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Refill compliance in type 2 diabetes mellitus: a predictor of switching to insulin therapy?

机译：2型糖尿病患者的补充治疗依从性：转向胰岛素治疗的预测指标？

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OBJECTIVE: To assess whether switching to insulin therapy in patients with type 2 diabetes mellitus is associated with medication refill compliance of oral hypoglycemic agents. RESEARCH DESIGN AND METHODS: The PHARMO Record Linkage System was used as data source for this study. Patients with newly treated type 2 diabetes mellitus were defined as subjects in whom oral hypoglycemic therapy was initiated between 1991 and 1998. We performed a matched case-control study in this cohort. Cases were patients who switched to insulin therapy. Date of switching in the case was defined as the index date. Controls were subjects still on oral therapy on the index date, matched on duration of diabetes and calendar time. We measured the medication refill compliance in the year starting 18 months before the index date and calculated various compliance indices. RESULTS: In total, 411 cases and 411 matched controls were identified. Cases suffered more often from more severe comorbidity and used a higher number of oral hypoglycemic agents and concomitant non-diabetic drugs. The overall compliance rate did not differ significantly between cases and controls, the adjusted odds ratio (OR) was 1.3 (CI 95% 0.6-2.8). After performing multivariate logistic regression modeling, age at onset of diabetes, gender, comedication, combination therapy, and daily dosage frequency, were independently related to switching. CONCLUSIONS: We were unable to confirm the hypothesis that noncompliance with treatment is more prevalent in patients with secondary failure. Other variables, like comorbidity and disease-related factors seem to play a more important role in switching to insulin therapy.
机译：目的：评估2型糖尿病患者转用胰岛素治疗是否与口服降糖药的药物补充依从性有关。研究设计和方法：PHARMO记录链接系统用作该研究的数据源。 1991年至1998年之间开始口服降糖治疗的受试者为新治疗的2型糖尿病患者。我们在该队列中进行了匹配的病例对照研究。病例是转用胰岛素治疗的患者。该情况下的切换日期被定义为索引日期。对照是在指标日期仍接受口服治疗的受试者，其糖尿病持续时间和日历时间相匹配。我们在索引日期前18个月开始的一年中测量了药物补充剂的合规性，并计算了各种合规性指标。结果：总共鉴定出411例病例和411例匹配的对照。合并症更为严重，使用了更多的口服降糖药和非糖尿病药物。病例和对照组之间的总体依从率没有显着差异，调整后的优势比（OR）为1.3（CI 95％0.6-2.8）。在进行多元逻辑回归建模后，糖尿病的发病年龄，性别，喜剧，联合治疗和每日用药频率与转换独立相关。结论：我们无法证实这种假说，即继发性衰竭患者不依从治疗的情况更为普遍。其他变量，例如合并症和与疾病相关的因素，似乎在转向胰岛素治疗中起着更为重要的作用。

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