title: The impact of treatment non-compliance on mortality in people with type 1 diabetes.
abstract: OBJECTIVE
  To determine if a diagnostic record of poor treatment compliance (medication non-compliance and/or non-attendance at medical appointments) was associated with all-cause mortality in people with type 1 diabetes.
  
  
  METHODS
  This is an observational cohort study of data extracted from The Health Improvement Network (THIN) database, comprising data on patients served by over 350 primary care practices in the U.K. Participants were included in the study if they had diagnostic codes indicative of type 1 diabetes. Treatment non-compliance was defined as missing one or more scheduled appointment, or one or more codes indicating medication non-compliance.
  
  
  RESULTS
  Of 2946 patients with type 1 diabetes, 867 (29.4%) had a record of either appointment non-attendance or medication non-compliance in the 30 month compliance assessment period. The crude, unadjusted mortality rate for those patients who were treatment non-compliant was 1.462 (95% CI 0.954-2.205). Following adjustment for confounding factors, treatment non-compliance was associated with increased all-cause mortality (HR=1.642; 95% CI 1.055-2.554).
  
  
  CONCLUSIONS
  Treatment non-compliance was associated with increased all-cause mortality in patients with type 1 diabetes. Understanding and addressing factors that contribute to patient treatment non-compliance will be important in improving the life expectancy of patients with type 1 diabetes.
authors.affiliation: Department of Medicine, School of Medicine, Cardiff University, Cardiff, UK. currie@cardiff.ac.uk
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Currie
authors.forename: Mark
authors.initials: M
authors.lastname: Peyrot
authors.forename: Christopher Ll
authors.initials: CL
authors.lastname: Morgan
authors.forename: Chris D
authors.initials: CD
authors.lastname: Poole
authors.forename: Sara
authors.initials: S
authors.lastname: Jenkins-Jones
authors.forename: Richard R
authors.initials: RR
authors.lastname: Rubin
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Burton
authors.forename: Marc
authors.initials: M
authors.lastname: Evans
mesh_terms: D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009026:Mortality; D010349:Patient Compliance; D011320:Primary Health Care; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents