A Multistate Model and an Algorithm for Measuring Long-Term Adherence to Medication: A Case of Diabetes Mellitus Type 2

Jensen, Majken Linnemann; Jørgensen, Marit Eika; Hansen, Ebba Holme; Aagaard, Lise; Carstensen, Bendix

doi:10.1016/j.jval.2013.11.014

Cited by 12 publications

(10 citation statements)

References 36 publications

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“…Besides, poor adherence to medication is common in patients with type 2 diabetes, and a large proportion never initiate glucose-lowering treatment. These patients are not captured in the register [26], but we have no reasons to believe that there may be a systematic bias according to baseline diabetes risk in the register. Hence, although the absolute incidence rates found in our study may underestimate the true incidence, the incidence rate ratios should be representative of the population in screened general practice.…”

Section: Discussionmentioning

confidence: 99%

Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study

et al. 2016

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Aims/hypothesis Screening programmes for type 2 diabetes inevitably find more people at high risk of developing diabetes than people with undiagnosed prevalent diabetes. We describe the incidence of diabetes for risk groups according to advancement in a screening process. Methods In 2001-2006, a diabetes screening programme based on the Danish diabetes risk score and measures of HbA 1c and glucose was carried out in Danish general practices. The present study includes 13,249 individuals with low diabetes risk scores and 22,726 with high diabetes risk scores but no diabetes according to WHO 1999 criteria. Seven incremental levels of diabetes risk were defined and followed for incident diabetes recorded in the Danish National Diabetes Register until December 2012. For each group, cumulative diabetes incidence was calculated. Incidence rates and rate ratios were estimated by Poisson regression analyses. Results After 10 years of follow-up 1,164 new diabetes cases were registered. Incidence rates were 1.0, 4.2, 14.5, 28.8 and 52.6 per 1,000 person-years in individuals at low risk and in those with normal glucose tolerance, impaired fasting glucose, impaired glucose tolerance and one diabetic glucose value, respectively. For each step in the screening algorithm, the risk of developing diabetes was higher than in the previous step. Conclusions/interpretation The risk of developing clinical diabetes in people who screen negative for diabetes depends on the level of risk stratification at screening, even at lower risk levels. This risk increases markedly in the presence of impaired glucose regulation. These results can inform policy recommendations concerning prevention strategies following screening.

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Section: Discussionmentioning

confidence: 99%

Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study

et al. 2016

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“…If a supply gap exceeds 50 days, then we assume that ( C ) treatment has been discontinued by the patient and he or she is no longer persistent. Details on definition of these outcomes are described by Jensen et al[18] based on a multistate model.…”

Section: Methodsmentioning

confidence: 99%

“…Implementation was calculated as the proportion of days with sufficient supply while being persistent[18]. It is inherent in the algorithm that the size of the implementation degree depends on both the maximum acceptable length of a supply gap and the prescribed amount of medicine, which at Steno is typically 3 months at a time.…”

Section: Methodsmentioning

confidence: 99%

“…Our aim was to estimate rates of initiation of medication therapy, the pattern of recurrent gaps in supply of medication as a measure of implementation, and early discontinuation of therapy for frequently used medicines among Danish patients with T2DM using a new method and algorithm[18] for calculation of adherence to medication. Furthermore, we aimed to investigate how condition-, therapy-, and patient-related factors are associated with the three different phases of adherence to medication: initiation, implementation and discontinuation among this group of T2DM patients.…”

Section: Introductionmentioning

confidence: 99%

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Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation

et al. 2017

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AimsPoor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study.MethodsAdherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998–2009. Rate-ratios of initiation of treatment, recurrent gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression.ResultsPoor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment for all six medicine groups (rate ratio ranging 0.79 95%CI [0.72–0.87] to 0.89 95%CI [0.82–0.96] per already prescribed medicine), but once patients were in treatment, polypharmacy was not associated with recurrence of gaps in supply of medication, and polypharmacy was associated with lower risk of discontinuation (rate ratio ranging 0.93 95%CI [0.86–1.00] to 0.96 95%CI [0.93–0.99] per prescribed medicine). Other identified risk factors for slow initiation, poor implementation, and discontinuation were diabetes duration, younger age, and Turkish/Pakistani origin.DiscussionThis study showed that a risk factor does not necessarily have the same association with all three elements of adherence (initiation, implementation and discontinuation), and that efforts supporting patients introduced to more complex drug combinations should be prioritized.

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“…Pharmacy tracking studies indicate that within 6 months to 1 year after having been prescribed cholesterol-lowering statins, up to 50% of patients discontinue them [21] , [22] , [23] , [24] ; after two years, non-adherence is as high as 75% [25] , [26] . Among a population of type 2 patients, from the same clinic as the present study population was drawn from, one in five participants was non-adherent [27] . Thus, suboptimal diabetes management is a likely pathway through which high SOC mediates low LDL-C.…”

Section: Discussionmentioning

confidence: 99%

Sense of Coherence is associated with LDL-cholesterol in patients with type 1 diabetes – The PROLONG-Steno study

Olesen

Jensen

Díaz

et al. 2017

Journal of Clinical & Translational Endocrinology

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A Multistate Model and an Algorithm for Measuring Long-Term Adherence to Medication: A Case of Diabetes Mellitus Type 2

Cited by 12 publications

References 36 publications

Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study

Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study

Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation

Sense of Coherence is associated with LDL-cholesterol in patients with type 1 diabetes – The PROLONG-Steno study

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