Biochemical Urine Testing of Adherence to Cardiovascular Medications Reveals High Rates of Nonadherence in People Attending Their Annual Review for Type 2 Diabetes

Abstract

OBJECTIVE Liquid chromatography—tandem mass spectrometry (LC-MS/MS) is a new method to objectively and robustly detect nonadherence. We applied this technique to study nonadherence to cardiovascular medications in people with type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS Routine urine samples, received at the time of the annual diabetes review from 228 people with T2DM in primary care, were assessed for adherence by LC-MS/MS. RESULTS A total of 28.1% patients (N = 64) were nonadherent to antidiabetic, antihypertensive, and/or lipid-lowering medications. Nonadherence to statins was the highest at 23.7%, and nonadherence to oral hypoglycemic agents was 9.3%. HbA1c, albumin-to-creatinine ratio, and lipid profiles were significantly higher in the patients who were nonadherent compared with those who were adherent to treatment. CONCLUSIONS This unique study shows that routine urine samples can be used for adherence testing screening by LC-MS/MS and has demonstrated high nonadherence rates especially to statins in people with T2DM. Future intervention studies using LC-MS/MS as a diagnostic/therapeutic tool may help to improve clinical outcomes.

Effectiveness of the Ready to Reduce Risk (3R) complex intervention for the primary prevention of cardiovascular disease: a pragmatic randomised controlled trial

“…The design also incorporated a novel, objective biochemical measure of adherence to statins in response to the need for more robust measures. This measure can detect sixty of the most common cardiovascular medications in a spot urine sample and has been shown to be a reliable and practical tool for detecting non-adherence [12,19] which can be used in conjunction with other measures to assess and improve adherence.…”

“…These samples were then sent to a central laboratory where they were analysed by the developers of the biochemical assay measure, which was used to test for the presence of atorvastatin (first choice recommendation for CVD primary prevention [ 3 ]), rosuvastatin (a second choice alternative) and common anti-hypertensives. Details of this urine test have been described previously [ 12 , 19 ].…”

“…Estimated rates of adherence to cardiovascular medication range from 50 to 60% [10,11]. In particular, rates of non-adherence to statins, when compared to other CVD preventative medications, are much higher [12], and poor adherence to statins (amongst primary prevention patients) is associated with an increased risk of CVD events or death [13]. Medication adherence is a complex phenomenon that involves patient, clinician and health system factors [14].…”

“…Following the development of the intervention, we conducted a pragmatic randomised controlled trial in primary care patients already taking statins for the primary prevention of CVD. The primary objective was to evaluate, using an objective biochemical adherence test [12,19], the impact of the 3R intervention on adherence to statins at 12 months follow-up, when compared to the 'usual care' control.…”

Hyphenated mass spectrometry techniques for assessing medication adherence: advantages, challenges, clinical applications and future perspectives

“…Surprisingly very few reports have addressed the assessment of adherence to oral hypoglycaemic drugs in the management of type 2 diabetes via direct MS-based bioanalytical assays. A very recent study [100] used an LC-MS/MS (qqq)-based urine assay and found that 28.1% of patients were nonadherent to antidiabetic, antihypertensive and/or lipid lowering medications. It is postulated that the paucity of data related to monitoring adherence to hypoglycaemic drugs may be because blood glucose levels are also routinely monitored by diabetic patients using simple fingerprick tests [1].…”