Gatwood JD, et al. - Using the Veterans Affairs Corporate Data Warehouse, a retrospective cohort study was conducted to explore the relationship of adherence to oral antidiabetes medication with macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among veterans with uncomplicated diabetes. It was observed that individuals who are non-adherent to treatment had a higher probability of experiencing detrimental health outcomes within the first 5 years of antidiabetes therapy. The findings suggested that adherence was paramount to disease management and this should be stressed from the time at which treatment was initiated.

Methods

• Participants in the study were 159,032 veterans diagnosed with uncomplicated diabetes during 2002–2014 and beginning oral antidiabetes therapy for the first time.
• By subsequent oral antidiabetes therapy initiation, the first uncomplicated diabetes diagnosis was identified and confirmed.
• Using the proportion of days covered over the first year of therapy, adherence was calculated from outpatient pharmacy records.
• Researchers observed health outcomes up to 5 years beyond the first oral antidiabetes agent fill, and compared according to adherence status utilizing Cox proportional hazards models adjusted for baseline demographic and clinical characteristics.

Results

• The study findings suggested that people initially non-adherent to oral antidiabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95% CI 1.03–1.27) and ischaemic stroke (hazard ratio 1.22, 95% CI 1.05–0.1.42), or to die (hazard ratio 1.21; 95% CI 1.15–1.28) during the first 5 years of oral antidiabetes treatment.
• It was observed that veterans with <20% adherence to oral antidiabetes therapy in the first year had especially high hazards for ischaemic stroke (hazard ratio 1.78, 95% CI 1.27–2.49) and all-cause death (hazard ratio 1.33, 95% CI 1.17–151).
• The outcomes highlighted that adherent individuals were more likely to be diagnosed with a microvascular complication or chronic kidney disease.