title: Comparative adherence to diabetes drugs: An analysis of electronic health records and claims data.
abstract: Non-adherence to medications is a major challenge in diabetes care. The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. We used a data source that linked electronic prescriptions with insurance claims to assess whether new electronic prescriptions for diabetes medications were followed by dispensing claims consistent with that prescription. After one year of follow-up, the daily medication possession probability (MPP) - a measure of overall adherence - at one year for sulfonylurea was 0.49 and for metformin was 0.46. Thiazolidinediones and basal insulin had a similar final daily MPP at 0.36 and 0.39, respectively, which was significantly lower than that for sulfonylurea or metformin (P < .05). GLP-1 receptor agonists and DPP-4 inhibitors were also comparable to one another at a final daily MPP of .30 and .21, respectively (P < .05 compared to any of the aforementioned drug classes). In summary, the rates at which diabetes drugs are prescribed, and the rates at which patients actually take them, differ substantially. Physicians should be aware of potentially significant challenges concerning adherence to newer agents.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell School of Medicine, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Flory
authors.affiliation: Health Care Policy and Aging Research, Institute for Health, Piscataway, New Jersey.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
authors.affiliation: AMGA, Alexandria, Virginia.
authors.forename: Nikita
authors.initials: N
authors.lastname: Stempniewicz
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell School of Medicine, New York, New York.
authors.forename: Scott
authors.identifier: 0000-0002-7092-3025
authors.initials: S
authors.lastname: Keating
authors.affiliation: COHRDATA, Santa Monica, California.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Rowan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000378:metabolism; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D055695:Electronic Prescribing; D005260:Female; D000067757:Glucagon-Like Peptide-1 Receptor / Q000037:antagonists & inhibitors* / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007356:Insurance, Pharmaceutical Services; D008137:Longitudinal Studies; D008297:Male; D020398:Medicare Part C; D054524:Medicare Part D; D055118:Medication Adherence; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000627:therapeutic use; D014481:United States
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D000067757:Glucagon-Like Peptide-1 Receptor; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin; C089946:2,4-thiazolidinedione
keywords: antidiabetic drug; observational study