From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP).
J Am Board Fam Med. 2023 Feb 8;36(1):15-24. doi: 10.3122/jabfm.2022.220272R2.
We examined the impact of various comorbid conditions on diabetes and condition-specific cost-related nonadherence (CRN), and HbA1c in adults with diabetes.
This was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 600). We computed prevalence of condition-specific CRN, prevalence of specific types of diabetes-related CRN by comorbid condition, prevalence of specific types of condition-specific CRN within each comorbidity, and the association between condition-specific and diabetes-related CRN and HbA1c for each comorbid condition.
Fifty-eight percent (n = 350) of participants reported diabetes-related CRN. Diabetes-related CRN rates were highest in those with liver problems (63%), anemia (61%), respiratory diseases (60%), and hyperlipidemia (60%). Condition-specific CRN rates were high in those with respiratory diseases (44%), back pain (41%), and depression (40%). Participants with cancer and kidney diseases reported the lowest rates of diabetes-related and condition-specific CRN. Delaying getting diabetes prescriptions filled was the most commonly reported form of diabetes-related CRN across all comorbid conditions and was the highest in those with liver problems (47%), anemia (46%), and respiratory diseases (45%). In adjusted models, those with back pain (beta-coefficient, 0.45; 95%CI 0.02-0.88; ) and hyperlipidemia (beta-coefficient, 0.50; 95%CI 0.11-0.88; ) who reported both diabetes-related and condition-specific CRN had higher HbA1c.
CRN in patients with diabetes is higher than in other comorbid conditions and is associated with poor diabetes control. These findings may be driven by higher out-of-pocket costs for medications to manage diabetes, lack of symptoms associated with poor diabetes control, or other factors, with implications for both clinicians and health insurance programs.
我们研究了各种合并症对糖尿病患者的影响，以及与特定疾病相关的费用相关不依从（CRN）和糖化血红蛋白（HbA1c）。
这是一项横断面分析，纳入了正在进行的试验中血糖控制不佳的糖尿病患者（n=600）。我们计算了特定类型的糖尿病相关 CRN 的患病率、每种合并症中特定类型的糖尿病相关 CRN 的患病率、每种合并症中特定类型的与疾病相关的 CRN 的患病率，以及每种合并症中与疾病相关的和糖尿病相关的 CRN 与 HbA1c 之间的关联。
58%（n=350）的参与者报告了糖尿病相关的 CRN。有肝脏问题（63%）、贫血（61%）、呼吸系统疾病（60%）和血脂异常（60%）的患者中，糖尿病相关 CRN 的发生率最高。有呼吸系统疾病（44%）、背痛（41%）和抑郁（40%）的患者中，与疾病相关的 CRN 发生率较高。有癌症和肾脏疾病的患者报告了最低的糖尿病相关和与疾病相关的 CRN 发生率。延迟开糖尿病处方是所有合并症中最常见的糖尿病相关 CRN 形式，在有肝脏问题（47%）、贫血（46%）和呼吸系统疾病（45%）的患者中最高。在调整模型中，报告同时存在糖尿病相关和与疾病相关的 CRN 的背痛（β系数，0.45；95%CI 0.02-0.88；）和血脂异常（β系数，0.50；95%CI 0.11-0.88；）患者的 HbA1c 更高。
糖尿病患者的 CRN 高于其他合并症，且与糖尿病控制不良有关。这些发现可能是由于管理糖尿病的药物自付费用较高、与糖尿病控制不良相关的症状缺乏，或其他因素导致的，这对临床医生和健康保险计划都有影响。
