Some studies on medication adherence and persistence based on data in people with type 2 diabetes .... Assessment of drug compliance of patients with type 2 diabetes at the 108th Militar
OVERVIEW
Diabetes mellitus
Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia caused by defects in insulin secretion, insulin action, or both Prolonged high blood sugar levels can disrupt carbohydrate, protein, and lipid metabolism, leading to severe damage to vital organs such as the heart, blood vessels, kidneys, eyes, and nerves.
Diabetes mellitus is a group of metabolic disorders characterized by persistent hyperglycemia caused by defects in insulin secretion, insulin resistance, or both Chronic high blood sugar levels can lead to severe damage and dysfunction in vital organs such as the eyes, kidneys, heart, nerves, and blood vessels, highlighting the importance of early diagnosis and effective management.
Thus, diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or the body cannot effectively use the insulin produced
Diabetes mellitus is classified into several types, including type 1 diabetes, type 2 diabetes, gestational diabetes, and diabetes caused by other factors Among these, type 2 diabetes is the most prevalent, accounting for approximately 90-95% of all diabetes cases worldwide.
Type 2 diabetes was formerly known as older adult diabetes or non-insulin- dependent diabetes This form of the disease includes people who are relatively insulin deficient along with insulin resistance Patients do not have autoimmune destruction of beta cells, no autoimmune antibodies in the blood The majority of patients are obese or overweight and/or obese in the abdomen with a large waist Due to insulin resistance, in the early stages of beta cells compensating and increasing insulin secretion in the blood, if insulin resistance persists or worsens, beta cells will not secrete enough insulin and clinical type 2 diabetes will appear Insulin resistance may improve with weight loss, or take certain medications, but never completely return to normal [3]
The risk of developing type 2 diabetes rises with age, obesity, and sedentary lifestyles It is especially common among women with a history of gestational diabetes, individuals with hypertension or dyslipidemia, and certain high-risk ethnic groups including Black Americans, Native Americans, Latinos, South Asians, and some Pacific Island populations.
Genetic factors play a significant role in the development of type 2 diabetes, with studies showing a 90% concordance rate among identical twins Many individuals with type 2 diabetes have close relatives also affected by the condition, indicating a strong hereditary component The disease is likely caused by the combined influence of multiple dominant genes, and identifying specific genes responsible for hyperglycemia could lead to classifying certain cases as a distinct genetic form of diabetes.
Environmental factors affect the increase in the incidence of type 2 diabetes related to obesity, eating foods rich in energy, carbohydrates, and sedentary [3]
Treatment goals for individuals with diabetes vary based on the patient's unique health status, age, presence of complications, and disease duration Personalized treatment plans are essential to effectively manage diabetes and improve outcomes.
Table 1.1 Treatment objectives for patients with type 2 diabetes mellitus in adults, not pregnant [3]
Capillary glucose on an empty stomach, before eating
Capillary plasma glucose peak 1-2 hours postprandial
+ Systolic < 140 mmHg, Diastolic < 90mmHg + If there are kidney complications, or there are cardiovascular risk factors due to high atherosclerosis: <
+ LDL cholesterol < 100 mg/dL (2.6 mmol/L) if there are no cardiovascular complications
+ LDL cholesterol < 70 mg/dL (1.8 mmol/L) if there have been complications of heart rupture or may < 50 mg/dL (1.3 mmol/L) if there are high risk factors for atherosclerosis + Triglycerides 40 mg/dL (1.0 mmol/L) in men and >
50 mg/dL (1.3 mmol/L) in women
Treatment goals for diabetes management can vary based on individual patient circumstances A more restrictive target of HbA1c 0.05) between the two groups.
Regarding the number of prescriptions of drug groups, there was a statistically significant difference between the group of patients who adhered to and did not comply with treatment for most groups of drugs from the 2 groups of meglitinide and glucosidase
3.1.2.3 Factors related to clinical test index between compliant and non-compliant groups
Factors related to the clinical test index of patients participating in the study when comparing according to 2 groups presented in the following table:
Table 3.3 Clinical testing index factor between compliant and non-compliant groups
Number of times the target is reached
Number of times the target is reached
Number of times the target is reached
Number of times all 3 indicators have been reached
The number of tests and the number of times the treatment target was met for HbA1c, glucose, and lipid indices were both higher in the compliance group than in the non-compliance group statistically significant (p < 0,001) Specifically, the compliance group had an average of 2,3 HbA1c tests and 1.2 times reached the target, while the non- compliance group had 1,4 and 0,7, respectively Similarly, the number of glucose and lipid tests and the number of times the target was met was also higher in the compliance group In addition, the number of times the target was met for all three indicators in the compliance group (0,5) was also higher than in the non-compliance group (0,2), and this difference was statistically significant (p < 0,001)
3.1.2.4 Factors related to treatment costs between compliant and non-compliant groups
Factors related to the treatment cost of patients participating in the study when compared according to the 2 groups presented in the following table:
Table 3.4 Treatment cost factor between adherence and non-adherence groups
Index Sum Non- compliance Compliance p
Index Sum Non- compliance Compliance p
Hospital fees for health insurance Medium ± SD Median (IQR)
Hospital fees for health insurance
Hospital fees paid by BN
Hospital fees to be paid by BN
Average cost of diabetes medication
Index Sum Non- compliance Compliance p
The average cost of treatment in the adherence group was lower than in the non- adherence group in most expenditures, and the difference was statistically significant (p
Patients in the compliance group experienced significantly lower costs across several healthcare categories, including medical examinations, testing, diabetes medications, co-paid hospital fees, and health insurance hospital fees (p 1) Notably, higher health insurance entitlement levels markedly improved compliance, with patients holding 100% coverage demonstrating the strongest effect, evidenced by an adjusted OR of 4.58 (KTC 95% CI: 3.14–6.69, p < 0.001) Additionally, aggressive diabetes treatment practices were linked to increased adherence, with corrected ORs ranging from 1.27 to 3.97 (p < 0.05), highlighting the importance of intensive management in promoting medication compliance.
