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首页> 外文期刊>Clinical therapeutics >Adherence to oral antidiabetic therapy in a managed care organization: a comparison of monotherapy, combination therapy, and fixed-dose combination therapy.
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Adherence to oral antidiabetic therapy in a managed care organization: a comparison of monotherapy, combination therapy, and fixed-dose combination therapy.

机译：在管理型护理组织中坚持口服降糖药治疗：单药治疗，联合治疗和固定剂量联合治疗的比较。

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BACKGROUND: Although medication adherence is one of the most important aspects of the management of diabetes mellitus, low rates of adherence have been documented. OBJECTIVE: This study sought to examine medication adherence among patients with diabetes mellitus in a managed care organization who were receiving antidiabetic monotherapy (metformin or glyburide), combination therapy (metformin and glyburide), or fixed-dose combination therapy (glyburide/metformin). METHODS: Medication adherence was evaluated through a retrospective database analysis of pharmacy claims. The adherence rate was defined as the sum of the days' supply of oral antidiabetic medication obtained by the patient during the follow-up period divided by the total number of days in the designated follow-up period (180 days). Health plan members were included in the analysis if they had an index pharmacy claim for an oral antidiabetic medication between August 1 and December 31, 2000, were continuously enrolled in the health plan, and were aged > or =18 years. A 6-month pre-index period was used to classify patients as newly treated or previously treated. Patients were grouped according to their medication-use patterns. RESULTS: After adjustment for potential confounding factors, including overall medication burden at index, there were no significant differences in adherence rates among 6502 newly treated patients receiving monotherapy, combination therapy, or fixed-dose combination therapy. Among the 1815 previously treated patients receiving glyburide or metformin monotherapy who required the addition of the alternative agent, resulting in combination therapy, adherence rates were significantly lower (54.0%; 95% CI, 0.52-0.55) than in the 105 patients receiving monotherapy who were switched to fixed-dose combination therapy (77.0%; 95% CI, 0.72-0.82). The 59 previously treated patients receiving combination therapy who were switched to fixed-dose combination therapy had a significant improvement in adherence after the switch (71.0% vs 87.0%; P < 0.001). CONCLUSIONS: In a managed care organization, previously treated patients receiving monotherapy with an oral antidiabetic medication who required additional therapy exhibited significantly greater adherence when they were switched to fixed-dose combination therapy compared with combination therapy. Patients receiving combination therapy who were switched to fixed-dose combination therapy exhibited significantly greater adherence after the switch.
机译：背景：尽管依从性是糖尿病治疗中最重要的方面之一，但是依从性低已被证明。目的：本研究旨在研究接受抗糖尿病单一疗法（二甲双胍或格列本脲），联合疗法（二甲双胍和格列本脲）或固定剂量联合疗法（格列本脲/二甲双胍）的管理型护理机构中糖尿病患者的药物依从性。方法：通过对药房索赔的回顾性数据库分析来评估药物依从性。依从率定义为患者在随访期内获得的口服抗糖尿病药物的天数之和除以指定随访期（180天）的总天数。如果健康计划的成员在2000年8月1日至12月31日期间对口服抗糖尿病药物具有索引药房要求，并且连续参加了健康计划并且年龄大于或等于18岁，则将其包括在分析中。使用6个月的预索引期将患者分类为新治疗或先前治疗。根据药物使用方式将患者分组。结果：在调整了潜在的混杂因素（包括指数中的总体药物负担）后，接受单一疗法，联合疗法或固定剂量联合疗法的6502名新治疗患者的依从率没有显着差异。在1815例接受格列本脲或二甲双胍单药治疗的先前接受治疗的患者中，需要添加替代药物，从而导致联合治疗，其依从率显着降低（54.0％; 95％CI，0.52-0.55），比105例接受单药治疗的患者低。改用固定剂量联合治疗（77.0％; 95％CI，0.72-0.82）。先前接受联合治疗的59名患者接受了固定剂量联合治疗后，其依从性明显改善（分别为71.0％和87.0％; P <0.001）。结论：在一个有管理的护理组织中，与联合疗法相比，以前接受口服抗糖尿病药物单药治疗且需要额外治疗的患者在转用固定剂量联合疗法时表现出明显更高的依从性。改用固定剂量联合疗法的接受联合疗法的患者在切换后表现出明显更高的依从性。

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