Differences in health outcomes associated with initial adherence to oral antidiabetes medications among veterans with uncomplicated Type 2 diabetes

a 5-year survival analysis

Research output: Contribution to journalArticle

Abstract

Aim: To determine the association of adherence to oral antidiabetes medication with macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among veterans with uncomplicated diabetes. Methods: This was a retrospective cohort study using the Veterans Affairs Corporate Data Warehouse to examine 159 032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and starting oral antidiabetes therapy for the first time. The first uncomplicated diabetes diagnosis was identified and confirmed by subsequent oral antidiabetes therapy initiation. Adherence was calculated from outpatient pharmacy records using the proportion of days covered over the first year of therapy. Health outcomes were observed up to 5 years beyond the first oral antidiabetes agent fill, and compared according to adherence status using Cox proportional hazards models adjusted for baseline demographic and clinical characteristics. Results: During the first 5 years of oral antidiabetes treatment, people initially non-adherent to oral antidiabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95% CI 1.03–1.27) and ischaemic stroke (hazard ratio 1.22, 95% CI 1.05–0.1.42), or to die (hazard ratio 1.21; 95% CI 1.15–1.28). Veterans with <20% adherence to oral antidiabetes therapy in the first year had particularly high hazards for ischaemic stroke (hazard ratio 1.78, 95% CI 1.27–2.49) and all-cause death (hazard ratio 1.33, 95% CI 1.17–151). Adherent people were more likely to be diagnosed with a microvascular complication or chronic kidney disease. Conclusions: People who are non-adherent to treatment were more likely to experience detrimental health outcomes within the first 5 years of antidiabetes therapy. Adherence is paramount to disease management and this should be stressed from the time at which treatment is initiated.

Original languageEnglish (US)
Pages (from-to)1571-1579
Number of pages9
JournalDiabetic Medicine
Volume35
Issue number11
DOIs
StatePublished - Nov 1 2018

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Veterans
Survival Analysis
Type 2 Diabetes Mellitus
Health
Therapeutics
Stroke
Disease Management
Chronic Renal Insufficiency
Proportional Hazards Models
Cause of Death
Cohort Studies
Outpatients
Retrospective Studies
Myocardial Infarction
Demography
Insulin

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{7988d81c6a3b4b31ab00a2615f3a8bd1,
title = "Differences in health outcomes associated with initial adherence to oral antidiabetes medications among veterans with uncomplicated Type 2 diabetes: a 5-year survival analysis",
abstract = "Aim: To determine the association of adherence to oral antidiabetes medication with macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among veterans with uncomplicated diabetes. Methods: This was a retrospective cohort study using the Veterans Affairs Corporate Data Warehouse to examine 159 032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and starting oral antidiabetes therapy for the first time. The first uncomplicated diabetes diagnosis was identified and confirmed by subsequent oral antidiabetes therapy initiation. Adherence was calculated from outpatient pharmacy records using the proportion of days covered over the first year of therapy. Health outcomes were observed up to 5 years beyond the first oral antidiabetes agent fill, and compared according to adherence status using Cox proportional hazards models adjusted for baseline demographic and clinical characteristics. Results: During the first 5 years of oral antidiabetes treatment, people initially non-adherent to oral antidiabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95{\%} CI 1.03–1.27) and ischaemic stroke (hazard ratio 1.22, 95{\%} CI 1.05–0.1.42), or to die (hazard ratio 1.21; 95{\%} CI 1.15–1.28). Veterans with <20{\%} adherence to oral antidiabetes therapy in the first year had particularly high hazards for ischaemic stroke (hazard ratio 1.78, 95{\%} CI 1.27–2.49) and all-cause death (hazard ratio 1.33, 95{\%} CI 1.17–151). Adherent people were more likely to be diagnosed with a microvascular complication or chronic kidney disease. Conclusions: People who are non-adherent to treatment were more likely to experience detrimental health outcomes within the first 5 years of antidiabetes therapy. Adherence is paramount to disease management and this should be stressed from the time at which treatment is initiated.",
author = "Justin Gatwood and Marie Chisholm-Burns and Robert Davis and Fridtjof Thomas and P. Potukuchi and A. Hung and Csaba Kovesdy",
year = "2018",
month = "11",
day = "1",
doi = "10.1111/dme.13775",
language = "English (US)",
volume = "35",
pages = "1571--1579",
journal = "Diabetic Medicine",
issn = "0742-3071",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Differences in health outcomes associated with initial adherence to oral antidiabetes medications among veterans with uncomplicated Type 2 diabetes

T2 - a 5-year survival analysis

AU - Gatwood, Justin

AU - Chisholm-Burns, Marie

AU - Davis, Robert

AU - Thomas, Fridtjof

AU - Potukuchi, P.

AU - Hung, A.

AU - Kovesdy, Csaba

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Aim: To determine the association of adherence to oral antidiabetes medication with macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among veterans with uncomplicated diabetes. Methods: This was a retrospective cohort study using the Veterans Affairs Corporate Data Warehouse to examine 159 032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and starting oral antidiabetes therapy for the first time. The first uncomplicated diabetes diagnosis was identified and confirmed by subsequent oral antidiabetes therapy initiation. Adherence was calculated from outpatient pharmacy records using the proportion of days covered over the first year of therapy. Health outcomes were observed up to 5 years beyond the first oral antidiabetes agent fill, and compared according to adherence status using Cox proportional hazards models adjusted for baseline demographic and clinical characteristics. Results: During the first 5 years of oral antidiabetes treatment, people initially non-adherent to oral antidiabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95% CI 1.03–1.27) and ischaemic stroke (hazard ratio 1.22, 95% CI 1.05–0.1.42), or to die (hazard ratio 1.21; 95% CI 1.15–1.28). Veterans with <20% adherence to oral antidiabetes therapy in the first year had particularly high hazards for ischaemic stroke (hazard ratio 1.78, 95% CI 1.27–2.49) and all-cause death (hazard ratio 1.33, 95% CI 1.17–151). Adherent people were more likely to be diagnosed with a microvascular complication or chronic kidney disease. Conclusions: People who are non-adherent to treatment were more likely to experience detrimental health outcomes within the first 5 years of antidiabetes therapy. Adherence is paramount to disease management and this should be stressed from the time at which treatment is initiated.

AB - Aim: To determine the association of adherence to oral antidiabetes medication with macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among veterans with uncomplicated diabetes. Methods: This was a retrospective cohort study using the Veterans Affairs Corporate Data Warehouse to examine 159 032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and starting oral antidiabetes therapy for the first time. The first uncomplicated diabetes diagnosis was identified and confirmed by subsequent oral antidiabetes therapy initiation. Adherence was calculated from outpatient pharmacy records using the proportion of days covered over the first year of therapy. Health outcomes were observed up to 5 years beyond the first oral antidiabetes agent fill, and compared according to adherence status using Cox proportional hazards models adjusted for baseline demographic and clinical characteristics. Results: During the first 5 years of oral antidiabetes treatment, people initially non-adherent to oral antidiabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95% CI 1.03–1.27) and ischaemic stroke (hazard ratio 1.22, 95% CI 1.05–0.1.42), or to die (hazard ratio 1.21; 95% CI 1.15–1.28). Veterans with <20% adherence to oral antidiabetes therapy in the first year had particularly high hazards for ischaemic stroke (hazard ratio 1.78, 95% CI 1.27–2.49) and all-cause death (hazard ratio 1.33, 95% CI 1.17–151). Adherent people were more likely to be diagnosed with a microvascular complication or chronic kidney disease. Conclusions: People who are non-adherent to treatment were more likely to experience detrimental health outcomes within the first 5 years of antidiabetes therapy. Adherence is paramount to disease management and this should be stressed from the time at which treatment is initiated.

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U2 - 10.1111/dme.13775

DO - 10.1111/dme.13775

M3 - Article

VL - 35

SP - 1571

EP - 1579

JO - Diabetic Medicine

JF - Diabetic Medicine

SN - 0742-3071

IS - 11

ER -