August 1, 2014

Failure to reach target glycated a1c levels among patients with diabetes who are adherent to their antidiabetic medication

Deborah Taira Juarez, Sc.D., Carolyn Ma, Pharm.D., Audrey Kumasaka,
Reid Shimada, and James Davis, Ph.D.

Population Health Management

The objectives of this study were to describe patient characteristics and types of medications taken by those with poor glycemic control (A1c >7%) despite being adherent to antidiabetic medications. This is a retrospective analysis of administrative data from adult patients with diabetes enrolled in a large health plan in Hawaii (n = 21,267 observations for 11,013 individuals) and adherent to their antidiabetic medications. Multivariable logistic regressions were estimated to determine characteristics and types of medications associated with poor glycemic control. Separate models were estimated to examine category of medication (insulin only, 1 oral medication, multiple oral medications, both oral medications and insulin) and specific therapeutic class of oral antidiabetic medications. Despite being adherent to their medications, 56.1% of patients had poor glycemic control. Compared to patients taking combination sulfonylureas, patients had a higher odds of having A1c >7% for all other oral diabetic medications, with odds ratios ranging from OR = 2.07 for sulfonylureas alone to OR = 1.33 for combination DPP-4 inhibitors. More than half of patients in this study had poor A1c control despite being adherent to their medications. This suggests that physicians, pharmacists, and other providers may need to monitor treatment regimens more carefully, encourage healthy behaviors, and intensify pharmacological treatment as needed. (Population Health Management 2014;17:218–223)

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