Knoxville, TN—How important is adherence to new oral medications in reducing diabetes complications? A new report suggests it is critical.

The research, published in Diabetic Medicine, looked at the relationship of following drug regimens with the development of macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among U.S. veterans with uncomplicated diabetes.

The retrospective cohort study was led by researchers from the University of Tennessee School of Pharmacy and used the Veterans Affairs Corporate Data Warehouse to examine 159,032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and starting oral antidiabetes therapy for the first time.

Researchers identified and confirmed the first uncomplicated diabetes diagnosis by subsequent oral antidiabetes 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 5 years beyond the first oral antidiabetes dispensation and analyzed with adjustments for baseline demographic and clinical characteristics.

Results indicate that, during the first 5 years of oral antidiabetes treatment, people initially nonadherent to oral antidiabetes 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, patients with less than 20% adherence in the first year had particularly high risks 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 point out.

Patients who were adherent, 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.”

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