyzed patients with newly diagnosed T2D with the intent of lessening intragroup disease severity differences, and adjusting for a range of other clinical and demographic characteristics.
This retrospective US claims database study evaluated adults with newly diagnosed T2D who started antidiabetic medications in 2005-2009, had ≥ 2 antidiabetic medication claims after their first (baseline). Medication adherence was evaluated using the medication possession ratio (MPR) of any or all antidiabetic medication(s) during the 3-year post-baseline period. Repeated-measures analyses examined changes in inpatient utilization from the pre- to post-baseline period. The impact of adherence on hospital utilization during the post-baseline period was evaluated with a logistic regression model to adjust for confounding factors.
The study included 192,717 patients (mean age, 55.0 years). Mean MPR for antidiabetic therapy was 0.74. MPR was highest in elderly patients and Medicare beneficiaries. Mean annualized inpatient admissions during the 3-year post-baseline period were significantly lower in patients with MPR ≥ 0.80 (1.4) than in those with MPR < 0.80 (2.2; P < 0.05). Logistic regression analysis, adjusting for patient characteristics and prior inpatient utilization, showed 39% lower odds of hospitalization (OR = 0.61; 95% CI = 0.534-0.693) for patients with MPR ≥ 0.80. People with T2D-related complications or hospitalization had approximately 2- to 3-fold higher risk of subsequent hospitalization.
In newly diagnosed T2D patients with antidiabetic therapy in the first three ensuing years, higher antidiabetic medication adherence was significantly associated with lower hospital inpatient utilization before and after adjusting for patient characteristics.
本研究旨在评估抗糖尿病药物依从性对新诊断2型糖尿病（T2D）患者住院率的影响。本研究特别分析了新诊断的T2D患者，目的是减少组内疾病严重程度差异，并对一系列其他临床和人口统计学特征进行调整。
这项回顾性美国索赔数据库研究评估了2005年至2009年开始使用抗糖尿病药物、首次（基线）后有≥2次抗糖尿病药物索赔的新诊断T2D成人患者。使用基线后3年内任何或所有抗糖尿病药物的药物持有率（MPR）评估药物依从性。重复测量分析检查了从基线前到基线后期间住院利用率的变化。使用逻辑回归模型评估基线后期间依从性对住院率的影响，以调整混杂因素。
该研究纳入了192,717名患者（平均年龄55.0岁）。抗糖尿病治疗的平均MPR为0.74。MPR在老年患者和医疗保险受益人中最高。MPR≥0.80的患者在基线后3年期间的年均住院次数（1.4次）显著低于MPR<0.80的患者（2.2次；P<0.05）。在调整患者特征和先前住院利用率后进行的逻辑回归分析显示，MPR≥0.80的患者住院几率降低39%（OR=0.61；95%CI=0.534-0.693）。患有T2D相关并发症或住院的患者随后住院的风险大约高2至3倍。
在随后三年首次接受抗糖尿病治疗的新诊断T2D患者中，在调整患者特征后，较高的抗糖尿病药物依从性与较低的住院率显著相关。
