5 years ago

A comparison of adherence and persistence by medication class in type 2 diabetes: A systematic review and meta-analysis

Andrew McGovern, Simon de Lusignan, Neil Munro, Martin Whyte, Zayd Tippu, William Hinton
Limited medication adherence and persistence are barriers to successful treatment in type 2 diabetes (T2D). We searched MEDLINE, EMBASE, The Cochrane Library, The Register of Controlled Trials, PsychINFO, and CINAHL for observational and interventional studies comparing medication adherence or persistence between two or more glucose lowering medications in people with T2D. Where several studies (n≥5) provided the same comparison a random effects meta-analysis was performed reporting mean difference (MD), odds ratio (OR), or hazard ratio (HR) depending on the pooled study outcomes. We included 48 studies. Compared with metformin, adherence (%) was better for sulfonylureas (n=5; MD 10.6%; 95%CI 6.5 to 14.7%) and thiazolidinediones (n=6; MD 11.3%; 95%CI 2.7 to 20.0%). Thiazolidinedione adherence was marginally better than sulfonylureas (n=5; MD 1.5%; 95%CI 0.1 to 2.9%). DPP4 inhibitors had better adherence than sulfonylureas and thiazolidinediones. GLP1 receptor agonists had higher OR for discontinuation than long acting analogue insulins (n=6; 1.95; 95%CI 1.17 to 3.27). Long acting insulin analogues had better persistence than human insulins (n=5; MD 43.1; 95%CI 22.0 to 64.2 days). Methods for defining adherence and persistence were highly variable.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/dom.13160

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