Comprehensive Medication Reviews Can Help Improve Adherence in Patients With T2D

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Medication therapy management can also increase the likelihood of using statins in this population.

Diabetes was the eighth leading cause of death in the United States in 2021. That year, over 29 million Americans—8.9% of the country’s total population—had a diagnosed case of diabetes. What’s more, it was estimated there were an additional 8.7 million undiagnosed cases.1 Adults with diabetes have a 50% increased risk of death from any cause compared to those without it, highlighting the crucial need for prevention and treatment efforts.2

Diabetes was the eighth leading cause of death in the United States in 2021 / greenapple78 - stock.adobe.com

Diabetes was the eighth leading cause of death in the United States in 2021 / greenapple78 - stock.adobe.com

Nonadherence to oral antidiabetic (OAD) medications can worsen disease outcomes and lead to poor glycemic control, excess mortality, and increased morbidity. That’s why the condition was prioritized in Medicare’s medication therapy management (MTM) program. Previous research has shown that MTM can be effective, but results were often conflicting. However, new data has found that comprehensive medication reviews (CMR) can improve adherence to OAD.3

The study’s results were presented at the American Pharmacists Association Annual Meeting & Exposition, held March 22-25 in Orlando, Florida.

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Investigators from the University of Minnesota’s College of Pharmacy conducted a retrospective observational study to examine whether the implementation of CMR could improve treatment quality in patients with type 2 diabetes (T2D). Particular importance was placed on medication adherence and utilization of statins. The study employed a difference-in-difference (DID) approach on Medicare beneficiaries with diagnosed T2D who were eligible for CMR between 2013 and 2019.

The study cohort included 78706 patients in the CRM group and 116739 in the control group. All participants had at least 2 OAD prescriptions within a 1 year period. The primary study endpoint was to compare the proportion of days covered (PDC) by OAD medications during the year before and after CMR services were first received for the exposure group and the date when CMR was offered for the treatment group. Secondary endpoints included changes in statin utilization rates.

Investigators found that both of the groups experienced a decline in PDC in the year after CMR services were received or offered, but the decline was significantly less pronounced in the CMR exposure group. Patients adherent to OAD who received CMR declined from 76.3% to 67.6%, compared to 74.1% to 63.6% in the control group over the same period. Patients who received CMR were also more likely to maintain a PDC over 0.8.

Additionally, statin use rate remained relatively stable. In the CMR exposure group, it changed from 43.6% to 43.7% prior to and after exposure, compared to a decrease of 43.6% to 42.9% in the control group. Patients in the CMR group were also more likely to have concurrent statin use compared to the control group.

“To our knowledge, this is the largest and most widely generalizable estimate of the effect of MTM on diabetes medication quality,” the authors concluded. “We find that receipt of a CMR improved adherence to oral antidiabetic treatment and an increased the likelihood of using statins in this population. To further enrich our comprehension, future investigations should explore the potential benefits of CMR in different facets of health outcomes, such as hospitalization rates and medical expenses among T2DM patients.”

Read more of our coverage from the 2024 APhA Annual Meeting & Exposition here.

References
1. National Diabetes Statistics Report. Report. CDC. November 29, 2023. Accessed March 22, 2024. https://www.cdc.gov/diabetes/data/statistics-report/index.html
2. Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag. 2017;20(1):6-12. doi:10.1089/pop.2015.0181
3. Shen TH, Hasan SA, Cheuk Wun Ting F, et al. Impact of Comprehensive Medication Review on Oral Antidiabetic Drugs Adherence in Type II Diabetic Medicare Beneficiaries. Presented at: American Pharmacists Association Annual Meeting & Exposition; March 22-25, 2024; Orlando, Fl. Poster 1173.
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