Adherence and persistence rates of major antidiabetic medications: a review

The objective of this paper was to review the adherence and persistence rates of major antidiabetic medication classes (i.e., metformin, sulfonylureas, sodium glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 inhibitors, insulin, glucagon-like peptide-1 receptor agonists, and thiazolidinediones) by summarizing the major findings of the studies published since 2017. In addition, we reported the potential causes for low adherence and persistence of antidiabetic medications. Based on the literature, the highest rate of adherence and persistence was consistently observed in metformin users. Second to metformin were sodium glucose cotransporter-2 inhibitors. Injectable therapies such as insulin and glucagon-like peptide-1 receptor agonists trailed low on the adherence and persistence rates. To the best of our knowledge, no studies published since the year 2017 analyzed the adherence and persistence of thiazolidinediones independently. The most frequently cited cause for low adherence and persistence was the severity of adverse events. Baseline characteristics (e.g., baseline HbA1c level), demographic information (e.g., age, gender, or ethnicity), and comorbidity profiles also had significant impacts on adherence and persistence in patients with type 2 diabetes mellitus.

Impact of Quality Improvement (QI) Program on 5-year Risk of Diabetes-related Complications: a Simulation Study

Objective <p>We successfully implemented the ADA’s Diabetes INSIDE^® quality improvement program at a University hospital and safety-net health system (Tulane and Parkland), focused on system-wide improvement in poorly controlled type 2 diabetes (HbA1c>8.0% [64 mmol/mol]). In this study, we estimated the 5-year risk reduction in complications and mortality associated with the QI program.</p> <p>Research Design and Methods</p> <p>The QI implementation period was one year, followed by the post-intervention period of six months to evaluate the impact of QI on clinical measures. We measured the differences between the baseline and post-intervention clinical outcomes in 2,429 individuals with HbA1c >8% (64 mmol/mol) at baseline and used the Building, Relating, Assessing, Validating Outcomes (BRAVO™) of diabetes model to project the 5-year risk reduction of diabetes-related complications under the assumption that intervention benefits persist over time. An alternative assumption that intervention benefits diminish by 30% every year was also tested.</p> <p>Results</p> <p>The QI program was associated with reductions in HbA1c (-0.84%) and LDL-C (-5.94 mg/dl) among individuals with HbA1c level >8.0% (64 mmol/mol), with greater reduction in HbA1c (-1.67%) and LDL-C (-6.81 mg/dl) among those with HbA1c level > 9.5% at baseline (all p<0.05). The implementation of the Diabetes INSIDE^®QI program was associated with 5-year risk reductions in major adverse cardiovascular events (MACE, Relative Risk (RR): 0.78, 95% confidence interval (CI):0.75-0.81) and all-cause mortality (RR:0.83, 95% CI: 0.82-0.85) among individuals with baseline HbA1c level >8.0% (64 mmol/mol), and MACE (RR: 0.60, 95% CI:0.56-0.65) and all-cause mortality (RR: 0.61, 95% CI: 0.59-0.64) among individuals with baseline HbA1c level > 9.5% (80 mmol/mol). Sensitivity analysis also identified a substantially lower risk of diabetes-related complications and mortality associated with the QI program.</p> <p>Conclusions</p> <p>Our modeling results suggest that the ADA’s Diabetes INSIDE^® QI program would benefit the patients and population by substantially reducing the 5-year risk of complications and mortality in individuals with diabetes. </p>

Impact of Quality Improvement (QI) Program on 5-year Risk of Diabetes-related Complications: a Simulation Study

Objective <p>We successfully implemented the ADA’s Diabetes INSIDE^® quality improvement program at a University hospital and safety-net health system (Tulane and Parkland), focused on system-wide improvement in poorly controlled type 2 diabetes (HbA1c>8.0% [64 mmol/mol]). In this study, we estimated the 5-year risk reduction in complications and mortality associated with the QI program.</p> <p>Research Design and Methods</p> <p>The QI implementation period was one year, followed by the post-intervention period of six months to evaluate the impact of QI on clinical measures. We measured the differences between the baseline and post-intervention clinical outcomes in 2,429 individuals with HbA1c >8% (64 mmol/mol) at baseline and used the Building, Relating, Assessing, Validating Outcomes (BRAVO™) of diabetes model to project the 5-year risk reduction of diabetes-related complications under the assumption that intervention benefits persist over time. An alternative assumption that intervention benefits diminish by 30% every year was also tested.</p> <p>Results</p> <p>The QI program was associated with reductions in HbA1c (-0.84%) and LDL-C (-5.94 mg/dl) among individuals with HbA1c level >8.0% (64 mmol/mol), with greater reduction in HbA1c (-1.67%) and LDL-C (-6.81 mg/dl) among those with HbA1c level > 9.5% at baseline (all p<0.05). The implementation of the Diabetes INSIDE^®QI program was associated with 5-year risk reductions in major adverse cardiovascular events (MACE, Relative Risk (RR): 0.78, 95% confidence interval (CI):0.75-0.81) and all-cause mortality (RR:0.83, 95% CI: 0.82-0.85) among individuals with baseline HbA1c level >8.0% (64 mmol/mol), and MACE (RR: 0.60, 95% CI:0.56-0.65) and all-cause mortality (RR: 0.61, 95% CI: 0.59-0.64) among individuals with baseline HbA1c level > 9.5% (80 mmol/mol). Sensitivity analysis also identified a substantially lower risk of diabetes-related complications and mortality associated with the QI program.</p> <p>Conclusions</p> <p>Our modeling results suggest that the ADA’s Diabetes INSIDE^® QI program would benefit the patients and population by substantially reducing the 5-year risk of complications and mortality in individuals with diabetes. </p>