Objective assessment of medication taking advised to reduce type 2 diabetes complications
medwireNews: Suboptimal medication-taking identified through urine testing is associated with a higher prevalence of microvascular and macrovascular complications in people with type 2 diabetes than found with consistent usage, report researchers.
Microvascular complications were present in 81.6% of study participants who were taking at least one of their prescribed medications inconsistently, compared with 66.2% of those who were taking all of them as prescribed. The corresponding rates of macrovascular complications were 55.1% versus 37.0%.
“This demonstrates a window of opportunity for early detection and interventions in cases of nonadherence,” write the researchers in Diabetes Care.
Most of the 457 participants of this observational prospective cohort study were taking all their prescribed medications, with 89.3% having detectable levels of all relevant metabolites in liquid chromatography–tandem mass spectrometry of 24-hour urine samples.
Jelle Beernink (Ziekenhuis Groep Twente, Almelo, the Netherlands) and co-researchers suggest that this relatively consistent medication taking may reflect the particular cohort, which was drawn from the specialist outpatient clinics of two hospitals, having been referred there from primary care owing to failure to achieve glycemic targets or the presence of multiple cardiovascular complications.
The team suggests that people “treated in specialist care may feel more urgency to adhere to their treatment in comparison with patients treated in primary care.”
The study participants were an average age of 64 years, with an average diabetes duration of 11 years. Overall, 95.7% had detectable metabolites for their prescribed oral antidiabetes medications, 92.0% for their antihypertensives, and 95.5% for their statins, although the researchers note that this latter figure was based on data from less than half of the cohort, due to high use of simvastatin, which cannot be detected via urinary metabolites.
Demographic and clinical variables were mostly similar for people who were and were not taking all their medications. However, people not consistently taking their medications were more often smokers than the other study participants (28.6 vs 15.0%), were taking a greater number of medications overall (median eight vs seven), and had higher levels of glycated hemoglobin and low-density lipoprotein (LDL) cholesterol.
In adjusted analyses, current smoking remained significantly associated with increased odds for incomplete medication taking, as was higher BMI, elevated glycated hemoglobin and LDL cholesterol, and the presence of diabetic kidney disease and macrovascular disease.
“Apparently, nonadherence in our population was not recognized by patients’ health care professionals,” observe the researchers.
“However, it is important to actively search for nonadherence, recognizing that poor medication adherence contributes to suboptimal clinical benefits,” they say.
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