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. 2008 May;23(5):588-94.
doi: 10.1007/s11606-008-0554-8. Epub 2008 Mar 4.

Why don't diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification

Julie A Schmittdiel  1 , Connie S Uratsu, Andrew J Karter, Michele Heisler, Usha Subramanian, Carol M Mangione, Joe V Selby
Affiliations

Why don't diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification

Julie A Schmittdiel et al. J Gen Intern Med. 2008 May.

Abstract

Background: Despite the availability of effective hypertension, hyperlipidemia, and hyperglycemia therapies, target levels of systolic blood pressure (SBP), LDL-cholesterol (LDL-c), and hemoglobin A1c control are often not achieved.

Objective: To examine the relative importance of patient medication nonadherence versus clinician lack of therapy intensification in explaining above target cardiovascular disease (CVD) risk factor levels.

Design: Cross-sectional assessment.

Participants: In 2005, 161,697 Kaiser Permanente Northern California adult diabetes patients were included in the study.

Measurement: "Above target" was defined as most recent A1c >/=7.0% for hyperglycemia, LDL-c >/=100 mg/dL for hyperlipidemia, and SBP >/=130 mmHg for hypertension. Poor adherence was defined as medication gaps for >/=20% of days covered for all medications for each condition separately. Treatment intensification was defined as an increase in the number of drug classes, increased dosage of a class, or a switch to a different class within the 3 months before or after notation of above target levels.

Results: Poor adherence was found in 20-23% of patients across the 3 conditions. No evidence of poor adherence with no treatment intensification was found in 30% of hyperglycemia patients, 47% of hyperlipidemia patients, and 36% of hypertension patients. Poor adherence or lack of therapy intensification was evident in 53-68% of patients above target levels across conditions.

Conclusions: Both nonadherence and lack of treatment intensification occur frequently in patients above target for CVD risk factor levels; however, lack of therapy intensification was somewhat more common. Quality improvement efforts should focus on these modifiable barriers to CVD risk factor control.

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Figures

Figure 1
Figure 1
Medication adherence and intensification for glycemic control in patients not on insulin at baseline. *Among patients who had a follow-up laboratory value within 6 months (44%). + p < .001 difference between treatment intensification group and other 2 groups.
Figure 2
Figure 2
Medication adherence and intensification for hyperlipidemia among diabetes patients. *Among patients who had a follow-up laboratory value within 6 months (46%). + p < .001 difference between treatment intensification group and other 2 groups.
Figure 3
Figure 3
Medication adherence and intensification for hypertension among diabetes patients. *Among patients who had a follow-up laboratory value within 6 months (49%). + p < .001 difference between treatment intensification group and other 2 groups.
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References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.diabres.2006.10.016', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.diabres.2006.10.016'}, {'type': 'PubMed', 'value': '17118478', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17118478/'}]}
    2. Malik S, Lopez V, Chen R, Wu W, Wong ND. Undertreatment of cardiovascular risk factors among persons with diabetes in the United States. Diabetes Res Clin Pract. 2007;77(1):126–33. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.291.3.335', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.291.3.335'}, {'type': 'PubMed', 'value': '14734596', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/14734596/'}]}
    2. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291:335–42. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.297.12.1308', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.297.12.1308'}]}
    2. Neyer JR, Greenlund KJ, Denny CH, Keenan NL, Labarthe DR, Croft JB. Prevalence of heart disease—United States, 2005. JAMA. 2007;297:1308–9.
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1161/01.CIR.0000020190.45892.75', 'is_inner': False, 'url': 'https://doi.org/10.1161/01.cir.0000020190.45892.75'}, {'type': 'PubMed', 'value': '12119259', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12119259/'}]}
    2. Pearson TA, Blair SN, Daniels S, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation. 2002;106:388–91. - PubMed
    1. Anonymous. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–9. - PubMed

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