Diabetes treatment failure may actually be nonadherence

(HealthDay)—Apparent diabetes treatment failures may in fact be attributable to nonadherence, according to a study published online Sept. 15 in Diabetes Care.

Yi-Ju Tseng, Ph.D., from Boston Children's Hospital, and colleagues retrospectively analyzed unidentifiable member claims data from 52,544 individuals covered by Aetna who had two physician claims or one hospitalization with a type 2 diabetes diagnosis (2010 to 2015).

The researchers found that of 22,956 patients given second-line treatment, only 8.2 percent had evidence of recommended use of metformin in the prior 60 days, and 28.0 percent had no prior claims evidence of having taken metformin. Only 49.5 percent of patients could have had recommended use. An additional second-line antihyperglycemic medication or insulin was more likely in patients given their initial second-line medication without evidence of recommended use of metformin (P < 0.001).

"Despite published guidelines, second-line therapy often is initiated without evidence of recommended use of first-line therapy. Apparent treatment failures, which may in fact be attributable to nonadherence to guidelines, are common," the authors write. "Point-of-care and population-level processes are needed to monitor and improve guideline adherence."