Advertisement

Endocrine

, Volume 61, Issue 1, pp 23–27 | Cite as

Glycemic control in type 2 diabetes: from medication nonadherence to residual vascular risk

  • Dario Giugliano
  • Maria Ida Maiorino
  • Giuseppe Bellastella
  • Katherine Esposito
Viewpoint

Abstract

Despite the availability of many new treatment options for type 2 diabetes, the proportion of patients achieving the HbA1c target < 7.0% remains around 50%. We put forward the hypothesis that the unchanged HbA1c results, observed in the last decade in type 2 diabetes patients, are also a consequence of medication nonadherence and clinical inertia. Poor medication-taking behavior is usually defined as medication nonadherence and is responsible for uncontrolled hemoglobin A1c level in 23% of cases. Medication nonadherence may also affect clinical outcomes, as diabetic patients with good adherence (≥80%) had a significant 10% lower rate of hospitalization events and a significant 28% lower rate of all-cause mortality when compared with patients with poor adherence (<80%). Residual vascular risk may be defined as the risk of macrovascular (major cardiovascular events) and microvascular (retinopathy, nephropathy, neuropathy) complications that remains after intensive and successful glycemic control in type 2 diabetes. For major cardiovascular events, risk reduction following intensive glycemic control is 9% and, therefore, residual vascular risk is 91%. For microvascular complications, as nephropathy, residual vascular risk is as high as 80%. Residual vascular risk remains high in type 2 diabetes despite intensive glycemic control. Medication nonadherence by the diabetic patient and clinical inertia by the clinician may have contributed to the high level of residual vascular risk (both macro and microvascular) of type 2 diabetic patients.

Keywords

Residual vascular risk Type 2 diabetes Glycemic control Medication nonadherence Clinical inertia 

Notes

Compliance with ethical standards

Conflict of interest

D.G. received speaker fee from Lilly, NOVO, Sanofi, Roche, and Novartis; K.E. received speaker fee from NOVO, Sanofi, Roche, Novartis, and Merck. The remaining authors declare that they have no conflict of interest.

