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Discontinuation of diabetes medications common
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Discontinuing oral hypoglycemic therapy is common among patients with diabetes and is associated with an increased risk for all-cause hospitalization and ED visits, according to data from a retrospective cohort study.
“Many studies have assessed medication adherence to oral hypoglycemic agents, but few studies have examined discontinuation of oral hypoglycemic therapy, and those studies have primarily examined discontinuation of monotherapy,” Kristi Reynolds, PhD, MPH, of the department of research and evaluation at Kaiser Permanente Southern California, Pasadena, and colleagues wrote. “The impact of discontinuation of oral hypoglycemic therapy in patients with diabetes on clinical outcomes, such as glycemic control and health care utilization following discontinuation, also remains largely unknown.”
Researchers identified 23,612 patients with diabetes aged 18 years and older who received dual oral hypoglycemic therapy at Kaiser Permanente Southern California between Jan. 1, 2005, and June 30, 2010. They analyzed the number of patients who discontinued one or both therapies, defining discontinuation as “a gap greater than 1.5 times the last days’ supply without subsequent reinitiation.”
Reynolds and colleagues reported 26.1% (n = 6,158) of patients discontinued therapy, and 64.7% (n = 15,270) were nonadherent. Of the entire cohort, 16.9% discontinued one therapy, and 9.2% discontinued both agents. The median time before therapy discontinuation was 6.6 months.
A number of factors were associated with discontinuation. Patients who discontinued were more likely to be women and black or Hispanic, and had more comorbidities and higher co-pays, in addition to having started both therapies at the same time compared with those who did not discontinue, the researchers wrote. Those who discontinued therapy were also less likely to use mail-order prescription services and to have a higher level of health care utilization.
The patients’ mean HbA1c decreased over the course of the study period in all groups. Among those whose HbA1c data were available at both baseline and after 24 to 36 months of follow-up (89.5%), researchers reported an HbA1c reduction of 1.26 (8.36% to 7.49%) among adherent patients and a change of -1.05 (8.54% to 7.49%) among nonadherent patients. Change in HbA1c was -1.02 (8.21% to 7.18%) in patients who discontinued one agent and -1.23 (8.83% to 7.60%) in those who continued both.
During the follow-up period, 11.8% of those who discontinued one agent were hospitalized at least once, along with 8.4% of those who discontinued both. Meanwhile, 7.6% of adherent patients and 8.9% of nonadherent patients were hospitalized. ED visits occurred among 23.7% of patients who discontinued one agent and 18.2% of those who discontinued both, compared with 15.6% of adherent patients and 18.8% of nonadherent patients.
“To enhance our findings, future research should examine the association of different oral hypoglycemic agent classes and risk of discontinuation and include the initiation and discontinuation of noninsulin injectable agents, as their use is increasing,” Reynolds and colleagues wrote. “Future studies should also examine the reasons for oral hypoglycemic agent discontinuation through qualitative and mixed methods research to understand patients’ perceived needs and concerns regarding dual oral hypoglycemic therapy so that appropriate interventions can be developed.” – by Andy Polhamus
Disclosure: Reynolds is a former employee of Merck. Please see the full study for a complete list of all other authors’ relevant financial disclosures.
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