title: Medication Regimen Complexity and A1C Goal Attainment in Underserved Adults With Type 2 Diabetes.
abstract: BACKGROUND
  From 2009 to 2012, 51.8% of American adults with diabetes had a hemoglobin A1C(A1C) >7.0%. The complexity of antidiabetic medication regimens may have an impact on glycemic control.
  
  
  OBJECTIVE
  The primary objective was to test the hypothesis that higher diabetes-specific medication regimen complexity index (MRCI) was associated with lower attainment of A1C goal <7.0% in an underserved, predominantly Hispanic population of adults with type 2 diabetes. Secondary analyses included less stringent A1C goals of <8.0% and <9.0% and overall patient-level MRCI.
  
  
  METHODS
  This study was a retrospective, observational, cross-sectional study of individuals with type 2 diabetes from January 2011 to January 2016. Data was obtained from the electronic medical record and MRCI was calculated using the 65-item validated Microsoft Access Version 1.0 medication regimen complexity electronic data capture tool. Logistic regression was used to compute unadjusted and adjusted odds ratios.
  
  
  RESULTS
  A total of 368 patients were included in the analysis. High diabetes-specific MRCI was associated with lower attainment of A1C goal <7.0% (adjusted OR = 0.09; 95% CI = 0.04-0.18) controlling for age, gender, ethnicity, insurance, body mass index, smoking status, hypertension, and hyperlipidemia. Similar results were obtained for the less stringent A1C goals. However, results for overall patient-level MRCI were mixed.
  
  
  CONCLUSIONS
  Higher diabetes-specific medication regimen complexity was associated with poorer glycemic control. Simplifying antidiabetic medication regimens, especially where the treatment guidelines give no preference, could be a step toward achieving treatment goals.
authors.affiliation: 1 Touro University California College of Pharmacy, Vallejo, CA, USA.|2 OLE Health, Napa, CA, USA.|3 Kaiser Permanente, Napa, CA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Yeh
authors.affiliation: 1 Touro University California College of Pharmacy, Vallejo, CA, USA.
authors.forename: Bijal
authors.initials: B
authors.lastname: Shah-Manek
authors.affiliation: 1 Touro University California College of Pharmacy, Vallejo, CA, USA.|2 OLE Health, Napa, CA, USA.|4 Medical College of Wisconsin School of Pharmacy, Milwaukee, WI, USA.
authors.forename: Kajua B
authors.initials: KB
authors.lastname: Lor
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002140:California; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006040:Goals; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D035862:Vulnerable Populations
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: adherence; ambulatory care; antihyperglycemics; compliance; diabetes; type 2