Lack of Treatment Persistence and Treatment Nonadherence as Barriers to Glycaemic Control in Patients with Type 2 Diabetes

Abstract

Treatment persistence (continuing to take medication for the prescribed period) and treatment adherence (complying with the prescription in terms of drug schedules and dosage) are both important when treating chronic diseases such as type 2 diabetes (T2D). They can be indicators of patient satisfaction with treatment. In T2D, the achievement of optimal outcomes requires both persistence with and adherence to prescribed therapy. Poor persistence with and adherence to T2D medication can have profound consequences for the patient, including non-achievement of glycaemic goals and an increased risk of long-term complications and mortality. Therefore, poor treatment persistence and adherence may also have economic consequences, including increased healthcare resource utilization and healthcare costs. Treatment persistence and adherence are affected by several factors, including the mode of administration, administration frequency/regimen complexity, and patient expectations. The aims of this review are as follows: to provide an overview of persistence with and adherence to different antidiabetes therapies for patients with T2D in the real-world setting; examine factors contributing to poor treatment persistence and adherence; and assess available data on the impact of poor treatment persistence and/or adherence on clinical and economic outcomes. Numerous potential targets for improving treatment persistence and/or adherence are identified, including developing less complex treatment regimens with lower pill burdens or less frequent injections, improving the convenience of drug-delivery systems, such as the use of insulin pen devices rather than the conventional vial and syringe, and developing therapies with an improved safety profile to alleviate patient fears of adverse effects, such as weight gain and risk of hypoglycaemia. Funding : Sanofi.

Comparison of persistence and adherence between DPP-4 inhibitor administration frequencies in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study

“…CURRENT MEDICAL RESEARCH AND OPINION in chronic conditions, such as T2DM, where extended treatment is required to prevent complications and mortality 11 . It has been reported that only 58% of patients take oral antidiabetic medication for more than 80% of their days 'on therapy' in the year average 31 .…”

“…Moreover, the reported inverse association between medication adherence and poor glycemic control has suggested that patients less than 50% compliant with their medication are almost three times more likely to have poor glycemic control than patients who are adherent to their medication more than 80% of the time 32 . Barriers to treatment adherence and persistence in patients with T2DM may include dosing frequency, patient expectations, and inadequate follow-up or support 1,11,20 . The number of medications and the complexity of the regimen may also affect adherence to treatment 11,20,33 .…”

“…Barriers to treatment adherence and persistence in patients with T2DM may include dosing frequency, patient expectations, and inadequate follow-up or support 1,11,20 . The number of medications and the complexity of the regimen may also affect adherence to treatment 11,20,33 . For example, fixeddose combinations are associated with greater persistence and adherence than two-pill combinations 34 .…”

“…Treatment adherence (also referred to as medication compliance in terms of drug schedule and dosage) and treatment persistence (i.e. continuing to take medication for the prescribed duration) to antidiabetes therapy are both critical for the achievement of optimal outcomes in patients with diabetes 11 . Measures of adherence and persistence are both recognized by the ISPOR (International Society for Pharmacoeconomics and Outcomes Research) Medication Compliance and Persistence Work Group 12,13 .…”

“…Moreover, assessing both persistence and adherence provides a richer understanding of medication-taking behavior, and thus both were assessed in our study. Of note, treatment persistence and adherence are affected by several factors, including the mode of administration, administration frequency, and patient expectations 11 . Data regarding the effect of administration frequency (once daily, twice daily, or once weekly) of antidiabetic drugs within the DPP-4i class, on persistence and adherence, are limited in Japan, and would help physicians to make more informed treatment decisions in clinical practice.…”