Introduction

Most adults with type 2 diabetes (T2D) have several chronic conditions treated with complex regimens and multiple medications. The burden and complexity of multiple medication use are associated with worse patient outcomes, including reduced adherence and increased costs, hospitalizations, mortality rates, and HbA1c. This study quantifies the chronic medication burden, regimen complexity, and potential medication interactions in patients with T2D using a nationwide claims database in the USA.

Methods

Adults with T2D treated for greater than half of the year with at least one glucose-lowering agent (GLA) in 2017 were included in this descriptive study. Chronic medications were defined as all GLAs and non-GLA medications prescribed for at least 90 days in 2017 to at least 2% of the cohort. Medication burden, defined as the number of medications prescribed, was examined. Medication complexity, proxied by the Medication Regimen Complexity Index (MRCI), and potential use of interacting medications were also examined. Results were investigated for all chronic medications and were reported on the basis of the disease treated (diabetes or other condition) and the route of administration (oral or other).

Results

On average, in 2017, the 814,156 patients included in the study filled prescriptions for 4.1 chronic medications (standard deviation [SD] = 2.0), 3.7 oral chronic medications (SD = 1.9), 1.5 GLAs (SD = 0.8), and 1.1 oral GLAs (SD = 0.7). The average MRCI was 14.7 for all chronic medications (SD = 7.4), with a mean of 12.4 for all oral chronic medications (SD = 6.3), 6.6 for all GLAs (SD = 3.8), and 4.9 for oral GLAs (SD = 2.6).

Conclusion

On average, patients with T2D used multiple medications, had a complex medication regimen, and were at potential risk of medication interactions. These findings suggest that patients, practitioners, pharmacists, and payers may benefit from interventions which decrease medication burden, complexity, and/or adverse events related to the treatment of T2D.

中文翻译：

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用降糖药治疗的美国2型糖尿病患者的长期药物负担和复杂性。

介绍

大多数2型糖尿病（T2D）成年人患有几种慢性病，需要采用复杂的治疗方案和多种药物治疗。多种药物使用的负担和复杂性与患者预后差有关，包括依从性降低和费用增加，住院，死亡率和HbA1c升高。这项研究使用美国全国性的索赔数据库，对T2D患者的慢性药物负担，方案复杂性和潜在的药物相互作用进行了量化。

方法

该描述性研究包括2017年接受至少一种降糖药（GLA）治疗的T2D成年人的半年以上。慢性药物定义为2017年开处方至少90天至同类人群至少2％的所有GLA和非GLA药物。检查了药物负担，定义为处方药的数量。还研究了药物复杂性指数（MRCI）所代表的药物复杂性以及相互作用药物的潜在用途。研究了所有慢性药物的结果，并根据治疗的疾病（糖尿病或其他疾病）和给药途径（口服或其他）报告了结果。

结果

平均而言，2017年，纳入研究的814,156名患者填写了4.1慢性药物（标准差[SD] = 2.0），3.7口服慢性药物（SD = 1.9），1.5 GLA（SD = 0.8）和1.1口服处方GLA（SD = 0.7）。所有慢性药物的平均MRCI为14.7（SD = 7.4），所有口服慢性药物的平均MRCI为12.4（SD = 6.3），所有GLA的平均值为6.6（SD = 3.8），口服GLA的平均值为4.9（SD = 2.6） ）。

结论

平均而言，患有T2D的患者使用多种药物治疗，具有复杂的药物治疗方案，并且存在药物相互作用的潜在风险。这些发现表明，患者，从业者，药剂师和付款人可以从减少与T2D治疗相关的药物负担，复杂性和/或不良事件的干预措施中受益。