Leicester Diabetes Centre, Leicester General Hospital, Leicester, U.K.
Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.
Diabetes Care. 2017 Nov;40(11):1588-1596. doi: 10.2337/dc16-1925. Epub 2017 Aug 11.
A previous study suggests an association between poor medication adherence and excess mortality in chronic disease. The purpose of this study was to assess the association between medication adherence and risk of cardiovascular disease (CVD), all-cause mortality, and hospitalization in type 2 diabetes.
We conducted an electronic search on many electronic databases from inception to 27 April 2016. We selected randomized controlled trials and case-control and cohort studies reporting on CVD, all-cause mortality, or hospitalization outcomes by adherence in adults with type 2 diabetes. Two reviewers independently screened for eligible studies and extracted outcome data. Pooled relative risks (RRs) were calculated using a random-effects meta-analysis; risk of bias in each of the included studies was assessed using the GRADE approach.
Eight observational studies were included ( = 318,125). The mean rate of poor adherence was 37.8% (95% CI 37.6-38.0). Adjusted estimates were provided by five studies only. The RRs of good (≥80%) versus poor adherence to medication were 0.72 (95% CI 0.62-0.82, = 0%, three studies) for all-cause mortality and 0.90 (0.87-0.94, = 63%, seven studies) for hospitalization. No evidence of small study bias was observed. Only one study reported CVD outcomes by adherence.
We identified no trials reporting on outcomes by adherence, suggesting a systematic failure to include this information. Pooled estimates from available observational studies suggest that good medication adherence is associated with reduced risk of all-cause mortality and hospitalization in people with type 2 diabetes, although bias cannot be excluded as an explanation for these findings.
先前的研究表明，慢性病患者药物治疗依从性差与死亡率过高有关。本研究旨在评估 2 型糖尿病患者药物治疗依从性与心血管疾病（CVD）、全因死亡率和住院风险之间的关系。
我们对许多电子数据库进行了电子检索，检索时间从建库至 2016 年 4 月 27 日。我们选择了报告 2 型糖尿病患者 CVD、全因死亡率或住院结局与依从性相关的随机对照试验、病例对照研究和队列研究。两名评审员独立筛选合格研究并提取结局数据。使用随机效应荟萃分析计算汇总相对风险（RR）；使用 GRADE 方法评估纳入研究的偏倚风险。
共纳入 8 项观察性研究（n=318125）。药物治疗依从性差的平均发生率为 37.8%（95%CI 37.6-38.0）。仅有 5 项研究提供了调整后的估计值。与药物治疗依从性差（<80%）相比，依从性好（≥80%）的全因死亡率 RR 为 0.72（95%CI 0.62-0.82，=0%，3 项研究），住院 RR 为 0.90（0.87-0.94，=63%，7 项研究）。未观察到小样本研究偏倚的证据。仅有 1 项研究报告了按依从性分组的 CVD 结局。
我们没有发现报告按依从性分组的结局的试验，这表明系统地未能纳入这一信息。来自现有观察性研究的汇总估计表明，2 型糖尿病患者药物治疗依从性好与全因死亡率和住院风险降低相关，但不能排除偏倚是这些发现的解释。
