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Randomized Controlled Trial
. 2020 May;43(5):1070-1076.
doi: 10.2337/dc19-0884. Epub 2020 Feb 27.

Medication Adherence During Adjunct Therapy With Statins and ACE Inhibitors in Adolescents With Type 1 Diabetes

Elżbieta Niechciał  1 , Carlo L Acerini  2 , Scott T Chiesa  3 , Tracey Stevens  2 , R Neil Dalton  4 , Denis Daneman  5 , John E Deanfield  3 , Timothy W Jones  6 , Farid H Mahmud  5 , Sally M Marshall  7 , H Andrew W Neil  8 , David B Dunger  2   9 , M Loredana Marcovecchio; Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) Study Group; Adolescent Type 1 Diabetes Cardio-renal Intervention Trial AdDIT Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Medication Adherence During Adjunct Therapy With Statins and ACE Inhibitors in Adolescents With Type 1 Diabetes

Elżbieta Niechciał et al. Diabetes Care. 2020 May.

Abstract

Objective: Suboptimal adherence to insulin treatment is a main issue in adolescents with type 1 diabetes. However, to date, there are no available data on adherence to adjunct noninsulin medications in this population. Our aim was to assess adherence to ACE inhibitors and statins and explore potential determinants in adolescents with type 1 diabetes.

Research design and methods: There were 443 adolescents with type 1 diabetes recruited into the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) and exposed to treatment with two oral drugs-an ACE inhibitor and a statin-as well as combinations of both or placebo for 2-4 years. Adherence was assessed every 3 months with the Medication Event Monitoring System (MEMS) and pill count.

Results: Median adherence during the trial was 80.2% (interquartile range 63.6-91.8) based on MEMS and 85.7% (72.4-92.9) for pill count. Adherence based on MEMS and pill count dropped from 92.9% and 96.3%, respectively, at the first visit to 76.3% and 79.0% at the end of the trial. The percentage of study participants with adherence ≥75% declined from 84% to 53%. A good correlation was found between adherence based on MEMS and pill count (r = 0.82, P < 0.001). Factors associated with adherence were age, glycemic control, and country.

Conclusions: We report an overall good adherence to ACE inhibitors and statins during a clinical trial, although there was a clear decline in adherence over time. Older age and suboptimal glycemic control at baseline predicted lower adherence during the trial, and, predictably, reduced adherence was more prevalent in subjects who subsequently dropped out.

Trial registration: ClinicalTrials.gov NCT01581476.

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Conflict of interest statement

Conflict of interest

None in related to the present work.

Figures

Figure 1
Figure 1
Adherence during the trial period based on MEMS and pill count Results at each study visit are reported as medians. N of participants are those still active at each follow up study visit with available adherence data. At the first 1-month visit. P for over time changes in each group: <0.001
Figure 2
Figure 2
Comparisons between adherence assessed by MEMS and pill count: A) Scatter plot of pill count vs MEMS, r=0.82, p<0.001. B) Bland-Altman plots of the two adherence methods
Figure 3
Figure 3
Percentage of participants showing different levels of adherence, from ≥75% to <25%
See this image and copyright information in PMC

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