Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta.
Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia.
JAMA Netw Open. 2023 Jan 3;6(1):e2253562. doi: 10.1001/jamanetworkopen.2022.53562.
Consistent medication use is critical for diabetes management. Population surveillance of consistency of medication use may identify opportunities to improve diabetes care.
To evaluate trends in longitudinal use of glucose-, blood pressure-, and lipid-lowering medications by adults with diabetes.
DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study assessed trends in longitudinal use of glucose-, blood pressure-, and lipid-lowering medications by adults with diagnosed diabetes participating in the Medical Expenditure Panel Survey (MEPS), which allows serial cross-sections and 2-year longitudinal follow-up, between the 2005 to 2006 panel and 2018 to 2019 panel. Population-weighted, nationally representative estimates for the US were reported. Included individuals were adult MEPS participants with diagnosed diabetes during both years (ie, during 2005 and 2006 or during 2018 and 2019) who participated in all survey rounds. Data were analyzed from August 2021 to November 2022.
Longitudinal use over the 2 years was categorized as continued use (at least 1 fill per year), no use, inconsistent use, and new use by medication type (glucose-, blood pressure-, and lipid-lowering medications). New medications were defined as prescription fills for a medication type first prescribed and filled in year 2 of MEPS participation.
A total of 15 237 participants with diabetes (7222 individuals aged 45-64 years [47.4%]; 8258 [54.2%] female participants; 3851 Latino [25.3%]; 3619 non-Latino Black (23.8%), and 6487 non-Latino White [42.6%]) were included in the analytical sample. A mean of 19.5% (95% CI, 18.6%-20.3%), 17.1% (95% CI, 16.2%-18.1%), and 43.3% (95% CI, 42.2%-44.3%) of participants did not maintain continuity in use of glucose-, blood pressure-, or lipid-lowering medications, respectively, during both years of follow-up. The proportion of participants who continued use of glucose-lowering medication in both years trended down from 84.5% (95% CI, 81.8%-87.3%) in 2005 to 2006 to 77.4% (95% CI, 74.8%-80.1%) in 2018 to 2019; this decrease coincided with rate increases in inconsistent use (3.3% [95% CI, 1.9%-4.7%] in 2005-2006 to 7.1% [95% CI, 5.6%-8.6%] in 2018-2019) and no use (8.1% [95% CI, 6.0%-10.1%] in 2005-2006 to 12.9% [95% CI, 10.9%-14.9%] in 2018-2019). Inconsistent use of blood pressure-lowering medications trended upward from 3.9% (95% CI, 1.8%-6.0%) in 2005 to 2006 to 9.0% (95% CI, 7.0%-11.0%) in 2016 to 2017. Inconsistent use of lipid-lowering medication trended up to a high of 9.9% (95% CI, 7.0%-12.7%) in 2017 to 2018.
This study found that a mean of 19.5% of participants did not maintain continuity in use of glucose-lowering medication, with recent decreases, while a mean of 17.1% and 43.2% of participants did not maintain continuity of use of blood pressure- or lipid-lowering medications, respectively.
糖尿病管理的关键是一致的药物使用。人群药物使用一致性的监测可能会发现改善糖尿病护理的机会。
评估成年糖尿病患者长期使用降血糖、降血压和降血脂药物的趋势。
设计、设置和参与者：本系列横断面研究评估了在医疗支出面板调查（MEPS）中，诊断为糖尿病的成年人长期使用降血糖、降血压和降血脂药物的趋势，MEPS 允许进行连续的横断面和 2 年的纵向随访，在 2005 年至 2006 年和 2018 年至 2019 年的面板之间。报告了针对美国的人口加权、全国代表性估计数。纳入的个体为在两年期间均被诊断为糖尿病的 MEPS 成年参与者（即在 2005 年和 2006 年期间或在 2018 年和 2019 年期间），并且参加了所有调查轮次。数据分析于 2021 年 8 月至 2022 年 11 月进行。
在这两年中，通过药物类型（降血糖、降血压和降血脂药物）将长期使用分为继续使用（每年至少有 1 次用药）、无使用、不连续使用和新使用。新药物被定义为 MEPS 参与的第二年首次开处方和配药的药物类型。
共有 15237 名患有糖尿病的参与者（45-64 岁的个体 7222 人[47.4%]；女性参与者 8258 人[54.2%]；拉丁裔参与者 3851 人[25.3%]；非拉丁裔黑人参与者 3619 人[23.8%]和非拉丁裔白人参与者 6487 人[42.6%]）被纳入分析样本。在两年的随访期间，分别有 19.5%（95%CI，18.6%-20.3%）、17.1%（95%CI，16.2%-18.1%）和 43.3%（95%CI，42.2%-44.3%）的参与者未连续使用降血糖、降血压或降血脂药物。在 2005 年至 2006 年期间，继续使用降血糖药物的参与者比例从 84.5%（95%CI，81.8%-87.3%）呈下降趋势，至 2018 年至 2019 年的 77.4%（95%CI，74.8%-80.1%）；这种下降与不连续使用的发生率增加相一致（2005 年至 2006 年的 3.3%（95%CI，1.9%-4.7%）至 2018 年至 2019 年的 7.1%（95%CI，5.6%-8.6%））和无使用（2005 年至 2006 年的 8.1%（95%CI，6.0%-10.1%）至 2018 年至 2019 年的 12.9%（95%CI，10.9%-14.9%））。降血压药物不连续使用的趋势从 2005 年至 2006 年的 3.9%（95%CI，1.8%-6.0%）上升至 2016 年至 2017 年的 9.0%（95%CI，7.0%-11.0%）。降脂药物不连续使用的趋势上升至 2017 年至 2018 年的最高水平 9.9%（95%CI，7.0%-12.7%）。
本研究发现，平均有 19.5%的参与者未连续使用降血糖药物，最近有所下降，而平均有 17.1%和 43.2%的参与者未连续使用降血压和降血脂药物。