References

  1. 1.
    American Diabetes Association, Standards of medical care in diabetes—2018. 1. Improving care and promoting health populations. Diabetes Care 41(Suppl 1), S7–S12 (2018)CrossRefGoogle Scholar
  2. 2.
    Institute of Medicine Committee on Quality of Health Care in America. in Crossing the quality chasm: a new health system for the 21st century (The National Academies Press, Washington, DC, 2001)Google Scholar
  3. 3.
    American Diabetes Association Standards of medical care in diabetes—2018. 8. Pharmacologic approaches to glycemic treatment. Diabetes Care 41(Suppl. 1), S73–S85 (2018)Google Scholar
  4. 4.
    S. Vijan, J.B. Sussman, J.S. Yudkin, R.A. Hayward, Effect of patients’ risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus. JAMA Intern. Med. 174, 1227–1234 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    K.J. Lipska, X. Yao, J. Herrin et al., Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006–2013. Diabetes Care 40, 468–754 (2017)CrossRefPubMedGoogle Scholar
  6. 6.
    M.K. Ali, K.M. Bullard, J.B. Saaddine, C.C. Cowie, G. Imperatore, E.W. Gregg, Achievement of goals in U.S. diabetes care, 1999-2010. N. Engl. J. Med. 368, 1613–1624 (2013)CrossRefPubMedGoogle Scholar
  7. 7.
    M.A. Raebel, J. Schmittdiel, A.J. Karter, J.L. Konieczny, J.F. Steiner, Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases. Med. Care 51(Suppl 3), S11–S21 (2013)CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    F. Alvarez Guisasola, S. Tofè Povedano, G. Krishnarajah, R. Lyu, P. Mavros, D. Yin, 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. 10(Suppl 1), 25–32 (2008)CrossRefPubMedGoogle Scholar
  9. 9.
    T.J. Bramley, P.P. Gerbino, B.S. Nightengale, F. Frech-Tamas, Relationship of blood pressure control to adherence with antihypertensive monotherapy in 13 managed care organizations. J. Manag. Care Pharm. 12, 239–245 (2006)PubMedGoogle Scholar
  10. 10.
    P.M. Ho, J.S. Rumsfeld, F.A. Masoudi et al., Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch. Intern. Med. 166, 1836–1841 (2006)CrossRefPubMedGoogle Scholar
  11. 11.
    W.J. Katon, E.H.B. Lin, M.Von Korff et al., Collaborative care for patients with depression and chronic illnesses. N. Engl. J. Med. 363, 2611–2620 (2010)CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    M.R. Patel, J.D. Piette, K. Resnicow, T. Kowalski-Dobson, M. Heisler, Social determinants of health, cost-related nonadherence, and cost-reducing behaviors among adults with diabetes: findings from the National Health Interview Survey. Med. Care 54, 796–803 (2016)CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    A.M. Farr, J.J. Sheehan, S.M. Curkendall, D.M. Smith, S.S. Johnston, I. Kalsekar, Retrospective analysis of long-term adherence to and persistence with DPP-4 inhibitors in US adults with type 2 diabetes mellitus. Adv. Ther. 31, 1287–1305 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    J. Yeaw, J.S. Benner, J.G. Walt, S. Sian, D.B. Smith, Comparing adherence and persistence across 6 chronic medication classes. J. Manag. Care Pharm. 15, 728–740 (2009)PubMedGoogle Scholar
  15. 15.
    S.V. Edelman, W.H. Polonsky, Type 2 diabetes in the real world: the elusive nature of glycemic control. Diabetes Care 40, 1469–1478 (2017)CrossRefPubMedGoogle Scholar
  16. 16.
    K. Khunti, S. Seidu, S. Kunutsor, M. Davies, Association between adherence to pharmacotherapy and outcomes in type 2 diabetes: a meta-analysis. Diabetes Care 40, 1588–1596 (2017)CrossRefPubMedGoogle Scholar
  17. 17.
    S.H. Simpson, D.T. Eurich, S.R. Majumdar, et al., A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 333, 15 (2006).CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    D. Giugliano, K. Esposito, Clinical inertia as a clinical safeguard. JAMA 305, 1591–1592 (2011)CrossRefPubMedGoogle Scholar
  19. 19.
    D. Giugliano, K. Esposito, Clinical inertia and uncertainty in medicine. JAMA 306, 383–384 (2011)CrossRefGoogle Scholar
  20. 20.
    K. Khunti, M.L. Wolden, B.L. Thorsted, M. Andersen, M.J. Davies, Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care 36, 3411–3417 (2013)CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    C.J. Currie, E.A. Gale, C.D. Poole, Estimation of primary care treatment costs and treatment efficacy for people with type 1 and type 2 diabetes in the United Kingdom from 1997 to 2007. Diabet. Med. 27, 938–948 (2010)CrossRefPubMedGoogle Scholar
  22. 22.
    D. Giugliano, M.I. Maiorino, G. Bellastella, K. Esposito, Type 2 diabetes and cardiovascular prevention: the dogmas disputed. Endocrine (2017). https://doi.org/10.1007/s12020-017-1418-y
  23. 23.
    F.M. Turnbull, C. Abraira, R.J. Anderson et al., Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 52, 2288–2298 (2009)CrossRefPubMedGoogle Scholar
  24. 24.
    S. Zoungas, H. Arima, H.C. Gerstein, R.R. Holman, M. Woodward, P. Reaven, R.A. Hayward, T. Craven, R.L. Coleman, J. Chalmers, Collaborators on Trials of Lowering Glucose (CONTROL) group, Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomized controlled trials. Lancet Diabetes Endocrinol. 5, 431–377 (2017)Google Scholar
  25. 25.
    R.B. Haynes, E. Ackloo, N. Sahota, H.P. McDonald, X. Yao, Interventions for enhancing medication adherence. Cochrane Databse Syst. Rev. 2, CD000011 (2008)Google Scholar
  26. 26.
    J.M. McWilliams, M. Najafzadeh, W.H. Shrank, J.M. Polinski, Association of changes in medication use and adherence with accountable care organization exposure in patients with cardiovascular disease or diabetes. JAMA Cardiol. 2, 1019–1023 (2017)CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    K. Esposito, A. Ceriello, D. Giugliano, Does personalized diabetology overcome clinical uncertainty and therapeutic inertia in type 2 diabetes? Endocrine 44, 343–345 (2013)CrossRefPubMedGoogle Scholar
  28. 28.
    A. Coppola, L. Sasso, A. Bagnasco, A. Giustina, C. Gazzaruso, The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine 53, 18–27 (2016)CrossRefPubMedGoogle Scholar
  29. 29.
    C. Gazzaruso, M. Fodaro, A. Coppola, Structured therapeutic education in diabetes: is it time to re-write the chapter on the prevention of diabetic complications? Endocrine 53, 347–349 (2016)CrossRefPubMedGoogle Scholar
  30. 30.
    X. He, J. Li, B. Wang et al., Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 55, 712–731 (2017)CrossRefPubMedGoogle Scholar
  31. 31.
    C.K.H. Wong, W.C.W. Wong, E.Y.F. Wan, A.K.C. Chan, F.W.K. Chan, C.L.K. Lam, Macrovascular and microvascular disease in obese patients with type 2 diabetes attending structured diabetes education program: a population-based propensity-matched cohort analysis of Patient Empowerment Programme (PEP). Endocrine 53, 412–422 (2016)CrossRefPubMedGoogle Scholar
  32. 32.
    A. Coppola, L. Luzi, T. Montalcini, A. Giustina, C. Gazzaruso, Role of structured individual patient education in the prevention of vascular complications in newly diagnosed type 2 diabetes: the Individual Therapeutic Education in Newly Diagnosed type 2 diabetes (INTEND) randomized controlled trial. Endocrine (2017). https://doi.org/10.1007/s12020-017-1427-x
  33. 33.
    U.S. Food and Drug Administration. Drugs@FDA: FDA approved drug products. https://www.accessdata.fda.gov/scripts/cder/drugsatfda/. Accessed 20 Dec 2017
  34. 34.
    R.B. Bean, W.B. Bean, in Sir William Osler: Aphorisms from his Bedside Teachings and Writings, ed. by H. Schuman. New York (1950)Google Scholar
  35. 35.
    D. Giugliano, M.I. Maiorino, G. Bellastella, K. Esposito, Diabetes is a cardiovascular disease, isn’t it? Diabetes Res. Clin. Pract (2017). https://doi.org/10.1016/j.diabres.2017.11.006
  36. 36.
    Evidence-Based Medicine Working Group, Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 268, 2420–2425 (1992)CrossRefGoogle Scholar
  37. 37.
    D.L. Sackett, W.M. Rosenberg, J.A. Gray, R.B. Haynes, W.S. Richardson., Evidence based medicine: what it is and what it isn’t. BMJ 312, 71–72 (1996)CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and AgingLuigi Vanvitelli UniversityNaplesItaly
  2. 2.Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and AgingLuigi Vanvitelli UniversityNaplesItaly

Personalised recommendations