medwireNews: Suboptimal drug intake, as determined by urine tests, is associated with a higher prevalence of microvascular and macrovascular complications in people with type 2 diabetes than with consistent use, researchers report.
Microvascular complications occurred in 81.6% of study participants who took at least one of their prescribed drugs inconsistently, compared with 66.2% of those who took all as prescribed. The corresponding rates of macrovascular complications were 55.1% versus 37.0%.
“This shows a window of time for early detection and intervention in the event of non-compliance,” write the Diabetes Care researchers.
Most of the 457 participants in this prospective observational cohort study were taking all prescribed drugs, with 89.3% having detectable levels of all relevant metabolites on liquid chromatography tandem mass spectrometry of 24-hour urine samples.
Jelle Beernink (Ziekenhuis Groep Twente, Almelo, The Netherlands) and co-researchers suggest that this relatively consistent medication intake may reflect the particular cohort that came from the specialized outpatient departments of two hospitals referred there for failure to achieve the glycemic Targets or presence of multiple cardiovascular complications.
The team suggests that people treated in special care may be more urgent to adhere to their treatment compared to patients treated in primary care.
The study participants were on average 64 years old and had an average duration of diabetes of 11 years. Overall, 95.7% had detectable metabolites for their prescribed oral antidiabetic drugs, 92.0% for their antihypertensive drugs, and 95.5% for their statins, although researchers find that this latter number is less than half due to the high value on data the cohort was based on the use of simvastatin, which cannot be detected via urea products.
Demographic and clinical variables were largely similar for people who took and did not take all of their medications. However, people who did not take their medication consistently smoked more frequently than the other study participants (28.6 vs. 15.0%), took more medication overall (median 8 vs. 7) and had a higher glycated hemoglobin content and one low density lipoprotein (LDL) cholesterol.
In adapted analyzes, current smoking remained significantly associated with an increased likelihood of incomplete drug use, as well as higher BMI, increased glycated hemoglobin and LDL cholesterol levels, and the presence of diabetic kidney disease and macrovascular disease.
“Apparently, non-compliance in our population has not been recognized by patient health professionals,” the researchers observe.
“However, it is important to actively look for non-compliance and recognize that poor drug compliance contributes to sub-optimal clinical benefit,” they say.
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Diabetes Care 2021; doi: 10.2337 / dc20-2533