Abstract
Dyslipidemia and diabetes mellitus are commonly coincident, and together contribute to the development of atherosclerotic disease. Medication therapy is the mainstay of treatment for dyslipidemia. Optimal medication therapy for dyslipidemia in patients with diabetes reduces cardiovascular events but necessitates patients take multiple medications. As a result, sub-optimal adherence to medication therapy is common. Factors contributing to medication non-adherence in patients taking multiple medications are complex and can be grouped into patient-, social and economic-, medication therapy-, and health provider and health system-related factors. Strategies aimed at improving medication adherence may target the patient, health care providers, or health systems. Recent data suggest medication non-adherence contributes to racial health disparities. In addition, health literacy, cost-related medication non-adherence, and patient beliefs regarding medication therapy have all been recently described as factors affecting medication adherence. Data from within the last year support an important role for regular contact between patients and health care providers to effectively address these factors. Cost-related barriers to medication adherence have recently been addressed through examination of health system approaches to decreasing cost-related non-adherence.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
O’Brien T, Nguyen TT, Zimmerman BR. Hyperlipidemia and diabetes mellitus. Mayo Clin Proc. 1998;73:969–76.
MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360, 7–22.
Kearney PM et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117–25.
Tourkmani AM et al. Medication adherence among patients in a chronic disease clinic. Saudi Med J. 2012;33:1278–84.
Zhang Q, Zhao C, Davies MJ, Radican L, Seck T. Compliance and persistence with concomitant statin and oral antihyperglycemic therapy. Am J Manag Care. 2011;17:746–52. 2011.
De Geest S, Sabaté E. Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs. 2003;2:323.
• Schroeder EB et al. Simultaneous Control of Diabetes Mellitus, Hypertension, and Hyperlipidemia in 2 Health Systems. Circ Cardiovasc Qual Outcomes. 2012;5:645–53. Important recent description of poor rates of simultaneous control of multiple chronic medical conditions. Highlights the challenges faced in management of diabetes with other coincident medical conditions.
Wallach-Kildemoes H, Andersen M, Diderichsen F, Lange T. Adherence to preventive statin therapy according to socioeconomic position. Eur J Clin Pharmacol. 2013. doi:10.1007/s00228-013-1488-6.
Saffar D, Williams K, Lafata JE, Divine G, Pladevall M. Racial disparities in lipid control in patients with diabetes. Am J Manag Care. 2012;18:303–11.
Marcum ZA et al. Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. Res Soc Adm Pharm Rsap. 2013. doi:10.1016/j.sapharm.2012.12.002.
Hunt KJ et al. Impact of diabetes control on mortality by race in a national cohort of veterans. Ann Epidemiol. 2013;23:74–9.
Jackevicius CA, Li P, Tu JV. Prevalence, Predictors, and Outcomes of Primary Nonadherence After Acute Myocardial Infarction. Circulation. 2008;117:1028–36.
Lee HY, Cooke CE, Robertson TA. Use of secondary prevention drug therapy in patients with acute coronary syndrome after hospital discharge. J Manag Care Pharm. 2008;14:271–80.
Sanfélix-Gimeno G et al. Adherence to evidence-based therapies after acute coronary syndrome: a retrospective population-based cohort study linking hospital, outpatient, and pharmacy health information systems in valencia, Spain. J Manag Care Pharm. 2013;19:247–57.
Natarajan N, Putnam W, Van Aarsen K, Beverley Lawson K, Burge F. Adherence to antihypertensive medications among family practice patients with diabetes mellitus and hypertension. Can Fam Physician Méd Fam Can. 2013;59:e93–e100.
Choudhry NK et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med. 2011;365:2088–97.
• Williams J, Steers WN, Ettner SL, Mangione CM, Duru OK. Cost-related nonadherence by medication type among Medicare Part D beneficiaries with diabetes. Med Care. 2013;51:193–8. Describes a significant rate of cost-related medication non-adherence in patients with diabetes mellitus enrolled in Medicare Part D plans.
Paes AHP, Bakker A, Soe-Agnie CJ. Impact of Dosage Frequency on Patient Compliance. Dia Care. 1997;20:1512–7.
Dailey G, Kim MS, Lian JF. Patient compliance and persistence with antihyperglycemic drug regimens: evaluation of a medicaid patient population with type 2 diabetes mellitus. Clin Ther. 2001;23:1311–20.
Laliberté F et al. Impact of daily dosing frequency on adherence to chronic medications among nonvalvular atrial fibrillation patients. Adv Ther. 2012;29:675–90.
