Tan X, Feng X, Chang J, Higa G, Wang L, Leslie D
School of Pharmacy, West Virginia University, Morgantown, WV, USA.
School of Pharmacy, University of Texas, El Paso, TX, USA.
J Clin Pharm Ther. 2016 Oct;41(5):524-31. doi: 10.1111/jcpt.12430. Epub 2016 Jul 25.
To assess oral antidiabetic drug use and associated health outcomes in American non-elderly adults with cancer
A retrospective study was conducted by analysing the Marketscan(®) Commercial Claims and Encounters Database from 2008 to 2009. Individuals 18-64 years with concomitant diagnoses of cancer (breast, prostate, colon or lung) and type 2 diabetes, and treated with oral antidiabetic medications were included. Medication adherence was assessed using the Medication Possession Ratio (MPR); logistic regression was used to analyse factors associated with non-adherence. Adherence was compared between patients with cancer and non-cancer controls matched by propensity scores. Negative binomial regression was utilized to examine the effect of antidiabetic drug adherence on all-cause hospitalizations and emergency room visits. The impact of adherence on total medical costs was then evaluated using the generalized linear model (GLM) with the log-link function and gamma error distribution.
Of 1918 diabetic, cancer patients who newly initiated oral diabetic drugs, only 37·6% were adherent to oral diabetic medications; a similar proportion of adherence was found in the non-cancer control population (35·8%, P = 0·24). Younger age, living in the southern region, using combination therapy vs. monotherapy, and using retail pharmacy vs. mail order pharmacy were significantly associated with non-adherence in patients with cancer. Adherence to oral antidiabetic drugs was associated with 24% fewer all-cause hospitalizations (P = 0·02).
We identified high prevalence of non-adherence to oral antidiabetic medications as well as negative consequences associated with non-adherence, among patients with cancer. These findings may underscore the importance of developing relevant intervention strategies for improving diabetes management and treatment outcomes among cancer patients with diabetes.
评估美国非老年癌症成人患者口服抗糖尿病药物的使用情况及相关健康结局
通过分析2008年至2009年的Marketscan®商业索赔和病历数据库进行一项回顾性研究。纳入年龄在18 - 64岁、同时患有癌症（乳腺癌、前列腺癌、结肠癌或肺癌）和2型糖尿病且接受口服抗糖尿病药物治疗的个体。使用药物持有率（MPR）评估药物依从性；采用逻辑回归分析与不依从相关的因素。通过倾向得分匹配，比较癌症患者与非癌症对照患者之间的依从性。利用负二项回归检验抗糖尿病药物依从性对全因住院和急诊就诊的影响。然后使用具有对数链接函数和伽马误差分布的广义线性模型（GLM）评估依从性对总医疗费用的影响。
在1918名新开始使用口服糖尿病药物的糖尿病癌症患者中，只有37.6%的患者坚持服用口服糖尿病药物；在非癌症对照人群中发现了相似的依从比例（35.8%，P = 0.24）。年龄较小、居住在南部地区、使用联合治疗而非单一疗法以及使用零售药房而非邮购药房与癌症患者的不依从显著相关。坚持服用口服抗糖尿病药物与全因住院次数减少24%相关（P = 0.02）。
我们发现癌症患者中口服抗糖尿病药物不依从的发生率很高，以及不依从带来的负面后果。这些发现可能凸显了制定相关干预策略以改善糖尿病癌症患者的糖尿病管理和治疗结局的重要性。
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