Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65,067 newly diagnosed type 2 diabetes patients

Abstract

This study determined the effects of anti-diabetic medication adherence on the long-term all-cause mortality and hospitalization for cerebrovascular disease and myocardial infarction among newly diagnosed patients. The study used retrospective cohort from the National Health Insurance Service. Study participants were 65,076 newly diagnosed type 2 diabetes mellitus patients aged ≥40 years. The medication adherence was evaluated from the proportion of days covered (PDC) between 2006 and 2007. Outcome variables were mortality, newly diagnosed cerebrovascular disease (CVD) and myocardial infarction (MI) in 2008–2017. Cox-proportional hazard regression analysis was performed. After adjusting for sex, age, monthly contribution, insurance type, medical institution type, Charlson comorbidity index score, disability, hypertension, and active ingredients of oral hypoglycemic agents, the adjusted hazard ratio (aHR) for all-cause-mortality of the lowest PDC group (<0.20) was 1.45 (95% confidence interval [CI] = 1.36–1.54) as compared to the highest PDC (≥0.8). The aHR for all-cause-mortality associated with PDC levels of 0.60–0.79, 0.40–0.59, and 0.20–0.39 were 1.19, 1.26, and 1.34, respectively (Ptrend < 0.001). Compared to the highest PDC group, diabetic patients with the lowest PDC had elevated risk for CVD (aHR = 1.41; 95% CI = 1.30–1.52; Ptrend < 0.001). Improving anti-diabetic medication adherence among newly diagnosed type 2 diabetes mellitus patients is essential to the reduce risk for cardiovascular disease and long-term all-cause mortality.

Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia

“…In another health care database study from Sweden, lower refill adherence to lipid‐lowering medications resulted in higher CVD mortality among patients with type 2 DM 28 . Similarly, in newly diagnosed type 2 DM patients, lower anti‐diabetic medication adherence has been associated with higher long‐term all‐cause mortality 29 . In the current study, the difference in mortality was insignificant between the FDC and FEC groups may be explained by the low event rates in both groups, which could be attributed to the limited sample size, limited 4‐year follow‐up period, and the primary preventive nature of the intervention.…”

Affordability of Medication Therapy in Diabetic Patients: A Scenario-Based Assessment in Iran’s Health System Context

“…40 Cost-related medications non-adherence is associated with higher rate of all-cause mortality and cardiovascular complications among newly diagnosed type 2 diabetes mellitus patients. 41 Although more adherent patients incur higher pharmacy costs, these are generally offset by savings in other areas such as costs of hospital admissions and physicians' visits. 42 Thus, the patients have to use NPH, as the basal insulin component.…”

Who suffers from pharmaceutical poverty and what are their needs? Evidence from a Spanish region.

“…The failure to effectively use prescription medicines can lead to worse health status and higher costs to the healthcare system [5]. Non-adherence worsens health outcomes and increases the risk of mortality and hospitalization [6,7]. Greater use of medical services and productivity losses are also consequences of from medication non-adherence, which places a signi cant cost burden on healthcare systems [8,9].…”