Adherence and Persistence to Basal Insulin Among People with Type 2 Diabetes in Europe: A Systematic Literature Review and Meta-analysis.

IF 3.8 3区医学 Q2 Medicine

Diabetes Therapy Pub Date : 2024-05-01 Epub Date: 2024-03-23 DOI:10.1007/s13300-024-01559-w

Esteban J Gimeno, Mette Bøgelund, Sara Larsen, Anna Okkels, Signe B Reitzel, Hongye Ren, Domingo Orozco-Beltran

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Abstract

Introduction: Diabetes is associated with a number of complications, particularly if glycaemic targets are not achieved. Glycaemic control is highly linked to treatment persistence and adherence. To understand the burden of poor persistence and adherence, this systematic literature review identified existing evidence regarding basal insulin adherence/non-adherence and persistence/non-persistence among people with diabetes in Western Europe (defined as the UK, France, Spain, Switzerland, the Netherlands, Ireland, Austria, Portugal, Denmark, Norway, Sweden, Finland, Italy, Germany, Iceland and Belgium).

Methods: Eligible studies were systematically identified from two databases, Medline and Embase (published between 2012 and June 2022). Conference abstracts from ISPOR and EASD were manually included. Identified studies were screened by two independent reviewers in a two-step blinded process. The eligibility of studies was decided on the basis of pre-established criteria. A proportional meta-analysis and comparative narrative analyses were conducted to analyse the included studies.

Results: Twelve studies were identified. Proportions of adherence/non-adherence and persistence/non-persistence varied across studies. Pooled rates of non-persistence at 6, 12 and 18 months were 20.3% (95% CI 13.8; 27.8), 33.8% (95% CI 24.1; 44.3) and 36.5% (95% CI 33.6; 39.4), respectively. In the literature, the proportion of adherent people ranged from 41% to 64% (using the outcome measure medication possession ratio (MPR) > 80%), with a pooled rate of 55.6% (95% CI 45.3; 65.6), suggesting that approximately 44% of people with type 2 diabetes (T2D) are non-adherent.

Conclusion: The results highlight that almost half of patients with T2D in Western Europe have poor adherence to insulin therapy and, at 18 months, one in three patients do not persist on treatment. These findings call for new basal insulin therapies and diabetes management strategies that can improve treatment persistence and adherence among people with T2D.

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欧洲 2 型糖尿病患者对基础胰岛素的依从性和持续性：系统文献综述与元分析》。

引言糖尿病与多种并发症有关，尤其是在无法实现血糖目标的情况下。血糖控制与治疗的持续性和依从性密切相关。为了解持续性和依从性差所造成的负担，本系统性文献综述确定了有关西欧（指英国、法国、西班牙、瑞士、荷兰、爱尔兰、奥地利、葡萄牙、丹麦、挪威、瑞典、芬兰、意大利、德国、冰岛和比利时）糖尿病患者基础胰岛素依从性/非依从性和持续性/非持续性的现有证据：从 Medline 和 Embase 两个数据库（2012 年至 2022 年 6 月间发表）中系统地确定了符合条件的研究。人工纳入了 ISPOR 和 EASD 的会议摘要。确定的研究由两名独立审稿人分两步进行盲法筛选。根据预先确定的标准决定研究是否合格。对纳入的研究进行了比例荟萃分析和比较叙述分析：结果：共确定了 12 项研究。不同研究的依从性/非依从性和持续性/非持续性比例各不相同。6个月、12个月和18个月未坚持治疗的汇总比例分别为20.3% (95% CI 13.8; 27.8)、33.8% (95% CI 24.1; 44.3)和36.5% (95% CI 33.6; 39.4)。在文献中，坚持用药者的比例从41%到64%不等（采用的结果衡量标准是药物持有率（MPR）>80%），汇总的比例为55.6%（95% CI 45.3; 65.6），这表明约有44%的2型糖尿病患者没有坚持用药：研究结果表明，西欧近一半的 2 型糖尿病患者对胰岛素治疗的依从性较差，在 18 个月时，每三名患者中就有一人没有坚持治疗。这些研究结果呼吁采用新的基础胰岛素疗法和糖尿病管理策略，以提高 T2D 患者的治疗持久性和依从性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.90

自引率

7.90%

发文量

130

审稿时长

6 weeks

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.