Routine health data describe adherence and persistence patterns for oral diabetes medication for a virtual cohort in the Khayelitsha sub-district of Cape Town, South Africa.
Routine health data describe adherence and persistence patterns for oral diabetes medication for a virtual cohort in the Khayelitsha sub-district of Cape Town, South Africa.
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DOI：
10.1371/journal.pgph.0002730
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发表时间：
2023
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2型糖尿病（T2 DM）通过生活方式改变和抗糖尿病药物联合治疗，但接受治疗的人通常无法达到血糖控制。依从性对于实现最佳的血糖控制非常重要，而糖尿病药物管理是一个终身过程，因此通过分析纵向药物数据来了解依从性非常重要。使用回顾性常规健康数据和二甲双胍配药记录作为药物使用的代理，我们描述了开普敦Khayelitsha区10541名糖尿病患者（PLWD）的虚拟队列中口服糖尿病药物的纵向持久性和依从性。在两年的120天滑动窗口中测量依从性，并用于估计二甲双胍依从性轨迹。多项逻辑回归确定了影响这些轨迹的因素。对药房配药记录的分析显示了不同的药物补充模式：虽然一些PLWD持续补充处方，但其他人的治疗间隙具有非持续性和多个治疗期-两年内每个人从一到五个。在两年期间，所有滑动窗口的依从性随时间推移而下降，只有25%的研究人群在两年后达到药物依从性（> = 80%依从性）。四种粘附轨迹;鉴定了“低粘附性逐渐下降”（A）、“高粘附性快速下降”（B）、“低粘附性逐渐增加”（C）和“粘附”（D）。仅轨迹D代表治疗开始时依从并在两年后保持依从的受试者。在糖尿病治疗之前或同时接受HIV抗逆转录病毒治疗以及二甲双胍联合磺脲类和/或胰岛素治疗与长期依从性相关（轨迹D）。常规数据显示了真实的生活用药模式，这在对照研究条件下可能看不到。这项研究说明了这些数据在描述纵向遵守模式在个人和人口水平上的效用。
Type 2 diabetes mellitus (T2DM) is managed with combined lifestyle modifications and antidiabetic drugs, but people on treatment often fail to reach glycaemic control. Adherence is important for achieving optimal glycaemic control, and management of diabetes with drugs is a lifelong process, so understanding adherence through analysis of longitudinal medications data is important. Using retrospective routine health data and metformin dispensing records as a proxy for medication use, we describe longitudinal persistence and adherence to oral diabetes medication in a virtual cohort of 10541 people with diabetes (PLWD) in Khayelitsha subdistrict, Cape Town. Adherence was measured in 120-day sliding windows over two years and used to estimate metformin adherence trajectories. Multinomial logistic regression identified factors influencing these trajectories. Analysis of pharmacy dispensing records showed varying medication refill patterns: while some PLWD refilled prescriptions consistently, others had treatment gaps with periods of non-persistence and multiple treatment episodes–from one to five per individual across two years. There was a general trend of decreasing adherence over time across all sliding windows in the two-year period, with only 25% of the study population achieved medication adherence (> = 80% adherence) after two years. Four adherence trajectories; ‘low adherence gradual decline (A), ‘high adherence rapid decline’ (B), ‘low adherence gradual increase (C) and ‘adherent’ (D) were identified. Only trajectory D represented participants who were adherent at treatment start and remained adherent after two years. Taking HIV antiretroviral treatment before or concurrently with diabetes treatment and taking metformin in combination with sulphonylurea and/or insulin were associated with the long-term adherence (trajectory D). Routine data shows real life medication implementation patterns which might not be seen under controlled study conditions. This study illustrates the utility of these data in describing longitudinal adherence patterns at both an individual and population level.