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Biochemical Urine Testing of Medication Adherence and Its Association With Clinical Markers in an Outpatient Population of Type 2 Diabetes Patients: Analysis in the DIAbetes and LifEstyle Cohort Twente (DIALECT)

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posted on 02.06.2021, 11:40 by Jelle M Beernink, Milou M Oosterwijk, Kamlesh Khunti, Pankaj Gupta, Prashanth Patel, Job FM van Boven, Hiddo J Lambers Heerspink, Stephan JL Bakker, Gerjan Navis, Roos M Nijboer, Gozewijn D Laverman
OBJECTIVE To assess adherence to the three main drug classes in real-world patients with type 2 diabetes using biochemical urine testing, and to determine the association of nonadherence with baseline demographics, treatment targets, and complications.

RESEARCH DESIGN AND METHODS Analyses were performed of baseline data on 457 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Adherence to oral antidiabetics (OADs), antihypertensives, and statins was determined by analyzing baseline urine samples using liquid chromatography–tandem mass spectrometry. Primary outcomes were microvascular and macrovascular complications and treatment targets of LDL cholesterol, HbA1c, and blood pressure. These were assessed cross-sectionally at baseline.

RESULTS Overall, 89.3% of patients were identified as adherent. Adherence rates to OADs, antihypertensives, and statins were 95.7, 92.0, and 95.5%, respectively. The prevalence of microvascular (81.6 vs. 66.2%; P = 0.029) and macrovascular complications (55.1 vs. 37.0%; P = 0.014) was significantly higher in nonadherent patients. The percentage of patients who reached an LDL cholesterol target of ≤2.5 mmol/L was lower (67.4 vs. 81.1%; P = 0.029) in nonadherent patients. Binary logistic regression indicated that higher BMI, current smoking, elevated serum LDL cholesterol, high HbA1c, presence of diabetic kidney disease, and presence of macrovascular disease were associated with nonadherence.

CONCLUSIONS Although medication adherence of real-world type 2 diabetes patients managed in specialist care was relatively high, the prevalence of microvascular and macrovascular complications was significantly higher in nonadherent patients, and treatment targets were reached less frequently. This emphasizes the importance of objective detection and tailored interventions to improve adherence.

History

Citation

Diabetes Care 2021 Apr; dc202533. https://doi.org/10.2337/dc20-2533

Author affiliation

Diabetes Research Centre, College of Life Sciences

Version

AM (Accepted Manuscript)

Published in

Diabetes Care

Volume

44

Issue

5

Pagination

dc202533

Publisher

American Diabetes Association

issn

0149-5992

eissn

1935-5548

Acceptance date

05/02/2021

Copyright date

2021

Spatial coverage

United States

Language

eng

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