The cornerstone of treatment for type 2 diabetes mellitus (T2DM) is the achievement of glycemic control, with a glycated hemoglobin (HbA1c) goal of less than 7% strongly recommended (1,2). The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recently published a consensus statement for successful T2DM management (2). Highlighting this approach is intervention at the time of diagnosis with metformin in combination with diet and exercise. As glycemic control is lost, augmentation of therapy with additional agents is recommended.
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Several studies have examined drug adherence in T2DM patients (3-6). In a literature review by Cramer et al. (3) the most frequently reported measure of compliance, the 12-month MPR, was 76% for oral glucose-lowering medications (OADs), meaning that 76% of days ‘on-therapy’ were actually covered by medication. MPR ≥80 was 58% and the 12-month persistence rate was 62.3%. Similarly, in a large managed care plan in Oregon mean overall OAD adherence was 81%, with a mean MPR≥80 of 65% for patients with at least 2 prescription claims for OAD monotherapy (4). Finally, in a managed care program in the southeastern United States, metformin- or sulfonylurea-treated patients had mean MPR values of 69% and 76%, respectively. Despite these relatively high compliance rates for OAD monotherapy, the majority of these patients will lose glycemic control and require additional diabetes treatments (2).
References
1. American Diabetes Association. Diabetes Care. 2009;32(suppl. 1):S13-S61.
2. Nathan DM, et al. Diabetes Care 2009;32:193-203.
3. Cramer JA, et al. Int J Clin Pract 2008;62:76-87.
4. Rozenfeld Y, et al. Am J Manag Care 2008;14:71-75.
5. Fabunmi R, et al. Curr Med Res Opin 2009;25:777-786.
6. Lawrence DB, et al. J Manag Care Pharm 2006; 12:466-471.
