Department of Clinical Pharmacy, School of Pharmacy, Kitasato University, Tokyo, Japan.
Department of Pharmacy, Kitasato University Medical Center, Kitamoto, Japan.
Medicine (Baltimore). 2024 Apr 12;103(15):e37711. doi: 10.1097/MD.0000000000037711.
This study aimed to investigate the association between medication adherence to oral hypoglycemic agents (OHAs) and HbA1c levels in patients with type 2 diabetes mellitus (T2DM) for more than 48 weeks, as well as the factors affecting long-term adherence to OHAs. This retrospective study included 83 patients who had been receiving OHAs for T2DM for ≥48 weeks. Medication adherence values (MAVs) were calculated using the following formula: (total prescription days - prescription days of OHAs brought at admission)/(days from the initiation of OHAs to hospitalization). We assessed the association between HbA1c and MAVs using the Jonckheere-Terpstra test. Furthermore, we examined the association between patient- and medication-related factors and MAVs affecting HbA1c levels. Based on the results, MAVs were categorized as MAV ≤0.86 and MAV >0.86, and factors affecting MAVs were analyzed. Logistic regression analysis revealed that the total number of medications, the number of nonhypoglycemic agents, and a family history of diabetes were independent determinants of MAV ≤0.86 (P < .05). Multiple regression analyses indicated that the number of dosages per day and the timing of OHA administration at lunch were independent determinants of lower MAVs (P < .05). Our findings suggest that poor medication adherence is associated with elevated HbA1c levels in T2DM patients. Independent factors contributing to poor adherence include a lower number of prescribed medications, fewer nonhypoglycemic agents, no family history, a higher daily dosage frequency, and the administration of OHAs at lunch.
这项研究旨在调查 2 型糖尿病(T2DM)患者接受口服降糖药(OHAs)治疗超过 48 周时药物依从性与 HbA1c 水平之间的关系,以及影响 OHAs 长期依从性的因素。这项回顾性研究纳入了 83 名 T2DM 患者,他们接受 OHAs 治疗超过 48 周。采用以下公式计算药物依从性值(MAVs):(总处方天数-入院时开具的 OHAs 处方天数)/(从开始使用 OHAs 到住院的天数)。我们使用 Jonckheere-Terpstra 检验评估 HbA1c 与 MAVs 之间的关系。此外,我们还研究了患者和药物相关因素与影响 HbA1c 水平的 MAVs 之间的关系。根据结果,将 MAVs 分为 MAV≤0.86 和 MAV>0.86,并分析影响 MAVs 的因素。逻辑回归分析显示,药物总数、非降糖药物数量和糖尿病家族史是 MAV≤0.86 的独立决定因素(P<.05)。多元回归分析表明,每天的剂量数和午餐时 OHA 给药时间是 MAV 较低的独立决定因素(P<.05)。我们的研究结果表明,T2DM 患者药物依从性差与 HbA1c 水平升高有关。导致药物依从性差的独立因素包括:处方药物数量较少、非降糖药物较少、无糖尿病家族史、每日剂量频次较高、午餐时服用 OHAs。