Boye Kristina S, Mody Reema, Lage Maureen J, Douglas Steven, Patel Hiren
Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, USA.
HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL, USA.
Diabetes Ther. 2020 Jul;11(7):1513-1525. doi: 10.1007/s13300-020-00838-6. Epub 2020 May 23.
Most adults with type 2 diabetes (T2D) have several chronic conditions treated with complex regimens and multiple medications. The burden and complexity of multiple medication use are associated with worse patient outcomes, including reduced adherence and increased costs, hospitalizations, mortality rates, and HbA1c. This study quantifies the chronic medication burden, regimen complexity, and potential medication interactions in patients with T2D using a nationwide claims database in the USA.
Adults with T2D treated for greater than half of the year with at least one glucose-lowering agent (GLA) in 2017 were included in this descriptive study. Chronic medications were defined as all GLAs and non-GLA medications prescribed for at least 90 days in 2017 to at least 2% of the cohort. Medication burden, defined as the number of medications prescribed, was examined. Medication complexity, proxied by the Medication Regimen Complexity Index (MRCI), and potential use of interacting medications were also examined. Results were investigated for all chronic medications and were reported on the basis of the disease treated (diabetes or other condition) and the route of administration (oral or other).
On average, in 2017, the 814,156 patients included in the study filled prescriptions for 4.1 chronic medications (standard deviation [SD] = 2.0), 3.7 oral chronic medications (SD = 1.9), 1.5 GLAs (SD = 0.8), and 1.1 oral GLAs (SD = 0.7). The average MRCI was 14.7 for all chronic medications (SD = 7.4), with a mean of 12.4 for all oral chronic medications (SD = 6.3), 6.6 for all GLAs (SD = 3.8), and 4.9 for oral GLAs (SD = 2.6).
On average, patients with T2D used multiple medications, had a complex medication regimen, and were at potential risk of medication interactions. These findings suggest that patients, practitioners, pharmacists, and payers may benefit from interventions which decrease medication burden, complexity, and/or adverse events related to the treatment of T2D.
大多数成年2型糖尿病（T2D）患者患有多种慢性病，需采用复杂的治疗方案并服用多种药物。多种药物联用的负担和复杂性与更差的患者预后相关，包括依从性降低、成本增加、住院率、死亡率以及糖化血红蛋白（HbA1c）升高。本研究使用美国全国性索赔数据库对T2D患者的慢性药物负担、治疗方案复杂性及潜在药物相互作用进行量化。
本描述性研究纳入了2017年接受至少一种降糖药物（GLA）治疗半年以上的成年T2D患者。慢性药物定义为2017年给至少2%的队列患者开具的所有GLA和非GLA药物，且用药时间至少90天。研究了用药负担（定义为所开具药物的数量）。还研究了以药物治疗方案复杂性指数（MRCI）为代表的药物治疗复杂性以及相互作用药物的潜在使用情况。对所有慢性药物的结果进行了调查，并根据所治疗的疾病（糖尿病或其他疾病）和给药途径（口服或其他）进行报告。
2017年，纳入研究的814,156名患者平均开具了4.1种慢性药物的处方（标准差[SD]=2.0），3.7种口服慢性药物（SD=1.9），1.5种GLA（SD=0.8），以及1.1种口服GLA（SD=0.7）。所有慢性药物的平均MRCI为14.7（SD=7.4），所有口服慢性药物的平均MRCI为12.4（SD=6.3），所有GLA的平均MRCI为6.6（SD=3.8），口服GLA的平均MRCI为4.9（SD=2.6）。
T2D患者平均使用多种药物，治疗方案复杂，且存在药物相互作用的潜在风险。这些发现表明，患者、从业者、药剂师和支付方可能会从降低与T2D治疗相关的药物负担、复杂性和/或不良事件的干预措施中受益。
