Determinants of Adherence to Diabetes Medications: Findings From a Large Pharmacy Claims Database
Open accessAbstract
OBJECTIVE: Adults with diabetes typically take multiple medications for hyperglycemia, diabetes-associated conditions, and other comorbidities. Medication adherence is associated with improved outcomes, including reduced health care costs, hospitalization, and mortality. We conducted a retrospective analysis of a large pharmacy claims database to examine patient, medication, and prescriber factors associated with adherence to antidiabetic medications. RESEARCH DESIGN AND METHODS: We extracted data on a cohort of >200,000 patients who were treated for diabetes with noninsulin medications in the second half of 2010 and had continuous prescription benefits eligibility through 2011. Adherence was defined as a medication possession ratio ≥0.8. We used a modified adherence measure that accounted for switching therapies. Logistic regression analysis was performed to determine factors independently associated with adherence. RESULTS: Sixty-nine percent of patients were adherent. Adherence was independently associated with older age, male sex, higher education, higher income, use of mail order versus retail pharmacies, primary care versus nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. Patients who were new to diabetes therapy were significantly less likely to be adherent. CONCLUSIONS: Several demographic, clinical, and potentially modifiable system-level factors were associated with adherence to antidiabetic medications. Patients typically perceived to be healthy (those who are younger, new to diabetes, and on few other medications) may be at risk for nonadherence. For all patients, efforts to reduce out-of-pocket costs and encourage use of mail order pharmacies may result in higher adherence.
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Male sex was independently associated with greater treatment adherence (OR 1.14, p = 0.0001).
“In further detail, a study focusing on a variety of factors influencing adherence rates to noninsulin antidiabetic agents indicated that male sex was independently associated with greater treatment adherence (OR 1.14, p = 0.0001) [89].”
From Sex Differences in Response to Treatment with Glucagon-like Peptide 1 Receptor Agonists: Opportunities for a Tailored Approach to Diabetes and Obesity Care (2022) · cites this paper as [89]
The Results (Patient Factors, Table 2) report that men had greater adjusted odds of adherence than women, with an OR of 1.14. The table gives P < 0.0001, not P = 0.0001 as claimed. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHigh out-of-pocket drug costs are identified as a factor that limits initiation of and adherence to prescribed glucose lowering therapies.
“High out-of-pocket (OOP) drug costs are identified as a factor that limit initiation of and adherence to prescribed glucose lowering therapies.8,9,10,11,12”
From Evaluation of Out-of-Pocket Costs and Treatment Intensification With an SGLT2 Inhibitor or GLP-1 RA in Patients With Type 2 Diabetes and Cardiovascular Disease (2023) · cites this paper as [8]
The Conclusions report that higher out-of-pocket costs were associated with lower odds of adherence to noninsulin antidiabetic medications. They also state that the study could not assess primary nonadherence—failure to fill an initial prescription—so it does not establish that costs limit initiation. (LLM, conf=0.90)
Experimental — accuracy not yet measured
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- Authors
- Kirkman, M. S., Rowan-Martin, M. T., Levin, R., Fonseca, V. A., Schmittdiel, J. A., Herman, W. H., & Aubert, R. E.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- American Diabetes Association (US)
- Express Scripts, Franklin Lakes, NJ
- Tulane University (US)
- Kaiser Permanente (US)
- University of Michigan (US)
- Research and Evaluation Analytics, LLC, Ringwood, NJ
- Corresponding author
- Kirkman, M. Sue
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-01-08
- Volume
- 38
- Issue
- 4
- Pages
- 604-609
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4370331
- OpenAlex
- W2050153005
- Cited by
- 388
- References
- 29
- Citations by year
- 2026: 20 · 2025: 34 · 2024: 37 · 2023: 43 · 2022: 25 · 2021: 54 · 2020: 35 · 2019: 39 · 2018: 28 · 2017: 27 · 2016: 31 · 2015: 15
- FWCI
- 39.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Novo Nordisk
- Amylin Pharmaceuticals
- 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, antidiabetic drugs, diabetes mellitus, medication possession ratio, predictors of adherence, medication burden, out-of-pocket costs, mail-order pharmacy, prescriber specialty, patient demographics, new-onset diabetes
- MeSH terms
- Assessment of Medication Adherence, Adult, Aged, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Insurance Claim Review, Male, Middle Aged, Pharmacies, Retrospective Studies, Epidemiologic Factors, Databases, Factual, Drug Monitoring, Health Care Costs, Medication Adherence
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