Defining the role of medication adherence in poor glycemic control among a general adult population with diabetes
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AIMS: This study assesses the attributable impact of adherence to oral glucose medications as a risk factor for poor glycemic control in population subgroups of a large general population, using an objective medication adherence measure. METHODS: Using electronic health records data, adherence to diabetes medications over a two-year period was calculated by prescription-based Medication Possession Ratios for adults with diabetes diagnosed before January 1, 2010. Glycemic control was determined by the HbA1c test closest to the last drug prescription during 2010-2012. Poor control was defined as HbA1c>75 mmol/mol (9.0%). Medication adherence was categorized as "good" (>80%), "moderate" (50-80%), or "poor" (<50%). Logistic regression models assessed the role medication adherence plays in the association between disease duration, age, and poor glycemic control. We calculated the change in the attributable fraction of glucose control if the non-adherent diabetic medication population would become adherent by age-groups. RESULTS: Among 228,846 diabetes patients treated by oral antiglycemic medication, 46.4% had good, 28.8% had moderate, and 24.8% had poor adherence. Good adherence rates increased with increasing disease duration, while glycemic control became worse. There was a strong inverse association between adherence level and poor control (OR = 2.50; CI = 2.43-2.58), and adherence was a significant mediator between age and poor control. CONCLUSIONS: A large portion of the diabetes population is reported to have poor adherence to oral diabetes medications, which is strongly associated with poor glycemic control in all disease durations. While poor adherence does not mediate the poorer glycemic control seen in patients with longer-standing disease, it is a significant mediator of poor glycemic control among younger diabetes patients. A greater fraction of poorly controlled younger patients, compared to older patients, could be prevented if at least 80% adherence to their medications was achieved. Therefore, our results suggest that interventions to improve adherence should focus on this younger sub-group.
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Consistent adherence to treatment regimens improves A1C, but the improvement is modest.
“While following treatment regimens consistently improves A1C (9–12), the impact is modest.”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [12]
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- Authors
- Feldman, B. S., Cohen-Stavi, C. J., Leibowitz, M., Hoshen, M. B., Singer, S. R., Bitterman, H., Lieberman, N., & Balicer, R. D.
- Affiliations
- Clalit Health Services (IL)
- New York University (US)
- Israel Ministry of Health (IL)
- Technion – Israel Institute of Technology (IL)
- Ben-Gurion University of the Negev (IL)
- Corresponding author
- Feldman, Becca S.
- Cohen-Stavi, Chandra J.
- Leibowitz, Morton
- Hoshen, Moshe B.
- Singer, Shepherd R.
- Bitterman, Haim
- Lieberman, Nicky
- Balicer, Ran D.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-09-26
- Volume
- 9
- Issue
- 9
- Pages
- e108145
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4178119
- OpenAlex
- W2117390981
- Cited by
- 79
- References
- 36
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 9 · 2022: 9 · 2021: 9 · 2020: 3 · 2019: 9 · 2018: 9 · 2017: 8 · 2016: 9 · 2015: 3
- FWCI
- 6.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Clalit Health Services
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- medication adherence, glycemic control, diabetes mellitus, HbA1c, medication possession ratio, disease duration, age differences, attributable fraction, mediation analysis, young adults
- MeSH terms
- Adult, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Risk Factors, Treatment Outcome, Medication Adherence, Young Adult, Public Health Surveillance
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