< 0.001), comorbidities such as dyslipidemia (corrected OR = 1.59, 95% CI: 1.28 – 1.99,
35 p < 0.001), and male sex (adjusted OR = 1.40, 95% CI: 1.12 – 1.75, p = 0.003) also showed a clear positive effect on patient compliance
A key finding is that the average drug quantity factor initially appeared to negatively impact compliance in the univariate regression model; however, after adjusting for other variables in the multivariate model, it showed a positive association (adjusted OR = 1.49, 95% CI: 1.3–1.71) This indicates that, when accounting for confounding factors, the use of multiple medications actually enhances patient medication adherence rather than reducing it.
3.2 Assessment of perseverance of patients with type 2 diabetes at the 108th Military Central Hospital
3.2.1 Analysis of some factors related to perseverance
3.2.1.1 Demographic factors between persistent and non-persistent groups
The demographic characteristics of the patients participating in the study when comparing in 2 groups are presented in the following table:
Table 3.10 Demographic factors between persistent and non-persistent groups
Index Sum Non - persistence Persistence p
Index Sum Non - persistence Persistence p
The persistent group was characterized by a younger average age (66.8 ± 9.67 years) compared to the non-persistent group (69.1 ± 9.02 years), with a significant difference (p < 0.001) Men were more likely to be persistently engaged, comprising 54.5% of the persistence group versus 44.3% in the non-persistence group (p < 0.001) Out-of-province residents showed a higher tendency for persistence (5.1% vs 2.4%, p = 0.001) The persistent group also had a greater number of comorbidities, including higher incidences of hypertension (53.2% vs 45.0%, p < 0.001), dyslipidemia (52.1% vs 45.7%, p = 0.004), and other diseases (59.3% vs 66.3%, p = 0.001) Additionally, a higher percentage of individuals in the persistent group had comprehensive health insurance coverage, with entitlement rates of 95.0% and 100.0%, compared to the non-persistent group (p = 0.007).
Demographic factors that have a statistically significant influence on treatment persistence include age, gender, residential address, comorbidities such as hypertension and blood lipids, and health insurance coverage
3.2.1.2 Factors related to treatment drugs between persistence and non-persistence groups
Factors related to treatment drugs of patients participating in the study when compared in 2 groups presented in the following table:
Table 3.11 Therapeutic drug factors between persistence and non-persistence groups
Index Sum Non - persistence Persistence p
Index Sum Non - persistence Persistence p
Number of visits to the doctor with diabetes medication, average ± SD
Number of prescriptions for a group of drugs
Biguanide Medium ± SD Median (IQR)
Meglitinide Medium ± SD Median (IQR)
Sulfonylure Medium ± SD Median (IQR)
DPP-4 Medium ± SD Median (IQR)
SGLT2 Medium ± SD Median (IQR)
Index Sum Non - persistence Persistence p
Glucosidase Medium ± SD Median (IQR)
DPP-4 + biguanide Medium ± SD Median (IQR)
The study revealed significant differences between persistence and non-persistence groups regarding treatment factors Notably, the persistence group was prescribed fewer total medications, with an average of 4.8 compared to 5.8 in the non-persistent group (p < 0.001), yet received slightly more diabetes-specific medications—2.3 versus 2.2 (p < 0.001) Additionally, patients in the persistence group had a higher percentage of visits involving diabetes medication, averaging 9.6 compared to 6.5 in the non-persistence group (p < 0.001), indicating better medication adherence among persistent patients.
Significant differences were observed in the use of certain antidiabetic drug groups between the persistence and non-persistence groups Specifically, the persistence group showed lower usage rates of meglitinide, sulfonylureas, SGLT2 inhibitors, and glucosidase inhibitors, with the most notable differences seen in the sulfonylurea and SGLT2 inhibitor groups (p < 0.001) In contrast, there were no significant differences in the use of biguanides, DPP4 inhibitors, or combinations of sulfonylurea-biguanide and DPP4-biguanide between the two groups (p > 0.05).
