2型糖尿病患者对心血管药物的依从性模式：在初级保健中使用基于组的轨迹分析的回顾性队列研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-08-06 DOI:10.1016/j.diabres.2025.112409

Sri Chodapuneedi , Jia Wei Koh , Zhomart Orman , Danijela Gasevic , Dianna J. Magliano , Sophia Zoungas , Peter Hamblin , Caroline Trin , Ella Zomer , Pilar Cataldo , Stella Talic

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引用次数: 0

摘要

目的：评估2型糖尿病患者对降血糖、降脂和降血压药物的依从性，并确定非持久性依从性行为的预测因素。方法：我们利用2013年至2023年诊断为T2DM的患者的初级保健数据进行了一项回顾性队列研究。药物依从性评估超过60 个月，定义为每六个月至少接受一次处方。基于组的轨迹分析（GBTA）确定了依从性模式。多项逻辑回归探讨了轨迹隶属度的预测因子。结果：在所有药物类别中观察到三个一致的依从性轨迹：持续依从性（40.6 %-44.3 %），逐渐下降（32.7 %-36.6 %）和早期停药（21.0 %-26.7 %）。持续坚持者在60 个月时保持高依从性（0.70-0.76）。逐渐下降的依从性从12 个月时的约0.84下降到60 个月时的0.20以下。早期停药者在24个月后几乎完全停止治疗。早期停药的关键危险因素包括女性(降糖：RRR 0.72；95 % CI: 0.57-0.92（男性vs女性），大都市居住(RRR 1.38；95 % CI: 1.07-1.78)，并且在降脂队列中LDL胆固醇升高(RRR 1.75；95 % ci: 1.36-2.26)。结论：本研究突出了T2DM患者明显的长期依从性模式，超过一半的患者在5年时间内未持续使用，属于早期停药组或逐渐下降组。这些轨迹虽然具有临床意义，但可能反映了不同的潜在因素，并强调了定制干预策略以支持持续治疗依从性的必要性。

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Adherence patterns to cardiovascular medications in people with type 2 diabetes mellitus: a retrospective cohort study using group-based trajectory analysis in primary care

Aim

To assess adherence to glucose-, lipid-, and blood pressure-lowering medications in people with T2DM and identify predictors of non-persistent adherence behaviours.

Methods

We conducted a retrospective cohort study using primary care data from 2013 to 2023 for people diagnosed with T2DM. Medication adherence was assessed over 60 months, defined as receiving at least one prescription every six months. Group-Based Trajectory Analysis (GBTA) identified adherence patterns. Multinomial logistic regression explored predictors of trajectory membership.

Results

Three consistent adherence trajectories were observed across all medication classes: persistent adherence (40.6 %–44.3 %), gradual decline (32.7 %–36.6 %), and early discontinuation (21.0 %–26.7 %). Persistent adherers maintained high adherence (0.70–0.76) at 60 months. Gradual decliners exhibited a steady decrease in adherence from approximately 0.84 at 12 months to below 0.20 at 60 months. Early discontinuers ceased therapy almost entirely by 24 months. Key risk factors for early discontinuation included female sex (glucose-lowering: RRR 0.72; 95 % CI: 0.57–0.92 for males vs females), metropolitan residence (RRR 1.38; 95 % CI: 1.07–1.78), and having an elevated LDL cholesterol in the lipid-lowering cohort (RRR 1.75; 95 % CI: 1.36–2.26).

Conclusion

This study highlights distinct long-term adherence patterns among individuals with T2DM, with over half showing non-persistent use over a five-year period, falling into either early discontinuation or gradual decline groups. These trajectories, while both clinically significant, likely reflect different underlying factors and underscore the need for tailored intervention strategies to support sustained treatment adherence.

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.