Diabetes – high rate of med discontinuation requires vigilance
YOUR DOSE OF MEDICINE - Charles C. Chante MD (The Philippine Star) - August 18, 2019 - 12:00am

Most patients with type 2 diabetes mellitus stop taking their medication within a year, and nearly one-third stop within the first 3 months, a retrospective analysis of claims data for more than 324,000 patients suggests.

The findings in this population of commercially insured adults are startling and highlight a need for interventions to improve treatment persistence.

Investigators reviewed medication claims data for 324,136 patients with at least one diagnosis for type 2 diabetes mellitus and one outpatient pharmacy claim for a type 2 diabetes medication after at least 12 months without such a claim.

Of those patients, 58% discontinued treatment within 12 months, 31% discontinued within the first 3 months, and 44% discontinued within six months.

Less than half of those patients who discontinued had a restart within the following year. So, what we are seeing here is a huge percentage of individuals who had a diagnosis of type 2 diabetes, were prescribed a medication, and then did not continue the medication.

Of those who discontinued  within the 12 months follow-up, 27% restarted therapy within 60 days and 39% restarted therapy anytime during the 12 month follow up (mean treatment gap-107 days).  Of those who discontinued by 3 months, 45% restarted within a year (mean treatment gap-112 days) and those who discontinued  by 6 months, 44% restarted within a year (mean treatment gap-119 days).

Patients had a mean age of 55 years, with 28% aged 45-54 years and 35% aged 55-64 years. About 46% were women, and all had at least one diagnosis for type 2 diabetes mellitus during the study period and at least one outpatient pharmacy claim for a type 2 diabetes medication that was prescribed to be taken for at least 30 days.

As expected, far and away the majority (68%) were given metformin. Other prescribed treatments after the initial diagnosis included sulfonylureas (7%), insulin (6%), dipeptidyl peptidase – 4 inhibitors (6%), sodium-glucose cotransporter 2 inhibitors (1.5%) and a variety of combination treatments –typically metformin plus sufonylureas (5%).

This study provides real-world evidence that a majority  of patients with type 2 diabetes discontinue their treatment within  one year – an important findings given that medication persistence is imperative for successful treatment. It was also noted that prior research has shown treatment discontinuation of prescribed  medication within the  first year is common for a number of chronic disease treatments and is associated with poor clinical outcome.  If you treat diabetes, this is an alarming according to investigators.  These are people who should be on a diabetes med, their doctor probably thinks they are on a diabetes med, and they are not taking it.

The findings are limited by factors associated with the use of administrative claims data, such as possible coding inaccuracies and missed cases in which patients paid out of pocket for medications through low-cost pharmacy offers, as well as by the 12-month window used for the study.

The findings are concerning and may reflect misunderstanding among patients about the need to refill prescriptions after the initial supply runs out, or may relate to side effects that patients don’t report to their physicians.

A doctor commented that she do treat diabetes patients and she is very alarmed, adding that there is really a need to improve communication between patients and physician about treatment and side effects.

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