title: Impact of cancer on adherence to glucose-lowering drug treatment in individuals with diabetes.
abstract: OBJECTIVE
  Adherence to glucose-lowering drug (GLD) treatment regimens is crucial for metabolic control and improving prognosis. Because a diagnosis of cancer might have an impact on adherence to medication, this study explored changes in adherence to GLDs following a cancer diagnosis.
  
  
  METHODS
  All new users of GLDs between 1998 and 2011 who lived in the Eindhoven Cancer Registry-PHARMO Database Network catchment area were selected. Those with a primary cancer diagnosis during follow-up were considered cases and matched with eligible controls without cancer during follow-up. Medication possession ratio (MPR) was used as indicator for medication adherence. Segmented linear auto-regression analysis with interrupted time series was used to assess changes in MPR for cases compared with controls (i.e. overall trend) due to (any) cancer diagnosis and specific cancer types.
  
  
  RESULTS
  From the 52,228 GLD users selected, 3,281 cases with cancer and 12,891 controls without cancer during follow-up were included in the study. In our analyses, before cancer diagnosis the MPR increased by 0.10% per month (95% CI 0.10, 0.10). Besides a significant drop in MPR at the time of cancer diagnosis of -6.3% (95% CI -6.5, -6.0), there was an ongoing, yet lower, monthly decline in MPR (-0.20%; 95% CI -0.21, -0.20) after cancer diagnosis. The largest drops in MPR at the time of cancer diagnosis, in the range of 11-15%, were seen among patients with stage IV disease and gastrointestinal or pulmonary cancers.
  
  
  CONCLUSIONS
  Our findings indicate a clear decline in adherence to GLD treatment regimens following a cancer diagnosis. The reason for the decline in MPR needs to be further elucidated.
authors: Department of Research, Netherlands Comprehensive Cancer Organisation, P. O. Box 231, 5600 AE, Eindhoven, the Netherlands, m.zanders@iknl.nl.
authors: Marjolein M J
authors: MM
authors: Zanders
authors: Harm R
authors: HR
authors: Haak
authors: Myrthe P P
authors: MP
authors: van Herk-Sukel
authors: Lonneke V
authors: LV
authors: van de Poll-Franse
authors: Jeffrey A
authors: JA
authors: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents
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