title: Oral antidiabetic medication adherence and glycemic control in managed care.
abstract: OBJECTIVE
  To evaluate adherence to oral diabetes medications (ODMs) in patients with type 2 diabetes and the impact of ODM adherence on glycemic control.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Medical and pharmacy claims from a managed care plan in Oregon were used to identify adults with diabetes who newly initiated ODM therapy (n = 2741); a subset of this cohort linked to electronic health records was used to evaluate the relationship between adherence and glycemic control (n = 249). Glycemic control was assessed based on most recent glycosylated hemoglobin (A1C) measurement within the study period.
  
  
  RESULTS
  Mean cohort age was 54 years; 46% initiated therapy with metformin, 39% with a sulfonylurea, and 12% with a thiazolidinedione. Mean adherence overall was 81%, and 65% of subjects had good adherence (>80%). Increasing age and comorbidity burden were associated with higher medication adherence. In the patient subset with A1C measurements, mean baseline A1C was 8%. An inverse relationship existed between ODM adherence and A1C; controlling for baseline A1C and therapy regimen, each 10% increase in ODM adherence was associated with a 0.1% A1C decrease (P = .0004).
  
  
  CONCLUSIONS
  Although most patients were adherent to ODM therapy, adherent patients were more likely to achieve glycemic control than nonadherent patients. Greater efforts are needed to facilitate diabetes self-management behaviors to improve patient outcomes.
authors.affiliation: Providence Physician Division, 3601 Murray Blvd, Ste 45, Beaverton, OR 97005, USA. yelena.rozenfeld@providence.org
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rozenfeld
authors.forename: Jacquelyn S
authors.initials: JS
authors.lastname: Hunt
authors.forename: Craig
authors.initials: C
authors.lastname: Plauschinat
authors.forename: Ken S
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000284:Administration, Oral; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007345:Insurance Claim Review; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D009922:Oregon; D010349:Patient Compliance; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; C089946:2,4-thiazolidinedione