Impact of Medication Adherence and Glycemic Control on the Risk of Micro/Macrovascular Diseases in Patients with Diabetes.
PURPOSE: To clarify the impact of medication adherence to oral hypoglycemic agents (OHAs) during a one-year period and subsequent glycemic control on the risk of micro/macrovascular diseases.
METHODS: Examined was a nationwide claims database on 13,256 individuals without prior-treatment-requiring diabetic eye disease, 7,862 without prior initiation of dialysis, 15,556 without prior coronary artery disease, 16,243 without prior cerebrovascular disease, and 19,386 without prior heart failure from 2008-2016 in Japan. Medication adherence was evaluated by the proportion of days covered. Patients were considered to have poor adherence if the proportion of days covered was <80%. Multivariate Cox regression model identified risks of micro/macrovascular diseases.
RESULTS: In each group, mean age was 53 to 54 years, HbA1c was 7.1 to 7.2%, and median follow-up period was 4.6 to 5.1 years, and the percentage of poor adherence was approximately 30%. During the study period, 532 treatment-requiring diabetic eye disease, 75 dialysis, 389 coronary artery disease, 316 cerebrovascular disease, and 144 heart failure events occurred. Multivariate Cox regression model revealed that the hazard ratio (95% CI) of dialysis in the poor adherence group was 2.04(1.27-3.30) compared with the good adherence group. The hazard ratios in the poor adherence/poor glycemic control group were 3.34(2.63-4.24) for treatment-requiring diabetic eye disease, 4.23(2.17-8.26) for dialysis, 1.69(1.23-2.31) for coronary artery disease and 2.08(1.25-3.48) for heart failure, compared with the good adherence/good glycemic control group.
CONCLUSIONS: Poor medication adherence was an independent risk factor for the initiation of dialysis, suggesting that clinicians must pay close attention to these patients.
|ジャーナル名||The American journal of medicine|
|投稿者||Yaguchi, Yuta; Fujihara, Kazuya; Yamada, Mayuko Harada; Matsubayashi, Yasuhiro; Yamada, Takaho; Iwanaga, Midori; Kitazawa, Masaru; Yamamoto, Masahiko; Seida, Hiroyasu; Kodama, Satoru; Sone, Hirohito|
|組織名||Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata,;Japan.;Japan. Electronic address: email@example.com.;Japan Medical Data Center Co., Ltd., Tokyo, Japan.|