Patient Nonadherence Often Misidentified as Diabetes Treatment Failure
Second-line treatments are often initiated without first using first-line therapies.
HealthDay News — Apparent diabetes treatment failures may in fact be attributable to nonadherence, according to a study published online in Diabetes Care.
Yi-Ju Tseng, PhD, from Boston Children's Hospital, and colleagues retrospectively analyzed unidentifiable member claims data from 52,544 individuals covered by Aetna who had 2 physician claims or 1 hospitalization with a type 2 diabetes diagnosis (2010 to 2015).
The researchers found that of 22,956 patients given second-line treatment, only 8.2% had evidence of recommended use of metformin in the prior 60 days, and 28% had no prior claims evidence of having taken metformin. Only 49.5% of patients could have had recommended use. An additional second-line antihyperglycemic medication or insulin was more likely in patients given their initial second-line medication without evidence of recommended use of metformin (P <.001).
"Despite published guidelines, second-line therapy often is initiated without evidence of recommended use of first-line therapy. Apparent treatment failures, which may in fact be attributable to nonadherence to guidelines, are common," the authors write. "Point-of-care and population-level processes are needed to monitor and improve guideline adherence."
Tseng Y-J, Steinberg G, Fox KP, Armstrong J, Mandl KD. Antihyperglycemic medications: a claims-based estimate of first-line therapy use before initalization of second-line medications. Diabetes Care. 2017;40(11):1500-1505. doi:10.2337/dc17-0213