Persistence and adherence to medication use of people with type 2 diabetes
Persistence and adherence to medication are crucial for controlling blood glucose and preventing complications in people with type 2 diabetes Despite this, studies show that the medication adherence rate remains low, particularly for oral antidiabetic drugs (OAD), with a global average compliance of only 55.53% Non-compliance diminishes the effectiveness of treatment, increases the risk of complications, and imposes a significant burden on healthcare systems Given the rising incidence of type 2 diabetes in Vietnam, identifying factors that influence treatment adherence is essential for developing targeted interventions This study provides valuable data on medication persistence and adherence among patients with type 2 diabetes at the 108th National Hospital.
The study revealed that only 31.2% of patients fully adhered to oral diabetes medication, with a high non-compliance rate of 68.8% This compliance rate is notably lower than previous research in Vietnam, such as Do Van Chien et al (2022), which reported a 61.7% adherence among 460 outpatients at National Hospital 108 Additionally, Pham Thi Lam Phuong et al (2024) found a higher compliance rate of 73.5% among 275 patients at Hanoi Medical University Hospital These findings highlight the need to improve medication adherence among diabetes patients in the region for better disease management. -**Sponsor**Need help making your rewritten article SEO-friendly and impactful? It sounds like you're looking to refine your content while adhering to SEO best practices [Article Generation](https://pollinations.ai/redirect-nexad/6JxViiWd) can instantly provide you with 2,000-word, SEO-optimized articles, extracting key sentences and meanings to build coherent paragraphs You can save time and resources, avoiding the costs of hiring a writer, and focus on delivering high-quality content It's like having a dedicated content team at your fingertips, ensuring your article shines!
Differences in adherence assessment may stem from variations in assessment methods, treatment drug groups, and study populations Our research utilizes secondary data from hospital management software, based on actual drug receptions, providing an objective measure of treatment adherence In contrast, comparative studies employed the Morisky scale (MMAS-8), relying on patient self-reports, which are prone to recall bias and social desirability bias.
This study focuses on oral diabetes medications, including various subgroups such as metformin, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, and alpha-glucosidase inhibitors It also examines combination drugs that pair two active ingredients, like sulfonylurea plus metformin and DPP-4 inhibitors plus metformin These medications differ in usage frequency and administration modes; for example, sulfonylureas can cause hypoglycemia if misused, while fixed-dose combination drugs offer less flexibility These characteristics can impact medication adherence and timely collection of prescriptions.
The study recorded an average of 46 days of treatment, highlighting challenges in medication adherence and persistence Unlike previous research at the 108th National Hospital, which focused solely on patients using metformin monotherapy—an easily tolerated drug with minimal side effects—this study at Hanoi Medical University Hospital included patients on oral medications, insulin, and combination therapies Notably, patients on insulin demonstrated the highest adherence rate at 84.2%, significantly boosting the overall adherence rate among all treatment groups.
Differences in adherence rates across studies are influenced by variations in participant characteristics My research focused on individuals with type 2 diabetes using oral medications, requiring at least two prescriptions in 2023, thereby capturing a broader and more realistic treatment spectrum, including monotherapy and combination therapies In contrast, the study at the 108th National Hospital only included patients treated with metformin, while the study at Hanoi Medical University Hospital focused on patients who had been treated for three months or longer and included insulin users—groups that generally exhibit higher compliance levels.
Our study found a significantly lower adherence rate (31.2%) to oral diabetes medications compared to international studies that utilized real-world insurance data or large databases, which reported median adherence rates ranging from approximately 51.2% to 54% Evans et al (2022) noted a median compliance of 51.2% and persistence of 47.7%, highlighting that higher adherence and persistence are linked to better glycemic control and reduced complications Similarly, Iglay et al (2015) reported an average adherence of 54%, with non-adherence associated with poor treatment outcomes and increased hospitalization risk Recent research from Japan (2025) indicated the highest compliance rate in the SGLT2i group at about 64.7%, whereas other drug groups showed lower rates These differences may stem from variations in study populations, with international studies often focusing on less complex or stabilized medication regimens, whereas our study encompasses the entire class of oral diabetes medications, including fixed-dose combinations requiring strict adherence Additionally, higher levels of patient monitoring and treatment management in developed countries may contribute to better medication adherence, while the use of objective insurance data in our study reflects actual medication-taking behavior more accurately.
47 behavior but is also more rigorous than self-reporting methods, which are common in meta-studies.
Some factors affecting compliance and persistence in the use of oral diabetes medications of people
Demographic factors significantly influence both treatment adherence and the persistence of long-term regimen maintenance Specifically, gender, comorbidities, and levels of health insurance entitlement were identified as key variables, with statistically significant differences observed between compliant and non-compliant groups These findings highlight the importance of considering demographic characteristics to improve patient adherence and ensure sustained treatment outcomes.
Analysis indicates that gender significantly influences medication adherence and persistence in patients with Type 2 diabetes, with men demonstrating higher compliance and persistence rates than women (OR 1.40, p=0.003 for compliance; OR 1.44, p