Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
Institute of Legal Medicine and Core Facility Metabolomics, Medical University Innsbruck, Innsbruck, Austria.
Diabetologia. 2024 Jul;67(7):1283-1294. doi: 10.1007/s00125-024-06149-w. Epub 2024 Apr 22.
AIMS/HYPOTHESIS: Non-adherence to medication is a frequent barrier in the treatment of patients with type 2 diabetes mellitus, potentially limiting the effectiveness of evidence-based treatments. Previous studies have mostly relied on indirect adherence measures to analyse outcomes based on adherence. The aim of this study was to use LC-MS/MS in urine-a non-invasive, direct and objective measure-to assess non-adherence to cardiometabolic drugs and analyse its association with kidney and cardiovascular outcomes.
This cohort study includes 1125 participants from the PROVALID study, which follows patients with type 2 diabetes mellitus at the primary care level. Baseline urine samples were tested for 79 cardiometabolic drugs and metabolites thereof via LC-MS/MS. An individual was classified as totally adherent if markers for all drugs were detected, partially non-adherent when at least one marker for one drug was detected, and totally non-adherent if no markers for any drugs were detected. Non-adherence was then analysed in the context of cardiovascular (composite of myocardial infarction, stroke and cardiovascular death) and kidney (composite of sustained 40% decline in eGFR, sustained progression of albuminuria, kidney replacement therapy and death from kidney failure) outcomes.
Of the participants, 56.3% were totally adherent, 42.0% were partially non-adherent, and 1.7% were totally non-adherent to screened cardiometabolic drugs. Adherence was highest to antiplatelet and glucose-lowering agents and lowest to lipid-lowering agents. Over a median (IQR) follow-up time of 5.10 (4.12-6.12) years, worse cardiovascular outcomes were observed with non-adherence to antiplatelet drugs (HR 10.13 [95% CI 3.06, 33.56]) and worse kidney outcomes were observed with non-adherence to antihypertensive drugs (HR 1.98 [95% CI 1.37, 2.86]).
CONCLUSIONS/INTERPRETATION: This analysis shows that non-adherence to cardiometabolic drug regimens is common in type 2 diabetes mellitus and negatively affects kidney and cardiovascular outcomes.
目的/假设：不遵守药物治疗是 2 型糖尿病患者治疗中的一个常见障碍，可能会限制基于证据的治疗的效果。先前的研究主要依赖于间接的依从性措施来根据依从性分析结果。本研究的目的是使用 LC-MS/MS 尿液分析-一种非侵入性、直接和客观的测量方法-评估对心血管代谢药物的不依从性，并分析其与肾脏和心血管结局的关系。
这项队列研究包括来自 PROVALID 研究的 1125 名参与者，该研究在初级保健水平上对 2 型糖尿病患者进行随访。通过 LC-MS/MS 对基线尿液样本进行了 79 种心血管代谢药物及其代谢物的检测。如果检测到所有药物的标志物，则将个体分类为完全依从；如果至少有一种药物的一种标志物被检测到，则为部分不依从；如果没有任何药物的标志物被检测到，则为完全不依从。然后，根据心血管（心肌梗死、中风和心血管死亡的复合）和肾脏（持续 eGFR 下降 40%、持续蛋白尿进展、肾脏替代治疗和肾衰竭死亡的复合）结局分析不依从情况。
在参与者中，56.3%为完全依从，42.0%为部分不依从，1.7%为筛选出的心血管代谢药物完全不依从。对抗血小板和降糖药物的依从性最高，对降脂药物的依从性最低。在中位（IQR）随访时间为 5.10（4.12-6.12）年期间，抗血小板药物不依从与心血管结局较差相关（HR 10.13[95%CI 3.06, 33.56]），降压药物不依从与肾脏结局较差相关（HR 1.98[95%CI 1.37, 2.86]）。
结论/解释：本分析表明，2 型糖尿病患者不遵守心血管代谢药物治疗方案很常见，会对肾脏和心血管结局产生负面影响。
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