Ab Rahman Norazida, Lim Ming Tsuey, Thevendran Shantini, Ahmad Hamdi Najwa, Sivasampu Sheamini
Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia.
Public Health Development Division, Ministry of Health, Putrajaya, Malaysia.
Front Pharmacol. 2022 Mar 21;13:808190. doi: 10.3389/fphar.2022.808190. eCollection 2022.
Most type 2 diabetes mellitus (T2DM) patients with chronic conditions require multiple medications to achieve and maintain good glycemic control. This study assessed medication burden, regimen complexity, and adherence among T2DM patients and evaluate its association with glycemic control. We analyzed data of 2,696 T2DM patients at public health clinics in Malaysia from January 2018 until May 2019. Medication burden was based on medication count, regimen complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and adherence was measured using proportion of days covered (PDC) formula. Logistic regression models were used to compute unadjusted and adjusted odds ratio (aOR) with 95% confidence interval (CI) for association between the medication parameters and glycemic control (HbA1c ≤ 7.0%) over a 90-day period. The cohort mean age was 60.4 years old (±10.8) and 62.9% were female. Overall, the average medication count was 4.8 with MRCI score of 15.1. Mean adherence score (PDC) was 90%. High medication count and MRCI scores were associated with lower odds of achieving good glycemic control (aOR 0.88; 95% CI 0.82, 0.94 and aOR 0.89; 95% CI 0.87, 0.92, respectively) while inverse association was observed between adherence and HbA1c level (aOR 2.7, 95% CI 1.66, 5.19). Similar findings were observed for diabetes-specific measures. High medication count, high regimen complexity, and low medication adherence were associated with poor glycemic control over the 3-month follow-up period. These parameters could be used to identify patients with complex pharmacotherapy regimens so that targets for intervention can be taken to achieve optimum outcomes and ease of self-care.
大多数患有慢性病的2型糖尿病（T2DM）患者需要多种药物来实现并维持良好的血糖控制。本研究评估了T2DM患者的用药负担、治疗方案复杂性和依从性，并评估了其与血糖控制的关联。我们分析了2018年1月至2019年5月在马来西亚公共卫生诊所的2696例T2DM患者的数据。用药负担基于用药数量，治疗方案复杂性使用经过验证的用药方案复杂性指数（MRCI）工具进行测量，依从性使用覆盖天数比例（PDC）公式进行测量。使用逻辑回归模型计算90天期间用药参数与血糖控制（糖化血红蛋白≤7.0%）之间关联的未调整和调整比值比（aOR）及95%置信区间（CI）。队列的平均年龄为60.4岁（±10.8），女性占62.9%。总体而言，平均用药数量为4.8，MRCI评分为15.1。平均依从性评分（PDC）为90%。高用药数量和MRCI评分与实现良好血糖控制的较低几率相关（分别为aOR 0.88；95%CI 0.82，0.94和aOR 0.89；95%CI 0.87，0.92），而依从性与糖化血红蛋白水平呈负相关（aOR 2.7，95%CI 1.66，5.19）。在糖尿病特异性指标方面也观察到了类似的结果。在3个月的随访期内，高用药数量、高治疗方案复杂性和低用药依从性与血糖控制不佳相关。这些参数可用于识别药物治疗方案复杂的患者，以便采取干预目标以实现最佳结果并便于自我护理。
