Medication Adherence and Glycemia Reduction in Type 2 Diabetes: a Subanalysis from the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study

Résumé fourni par la source

Objective: To address previous inconsistencies in reports of differential adherence to diabetes medications, we examined medication adherence and evaluated treatment group differences in a subset of participants in the GRADE study. Research Design and Methods: GRADE participants (T2DM<10 years, HbA1c=6.8-8.5%, on metformin alone) were randomly assigned to add insulin glargine, glimepiride, liraglutide, or sitagliptin. Adherence was measured semiannually for 3 years using a validated 3-item scale (0-100, lowest to highest adherence) in a substudy (N=1739). Analyses evaluated adherence over time and tested treatment group differences in adherence and in the association between adherence and primary (HbA1c 7.0%) and secondary (HbA1c >7.5%) glycemic outcomes. Results: Overall, mean (SD) adherence was high over 3 years of follow-up at 88.7(10.01) and decreased slightly by 3 years relative to baseline (-2.0±14.7,p<0.0001). No inter-group differences were observed until 3 years, when adherence was 5% and 3% higher for the glimepiride and sitagliptin groups, than for liraglutide (both p<0.05). Over follow-up and across groups, a 10-point decrease in adherence was associated with 15% and 19% increased risk of reaching primary (HbA1c 7.0%) and secondary (HbA1c >7.5%) glycemic outcomes (both p<0.0001). Lower adherence was somewhat more predictive of the secondary outcome for those assigned to glargine or liraglutide, compared to glimepiride or sitagliptin (each p<0.05). No other comparisons were significant. Conclusions: Medication adherence was consistently high in GRADE. Observed treatment group differences were small, and of unclear clinical significance. Overall, lower adherence robustly predicted worsening glycemic control, highlighting the importance of ongoing assessment.

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