KNOXVILLE, TN—How important is adherence to oral medications in reducing complications for veterans with diabetes?

A new study published in Diabetic Medicine looked at the relationship of following drug regimens to macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions and death among veterans with uncomplicated diabetes.1

The retrospective cohort study was led by researchers from the University of Tennessee School of Pharmacy and included input from VAMCs in Nashville and Memphis. The study team used the VA Corporate Data Warehouse to examine 159,032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and starting oral anti-diabetes therapy for the first time.

Researchers identified and confirmed the first uncomplicated diabetes diagnosis by subsequent oral anti-diabetes therapy initiation. To calculate adherence, they used outpatient pharmacy records including the proportion of days covered over the first year of therapy. Health outcomes were observed up to five years beyond the first oral anti-diabetes dispensation and analyzed with adjustments for baseline demographic and clinical characteristics.

Results indicated that, during the first five years of oral anti-diabetes treatment, people initially non‐adherent to oral anti-diabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95% CI 1.03-1.27) and ischemic stroke (hazard ratio 1.22, 95% CI 1.05-0.1.42), or to die (hazard ratio 1.21; 95% CI 1.15-1.28).

In fact, veterans with less than 20% adherence in the first year had particularly high hazards for ischemic stroke (hazard ratio 1.78, 95% CI 1.27-2.49) and all‐cause death (hazard ratio 1.33, 95% CI 1.17-151), study authors pointed out. Patients who were adherence, however, were more likely to be diagnosed with a microvascular complication or chronic kidney disease.

“People who are non‐adherent to treatment were more likely to experience detrimental health outcomes within the first five years of anti-diabetes therapy,” study authors concluded. “Adherence is paramount to disease management and this should be stressed from the time at which treatment is initiated.”

1. Gatwood JD, Chisholm-Burns M, Davis R, Thomas F, Potukuchi P, Hung A, Kovesdy CP. Differences in health outcomes associated with initial adherence to oral antidiabetes medications among veterans with uncomplicated Type 2 diabetes: a 5-year survival analysis. Diabet Med. 2018 Jul 6. doi: 10.1111/dme.13775. [Epub ahead of print] PubMed PMID: 29978496.