Medication Regimen Complexity and Medication Burden Among Patients With Type 2 Diabetes Mellitus: A Retrospective Analysis

Abstract

Introduction: Most type 2 diabetes mellitus (T2DM) patients with chronic conditions require multiple medications to achieve and maintain good glycemic control.Objective: This study assessed medication burden, regimen complexity, and adherence among T2DM patients and evaluate its association with glycemic control.Method: We analyzed data of 2,696 T2DM patients at public health clinics in Malaysia from January 2018 until May 2019. Medication burden was based on medication count, regimen complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and adherence was measured using proportion of days covered (PDC) formula. Logistic regression models were used to compute unadjusted and adjusted odds ratio (aOR) with 95% confidence interval (CI) for association between the medication parameters and glycemic control (HbA1c ≤ 7.0%) over a 90-day period.Results: The cohort mean age was 60.4 years old (±10.8) and 62.9% were female. Overall, the average medication count was 4.8 with MRCI score of 15.1. Mean adherence score (PDC) was 90%. High medication count and MRCI scores were associated with lower odds of achieving good glycemic control (aOR 0.88; 95% CI 0.82, 0.94 and aOR 0.89; 95% CI 0.87, 0.92, respectively) while inverse association was observed between adherence and HbA1c level (aOR 2.7, 95% CI 1.66, 5.19). Similar findings were observed for diabetes-specific measures.Conclusions: High medication count, high regimen complexity, and low medication adherence were associated with poor glycemic control over the 3-month follow-up period. These parameters could be used to identify patients with complex pharmacotherapy regimens so that targets for intervention can be taken to achieve optimum outcomes and ease of self-care.

Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia

“…Further, the current study also disclosed that patients with a lower number of medications and medical conditions were found less likely to be low adherent to their medications compared with patients with a higher number of medications and medical conditions. This finding is consistent with previous studies [ 30 , 31 , 36 , 37 ], which higher number of medications and medical conditions resulted in low medication adherence because of medication regimen complexity, medication adverse effects, the inability of patients to afford multiple medications. A higher number of medications may also contribute to the loss of the time of administration of medications.…”

“…In Ethiopia, a significant proportion of patients with T2DM have comorbid conditions like hypertension, dyslipidemia and macrovascular and microvascular complications [ 29 ]. However, medication adherence can be influenced by the medication regimen complexity and the polypharmacy [ 30 , 31 , 37 ] used to treat these comorbidities. Poor glycemic control because of poor medication adherence can increase the risk of negative consequences and medical costs with significant impactful problems to the sustainability of the healthcare system [ 3 , 17 , 22 – 24 ].…”

Evaluating the Medication Regimen Complexity Score as a Predictor of Clinical Outcomes in the Critically Ill

“…MRC scoring tools have the potential to aid in the identification of which patients may benefit from subsequent interventions (i.e., comprehensive medication review) [ 23 , 24 ]. In the critical care setting, the tool can further support the need for clinical pharmaceutical expertise and workload assignment to address the complex pharmacotherapeutic needs of the patient.…”

“…Yet, the most commonly utilized and validated objective scoring tool is the 65-item, weighted MRC Index (MRCI), which has been developed for outpatient use only [ 14 , 15 , 16 , 17 , 18 ]. The MRCI has been used to evaluate conditions such as neurological impairment in children and hypertension, diabetes, chronic obstructive pulmonary disease, and chronic kidney disease in adults [ 19 , 20 , 21 , 22 , 23 , 24 ]. The MRC for the intensive care unit (ICU) scoring tool has been developed and intended for use in critically ill patients [ 25 , 26 ].…”

Medication-related burden among patients with diabetes mellitus and its relation to diabetic control parameters: an observational study

“…The prevalence of many comorbidities and diabetic complications increase the number and burden of medication use. 12 Extra medication and much more complicated prescription programs have been associated with poorer patient outcomes, notably higher patient non-adherence. 13,14 Increased medication complexity or burden has also been associated with higher HbA1c, healthcare costs, and death rates among elderly individuals.…”