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Medication adherence? No thanks, say almost 40% of Type 2 Diabetes Patients for their second-line meds


Study shows the need for greater communication with patients beyond the initial prescription

Diabetes patients not adhering to their second-line meds: ©Onephoto -

Diabetes patients not adhering to their second-line meds: ©Onephoto -

A study from Northwestern University highlights a concerning trend among Type 2 diabetes patients, indicating that nearly 40% discontinue their second-line medications within one year of the initial prescription. The study, which will be published in American Journal of Managed Care, underscores the critical need for physicians to address medication adherence issues and explores the potential consequences of non-compliance, according to researchers.

The study, spanning more than 82,000 patients from 2014 to 2017, revealed that two-thirds of patients either discontinued their medication, switched to a different class of medication, or intensified their treatment within the first year. The study identifies a higher discontinuation rate of 50% among patients prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs), drugs associated with gastrointestinal side effects.

The research shows that a physician may be prescribing a new medication to control a patient’s Type 2 diabetes, but within a year, half of them stop taking it and don’t start anything else. The study authors say it is important to understand the barriers patients face and adopt new prescribing approaches to enhance medication adherence, thereby preventing unnecessary wastage of time, resources, and costs to the health care system.

While the study did not delve into specific reasons for discontinuation, it points to potential adverse gastrointestinal side effects associated with GLP-1 RAs. These side effects, including nausea, vomiting, and diarrhea, could contribute to the observed discontinuation rates, according to the study.

The study highlights the risks for patients who discontinue their medications, noting that while it might not immediately lead to hyperglycemia symptoms, it elevates the risk of hospitalizations related to diabetes in the future.

The study also explored differences based on prescriber specialties, indicating that endocrinologists had a lower discontinuation risk and a higher intensification risk compared to family medicine or internal medicine physicians. This discrepancy could be attributed to the endocrinologists' expertise in newer classes of diabetes drugs, enabling them to have more informed discussions with patients about medication decisions, researchers say.

The findings serve as a call for clinicians to engage in ongoing communication with patients about medication benefits, side effects, and costs, emphasizing the need for vigilance beyond the initial prescription, according to the researchers.

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Jennifer N. Lee, MD, FAAFP
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© National Institute for Occupational Safety and Health
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© National Institute for Occupational Safety and Health