Learning you’ve developed type 2 diabetes can be a tough pill to swallow, but sticking to a treatment regimen is important to ensure that your condition doesn’t continue to worsen, which can come with all sorts of symptoms, health risks, and complications.
Sadly, however, new research out of Alberta, Canada, suggests that nearly half of adults who are newly diagnosed with diabetes will discontinue their medications or stop following their treatment plans as directed within one year of diagnosis.
According to the study, which was published in Diabetes Medicine, most adults with type 2 diabetes are prescribed metformin monotherapy when they’re first diagnosed. One year after diagnosis, however, only slightly more than half of these folks are using their medication as prescribed, despite its being a rather inexpensive medication that comes in a simple pill form and tends not to cause side effects for most people.
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“While the expansion of medical options provides prescribers with more options, local guidelines still recommend that metformin monotherapy be chosen for cases of uncomplicated diabetes with an HbA1c less than 8.5%, due largely to the cost-effectiveness of this therapy relative to other more expensive medications,” says David J.T. Campbell, MD, PhD, MSc, FRCPC, assistant professor and consultant endocrinologist in the departments of medicine, community health sciences and cardiac sciences at the Cumming School of Medicine, University of Calgary, in Canada. “Therefore, the point of our study was to see if prescribers were still using metformin when appropriate, in the face of so many new medications.”
The study involved data from 17,932 adults from Alberta diagnosed with diabetes between April 2012 and March 2017. All participants had an HbA1c between 6.5% and 8.5% and had filled a prescription for a diabetes medication at least once within a year of diagnosis.
The study subjects were split into groups based on treatment regimen: metformin monotherapy (89 percent), non-metformin diabetes medication (3.3 percent), or metformin-containing combination therapy (7.6 percent). They were considered to have adhered to their medication plans if they had filled prescriptions for at least 80 percent of the supply needed for the observed treatment days.
Overall, 48 percent of subjects did not adhere to their diabetes therapy in their first year of treatment. Older people and those with comorbidities were more likely to stick to their treatment plans, as were those living in high-income neighborhoods. Those taking metformin monotherapy were less likely to stay on their medication than those taking combination therapies or non-metformin drugs.
Of those who started taking metformin after diagnosis, 54 percent remained on the medication. The number of people staying on metformin dropped by 10 percent after 30 days, 90 days, and 100 days. Those who stopped taking metformin tended not to switch to another medication, but adults with a higher HbA1c were more likely to switch to combination therapies than adults with lower HbA1cs.
“There are important implications for patients who discontinue therapy that is initially prescribed,” says Campbell. “We know that metformin helps to lower blood glucose, and there is even evidence that it helps to reduce diabetes complications in the long run, yet many patients are forgoing these benefits by discontinuing their treatment shortly after starting.”
Researchers hope that more people can be persuaded to stick with their metformin monotherapy, because it is an effective medication and cheaper than many of the alternatives. In the study, people who were prescribed metformin combination therapies or non-metformin medications incurred about double the healthcare costs compared to those who were prescribed metformin. And in terms of medication alone, the difference was quite significant. One year of metformin cost an average of CA$139, while combination therapy cost CA$932 and non-metformin medications cost CA$817.
“We would like to better explore the reasons for nonadherence to metformin and other diabetes treatments in order to plan and design programs and supports to help patients remain on effective medical therapies,” says Campbell. “Furthermore, we hope to use our database of patients with diabetes to answer other real-world medication-related questions, including better understanding if other therapies are used in the appropriate clinical settings, as per guidelines.”
Future studies will hopefully reveal more about the reasons people fail to adhere to their diabetes treatment plans and develop ideas to encourage more people to stay on their medications.
Sticking to your diabetes medication early on could make a huge difference as time progresses. We encourage all people with diabetes to follow their doctors’ orders and adhere to their treatment plans in order to avoid complications.Whizzco