Alvarez Guisasola F et al. Hypoglycaemic symptoms, treatment satisfaction, adherence and their associations with glycaemic goal in patients with type 2 diabetes mellitus: findings from the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) Study. Diabetes Obes Metab. 2008;10 Suppl 1:25–32.
Hauber AB, Mohamed AF, Johnson FR, Falvey H. Treatment preferences and medication adherence of people with Type 2 diabetes using oral glucose-lowering agents. Diabet Med J Br Diabet Assoc. 2009;26:416–24.
Osborn CY et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun. 2011;16 Suppl 3:268–78.
Loke YK, Hinz I, Wang X, Salter C. Systematic Review of Consistency Between Adherence to Cardiovascular or Diabetes Medication and Health Literacy in Older Adults. Ann Pharmacother. 2012;46:863–72.
Bauer AM et al. Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE). J Gen Intern Med. 2013. doi:10.1007/s11606-013-2402-8.
Grodensky CA, Golin CE, Ochtera RD, Turner BJ. Systematic review: effect of alcohol intake on adherence to outpatient medication regimens for chronic diseases. J Stud Alcohol Drugs. 2012;73:899–910.
Bryson CL et al. Alcohol Screening Scores and Medication Nonadherence. Ann Intern Med. 2008;149:795–W165.
Osborn CY, Egede LE. The relationship between depressive symptoms and medication nonadherence in type 2 diabetes: the role of social support. Gen Hosp Psychiatry. 2012;34:249–53.
Amar J, Ferrières J, Cambou J-P, Amelineau E, Danchin N. Persistence of combination of evidence-based medical therapy in patients with acute coronary syndromes. Arch Cardiovasc Dis. 2008;101:301–6.
Al-Omran M et al. Suboptimal use of statin therapy in elderly patients with atherosclerosis: A population-based study. J Vasc Surg. 2008;48:607–612.e1.
Farmer A, Kinmonth A-L, Sutton S. Measuring beliefs about taking hypoglycaemic medication among people with Type 2 diabetes. Diabet Med. 2006;23:265–70.
Sirey JA, Greenfield A, Weinberger MI, Bruce ML. Medication Beliefs and Self-Reported Adherence Among Community-Dwelling Older Adults. Clin Ther. 2013;35:153–60.
Walker RJ et al. Effect of diabetes fatalism on medication adherence and self-care behaviors in adults with diabetes. Gen Hosp Psychiatry. 2012;34:598–603.
Carter SR, Moles R, White L, Chen TF. Medication information seeking behavior of patients who use multiple medicines: How does it affect adherence? Patient Educ Couns. 2013. doi:10.1016/j.pec.2013.01.019.
Ratanawongsa N et al. Communication and medication refill adherence: the Diabetes Study of Northern California. Jama Intern Med. 2013;173:210–8.
Vanderpoel DR, Hussein MA, Watson-Heidari T, Perry A. Adherence to a fixed-dose combination of rosiglitazone maleate/metformin hydrochloride in subjects with type 2 diabetes mellitus: A retrospective database analysis. Clin Ther. 2004;26:2066–75.
Hutchins V, Zhang B, Fleurence RL, Krishnarajah G, Graham J. A systematic review of adherence, treatment satisfaction and costs, in fixed-dose combination regimens in type 2 diabetes. Curr Med Res Opin. 2011;27:1157–68.
Scanlon DP et al. Financial and Clinical Impact of Team-Based Treatment for Medicaid Enrollees With Diabetes in a Federally Qualified Health Center. Dia Care. 2008;31:2160–5. 2008.
Nieuwkerk PT et al. Intervention to Improve Adherence to Lipid-Lowering Medication and Lipid-Levels in Patients With an Increased Cardiovascular Risk. Am J Cardiol. 2012;110:666–72.
Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Pharm. 2012;18:516–26.
Lin EHB et al. Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial. Ann Fam Med. 2012;10:6–14.
• Elliott DJ, Robinson EJ, Anthony KB, Stillman PL. Patient-centered outcomes of a value-based insurance design program for patients with diabetes. Popul Heal Manag. 2013;16:99–106. Prospective cohort study demonstrating a value-based insurance plan is associated with an improvement in patient-reported medication adherence.
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Thomas M. Maddox has received a Career Development Award from the Department of Veterans Affairs.
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Lucas N. Marzec and Thomas M. Maddox declare that they have no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Lipid Abnormalities and Cardiovascular Prevention
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Marzec, L.N., Maddox, T.M. Medication Adherence in Patients with Diabetes and Dyslipidemia: Associated Factors and Strategies for Improvement. Curr Cardiol Rep 15, 418 (2013). https://doi.org/10.1007/s11886-013-0418-7
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DOI: https://doi.org/10.1007/s11886-013-0418-7