Effect of initial combination therapy vs. step-therapy on adherence and persistence in drug naïve type 2 diabetes patients

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications Pub Date : 2025-05-14 DOI:10.1016/j.jdiacomp.2025.109080

Zahra Majd , Hua Chen , Michael L. Johnson , Kim K. Birtcher , Omar Serna , Bilqees Fatima , Susan Abughosh

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引用次数: 0

Abstract

Background/objectives

Emerging evidence supports the early use of intensive combination treatments among type 2 diabetes (T2D) patients for rapid and sustained glycemic control. However, the impact of initial combination therapy on treatment adherence and persistence has not been explored. Therefore, we aimed to compare adherence and persistence to antidiabetic treatments between patients receiving initial combination therapy vs. conventional step-therapy.

Materials and methods

A retrospective cohort study of MarketScan® research database (2017–2019) was conducted. We included drug naïve T2D patients who received step-therapy or initial combination therapy and were continuously enrolled in Commercial, Medicare, or Medicaid health plans during the pre-index and follow-up period. Primary outcomes of interest were antidiabetic treatment adherence and persistence during the first year of treatment initiation.

Results

In the Commercial/Medicare population, out of the total 116,597 patients, 52 % were nonadherent and 58 % were nonpersistent. Similarly, in the Medicaid population of 18,295 patients, 63 % were nonadherent and 67 % were nonpersistent. Patients receiving step-therapy were more likely to be adherent compared to the initial combination group in both populations (Commercial/Medicare: OR 1.52, 95 % CI 1.46–1.57; Medicaid: OR 1.24, 95 % CI 1.11–1.38). Additionally, in the Commercial/Medicare population, the multivariable Cox regression model showed that the step-therapy cohort had a significantly lower hazard for time to non-persistence compared to the initial combination cohort (HR 0.9, 95 % CI 0.86–0.94). However, this was not significantly different in the Medicaid population.

Conclusions

This study suggests that step-therapy as an initial pharmacotherapy approach may be associated with improved adherence and persistence in managing diabetes compared to initial combination therapy.

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初始联合治疗与分步治疗对naïve 2型糖尿病患者药物依从性和持久性的影响

背景/目的越来越多的证据支持在2型糖尿病（T2D）患者中早期使用强化联合治疗来快速和持续控制血糖。然而，初始联合治疗对治疗依从性和持久性的影响尚未探讨。因此，我们的目的是比较接受初始联合治疗和常规分步治疗的患者对降糖治疗的依从性和持久性。材料与方法对MarketScan®研究数据库（2017-2019）进行回顾性队列研究。我们纳入了药物naïve T2D患者，这些患者接受了分步治疗或初始联合治疗，并在索引前和随访期间连续登记在商业、医疗保险或医疗补助健康计划中。研究的主要结果是抗糖尿病治疗依从性和治疗开始第一年的持续性。结果在商业/医疗保险人群中，在总共116,597名患者中，52%的患者不坚持，58%的患者不坚持。同样，在18,295名医疗补助患者中，63%为非坚持治疗，67%为非坚持治疗。在这两个人群中，与最初的联合治疗组相比，接受分步治疗的患者更有可能坚持治疗(商业/医疗保险：OR 1.52, 95% CI 1.46-1.57；医疗补助：OR 1.24, 95% CI 1.11-1.38)。此外，在商业/医疗保险人群中，多变量Cox回归模型显示，与最初的联合治疗队列相比，分步治疗队列从时间到非持续性的风险显著降低（HR 0.9, 95% CI 0.86-0.94）。然而，这在医疗补助人群中没有显著差异。结论：本研究表明，与最初的联合治疗相比，作为初始药物治疗方法的分步治疗可能与改善糖尿病治疗的依从性和持久性有关。

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

Journal of diabetes and its complications 医学-内分泌学与代谢

CiteScore

5.90

自引率

3.30%

发文量

153

审稿时长

16 days

期刊介绍： Journal of Diabetes and Its Complications (JDC) is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. JDC also publishes articles on physiological and molecular aspects of glucose homeostasis. The primary purpose of JDC is to act as a source of information usable by diabetes practitioners and researchers to increase their knowledge about mechanisms of diabetes and complications development, and promote better management of people with diabetes who are at risk for those complications. Manuscripts submitted to JDC can report any aspect of basic, translational or clinical research as well as epidemiology. Topics can range broadly from early prediabetes to late-stage complicated diabetes. Topics relevant to basic/translational reports include pancreatic islet dysfunction and insulin resistance, altered adipose tissue function in diabetes, altered neuronal control of glucose homeostasis and mechanisms of drug action. Topics relevant to diabetic complications include diabetic retinopathy, neuropathy and nephropathy; peripheral vascular disease and coronary heart disease; gastrointestinal disorders, renal failure and impotence; and hypertension and hyperlipidemia.