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Association Between Adherence to Pharmacotherapy and Outcomes in Type 2 Diabetes: A Meta-analysis
Diabetes Care ( IF 16.2 ) Pub Date : 2017-11-01 , DOI: 10.2337/dc16-1925
Kamlesh Khunti 1, 2 , Samuel Seidu 1, 2 , Setor Kunutsor 3 , Melanie Davies 1, 2
Affiliation  

OBJECTIVE A previous study suggests an association between poor medication adherence and excess mortality in chronic disease. The purpose of this study was to assess the association between medication adherence and risk of cardiovascular disease (CVD), all-cause mortality, and hospitalization in type 2 diabetes.

RESEARCH DESIGN AND METHODS We conducted an electronic search on many electronic databases from inception to 27 April 2016. We selected randomized controlled trials and case-control and cohort studies reporting on CVD, all-cause mortality, or hospitalization outcomes by adherence in adults with type 2 diabetes. Two reviewers independently screened for eligible studies and extracted outcome data. Pooled relative risks (RRs) were calculated using a random-effects meta-analysis; risk of bias in each of the included studies was assessed using the GRADE approach.

RESULTS Eight observational studies were included (n = 318,125). The mean rate of poor adherence was 37.8% (95% CI 37.6–38.0). Adjusted estimates were provided by five studies only. The RRs of good (≥80%) versus poor adherence to medication were 0.72 (95% CI 0.62–0.82, I2 = 0%, three studies) for all-cause mortality and 0.90 (0.87–0.94, I2 = 63%, seven studies) for hospitalization. No evidence of small study bias was observed. Only one study reported CVD outcomes by adherence.

CONCLUSIONS We identified no trials reporting on outcomes by adherence, suggesting a systematic failure to include this information. Pooled estimates from available observational studies suggest that good medication adherence is associated with reduced risk of all-cause mortality and hospitalization in people with type 2 diabetes, although bias cannot be excluded as an explanation for these findings.



中文翻译:

坚持药物治疗和2型糖尿病的结局之间的关联:荟萃分析。

目的一项先前的研究表明,慢性病中药物依从性差与死亡率过高之间存在关联。这项研究的目的是评估药物依从性与心血管疾病(CVD)风险,全因死亡率和2型糖尿病住院之间的关系。

研究设计与方法从开始到2016年4月27日,我们在许多电子数据库中进行了电子搜索。我们选择了随机对照试验以及病例对照研究和队列研究,这些研究报告了成人依从性依从性,CVD,全因死亡率或住院结局的情况2糖尿病。两名评价者独立筛选了合格的研究并提取了结果数据。使用随机效应荟萃分析计算合并的相对风险(RRs);使用GRADE方法评估了每个纳入研究的偏倚风险。

结果纳入八项观察性研究(n = 318,125)。依从性差的平均发生率为37.8%(95%CI 37.6–38.0)。仅五项研究提供了调整后的估计值。对全因死亡率的良好(≥80%)与较差药物依从性的RR分别为0.72(95%CI 0.62-0.82,I 2 = 0%,三项研究)和0.90(0.87-0.94,I 2 = 63%) (七项研究)进行住院治疗。没有观察到小的研究偏倚的证据。只有一项研究通过依从性报告了CVD结果。

结论我们没有发现依从性报告结局的试验,提示系统性地没有包括这些信息。来自现有观察性研究的汇总估计值表明,良好的药物依从性与2型糖尿病患者全因死亡率和住院风险的降低相关,尽管不能排除偏倚作为这些发现的解释。

更新日期:2017-10-24
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