Boye Kristina S, Shinde Shraddha, Kennedy-Martin Tessa, Robinson Susan, Thieu Vivian T
Eli Lilly and Company, Indianapolis, IN, USA.
Kennedy-Martin Health Outcomes Ltd, Brighton, UK.
Patient Prefer Adherence. 2022 Jan 6;16:23-39. doi: 10.2147/PPA.S328583. eCollection 2022.
Type 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation.
Searches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD).
Nine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug's weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type.
Findings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual's treatment, weight journey, and behaviors over time should be undertaken.
2型糖尿病（T2D）患者的药物依从性较差，且受到个体药物特性的影响。与治疗相关的体重变化会影响用药行为。本综述旨在探讨T2D治疗中的体重变化，并考虑其对依从性和停药的影响。
在MEDLINE和EMBASE数据库（2005年至2020年9月）以及近期的会议摘要集中进行检索，以查找提供T2D患者药物依从性或停药情况以及体重变化数据的研究。
从9188条书目记录中识别出9项符合纳入标准的研究。所有3项探讨体重变化与停药情况的研究均报告称体重减轻与更高的持续用药率相关。7项设计各异的研究探讨了体重变化与依从性。4项研究报告了绝对体重变化（千克）与依从性：其中1项汇总了不同糖尿病药物的数据，表明自我报告的依从性与体重减轻显著相关；然而，另外3项研究发现，依从性好的T2D患者的体重变化与所评估药物已知的体重特征（减轻/增加）方向一致。2项研究报告了分类体重减轻（≥3%）与依从性：1项研究报告称，无论药物的体重特征如何，在数值上，更多依从性好的T2D患者体重减轻≥3%，而不依从的患者则不然；另一项研究表明，使用胰高血糖素样肽-1激动剂早期体重减轻与更好的依从性显著相关。1项研究按分类体重变化报告了依从性；随着体重减轻增加，依从性得分提高，与药物类型无关。
研究结果表明，与在T2D治疗中体重增加的患者相比，体重减轻的患者停药率可能更低。由于研究设计的多样性，关于依从性和体重变化的证据基础更难解释。鉴于体重控制在T2D中的重要性，应开展进一步研究，探讨个体的治疗、体重变化历程以及随时间推移的行为。
