Persistence and adherence to oral antidiabetics: a population-based cohort study

Area of Science:

• Pharmacoeconomics and Health Outcomes Research
• Diabetes Mellitus Management
• Real-World Evidence in Therapeutics

Background:

• Oral antidiabetic (OAD) medications are widely prescribed for type 2 diabetes.
• Understanding patient persistence and adherence is crucial for effective diabetes management and healthcare resource utilization.

Purpose of the Study:

• To estimate persistence, re-initiation, and adherence rates among new oral antidiabetic users.
• To identify predictors of non-persistence and non-adherence to OAD therapy.

Main Methods:

• A population-based cohort study of 160,231 incident OAD users in Quebec, Canada (2000-2009).
• Analysis of persistence, re-initiation, and adherence over two years using healthcare databases.
• Cox and logistic regression models were used to identify predictors of non-persistence and non-adherence.

Main Results:

• One-year persistence was 51% and adherence was 67%.
• 80.6% of non-persistent users re-initiated OADs within 12 months.
• Persistence varied by OAD class (highest for thiazolidinediones, lowest for alpha-glucosidase inhibitors).
• Drug copayments increased non-persistence (39-54% higher likelihood).
• Comorbidities like schizophrenia, dyslipidemia, and hypertension were associated with lower discontinuation risk.

Conclusions:

• Non-persistence and non-adherence to OADs are prevalent but often followed by re-initiation.
• OAD class, copayments, comorbidities, and co-medications are key factors influencing persistence and adherence.
• Identifying at-risk patients can guide targeted counseling to improve therapeutic outcomes.