title: Understanding disparities in lipid management among patients with type 2 diabetes: gender differences in medication nonadherence after treatment intensification.
abstract: BACKGROUND
  Gender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid-lowering medication regimen, and medication adherence can explain this disparity.
  
  
  METHODS
  Secondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n = 1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was low-density lipoprotein (LDL) cholesterol.
  
  
  RESULTS
  Women had higher LDL cholesterol levels than men (mean [SD], 101.2 [35.2] vs. 92.3 [33.0] mg/dL; p < .001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence related to cost (32.7% vs. 24.2%; p = .040) and related to side effects (47.2% vs. 36.8%; p = .024). For all patients, regimen intensity (p < .05) and nonadherence related to side effects (p < .01) were each associated with higher LDL cholesterol levels. The addition of a new lipid-lowering agent was associated with subsequent nonadherence related to side effects for women (p < .001), but not for men (p = .45; test for interaction p = .048).
  
  
  CONCLUSIONS
  Despite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence seemed to be a major contributor to dyslipidemia, particularly for women because of side effects associated with intensifying the lipid-lowering regimen.
authors.affiliation: Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California. Electronic address: jbillime@uci.edu.
authors.forename: John
authors.initials: J
authors.lastname: Billimek
authors.affiliation: Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, California.
authors.forename: Shaista
authors.initials: S
authors.lastname: Malik
authors.affiliation: Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
authors.forename: Dara H
authors.initials: DH
authors.lastname: Sorkin
authors.affiliation: School of Social Ecology, University of California, Irvine, California; School of Medicine, University of California, Irvine, California.
authors.forename: Priel
authors.initials: P
authors.lastname: Schmalbach
authors.affiliation: Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
authors.forename: Quyen
authors.initials: Q
authors.lastname: Ngo-Metzger
authors.affiliation: Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.affiliation: Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001786:Blood Glucose; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000208:ethnology; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D011787:Quality of Health Care; D012727:Sex Characteristics; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000924:Anticholesteremic Agents; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors