Vojtěch Škop, Ivana Laňková, Simona Antalová, Iva Míšková, Kateřina Malá-Ládová, Josef Malý, Terezie Pelikánová, Jiří Hricko, Tomáš Čajka, Martin Haluzík
{"title":"部分不坚持抗糖尿病治疗破坏糖尿病管理，并与治疗复杂性相关：一项使用血浆分析的横断面研究。","authors":"Vojtěch Škop, Ivana Laňková, Simona Antalová, Iva Míšková, Kateřina Malá-Ládová, Josef Malý, Terezie Pelikánová, Jiří Hricko, Tomáš Čajka, Martin Haluzík","doi":"10.1111/dom.70174","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>To evaluate medication adherence in patients with type 2 diabetes (T2D) using plasma drug measurements and assess the clinical impact of partial non-adherence on glycemic control and complications.</p><p><strong>Materials and methods: </strong>This cross-sectional study included 641 T2D outpatients attending routine follow-up visits. After overnight fasting, blood samples were collected and analysed by LC-MS to quantify plasma concentrations of 13 oral antidiabetic drugs. Adherence was defined as the detection of a prescribed drug above the limit of quantification. Self-reported lifestyle factors, dosing regimens, and clinical outcomes were assessed in relation to drug presence.</p><p><strong>Results: </strong>Metformin adherence was very high, with the drug undetected in only 1.9% of patients. In contrast, adherence rates were lower for sulfonylureas (94%), DPP-4 inhibitors (90%), pioglitazone (82%), and SGLT2 inhibitors (73%). Non-adherence was predominantly partial: only one of the analysed antidiabetics taken by patients was not detected in 93% of non-adherent patients. Adherence declined with increasing numbers of prescribed agents and daily doses, suggesting treatment complexity as a key factor. No other tested lifestyle or drug management parameters were significantly associated with adherence. Glycemic control was worse in non-adherent patients: 63% did not reach target glucose and HbA1<sub>c</sub> levels, compared to 37% of fully adherent patients. Non-adherence was also associated with a higher prevalence of diabetic kidney disease.</p><p><strong>Conclusions: </strong>Partial non-adherence is common in T2D and strongly associated with treatment complexity and poor glycemic outcomes. These findings emphasize the need for individualized strategies to support adherence and improve long-term diabetes care. Our study further indicates that plasma analysis using LC-MS methods may serve as a robust tool for adherence assessment.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Partial non-adherence to antidiabetic therapy undermines diabetes management and correlates with treatment complexity: A cross-sectional study using blood plasma analysis.\",\"authors\":\"Vojtěch Škop, Ivana Laňková, Simona Antalová, Iva Míšková, Kateřina Malá-Ládová, Josef Malý, Terezie Pelikánová, Jiří Hricko, Tomáš Čajka, Martin Haluzík\",\"doi\":\"10.1111/dom.70174\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>To evaluate medication adherence in patients with type 2 diabetes (T2D) using plasma drug measurements and assess the clinical impact of partial non-adherence on glycemic control and complications.</p><p><strong>Materials and methods: </strong>This cross-sectional study included 641 T2D outpatients attending routine follow-up visits. After overnight fasting, blood samples were collected and analysed by LC-MS to quantify plasma concentrations of 13 oral antidiabetic drugs. Adherence was defined as the detection of a prescribed drug above the limit of quantification. Self-reported lifestyle factors, dosing regimens, and clinical outcomes were assessed in relation to drug presence.</p><p><strong>Results: </strong>Metformin adherence was very high, with the drug undetected in only 1.9% of patients. In contrast, adherence rates were lower for sulfonylureas (94%), DPP-4 inhibitors (90%), pioglitazone (82%), and SGLT2 inhibitors (73%). Non-adherence was predominantly partial: only one of the analysed antidiabetics taken by patients was not detected in 93% of non-adherent patients. Adherence declined with increasing numbers of prescribed agents and daily doses, suggesting treatment complexity as a key factor. No other tested lifestyle or drug management parameters were significantly associated with adherence. Glycemic control was worse in non-adherent patients: 63% did not reach target glucose and HbA1<sub>c</sub> levels, compared to 37% of fully adherent patients. Non-adherence was also associated with a higher prevalence of diabetic kidney disease.</p><p><strong>Conclusions: </strong>Partial non-adherence is common in T2D and strongly associated with treatment complexity and poor glycemic outcomes. These findings emphasize the need for individualized strategies to support adherence and improve long-term diabetes care. Our study further indicates that plasma analysis using LC-MS methods may serve as a robust tool for adherence assessment.</p>\",\"PeriodicalId\":158,\"journal\":{\"name\":\"Diabetes, Obesity & Metabolism\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2025-10-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetes, Obesity & Metabolism\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/dom.70174\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes, Obesity & Metabolism","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/dom.70174","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Partial non-adherence to antidiabetic therapy undermines diabetes management and correlates with treatment complexity: A cross-sectional study using blood plasma analysis.
Aims: To evaluate medication adherence in patients with type 2 diabetes (T2D) using plasma drug measurements and assess the clinical impact of partial non-adherence on glycemic control and complications.
Materials and methods: This cross-sectional study included 641 T2D outpatients attending routine follow-up visits. After overnight fasting, blood samples were collected and analysed by LC-MS to quantify plasma concentrations of 13 oral antidiabetic drugs. Adherence was defined as the detection of a prescribed drug above the limit of quantification. Self-reported lifestyle factors, dosing regimens, and clinical outcomes were assessed in relation to drug presence.
Results: Metformin adherence was very high, with the drug undetected in only 1.9% of patients. In contrast, adherence rates were lower for sulfonylureas (94%), DPP-4 inhibitors (90%), pioglitazone (82%), and SGLT2 inhibitors (73%). Non-adherence was predominantly partial: only one of the analysed antidiabetics taken by patients was not detected in 93% of non-adherent patients. Adherence declined with increasing numbers of prescribed agents and daily doses, suggesting treatment complexity as a key factor. No other tested lifestyle or drug management parameters were significantly associated with adherence. Glycemic control was worse in non-adherent patients: 63% did not reach target glucose and HbA1c levels, compared to 37% of fully adherent patients. Non-adherence was also associated with a higher prevalence of diabetic kidney disease.
Conclusions: Partial non-adherence is common in T2D and strongly associated with treatment complexity and poor glycemic outcomes. These findings emphasize the need for individualized strategies to support adherence and improve long-term diabetes care. Our study further indicates that plasma analysis using LC-MS methods may serve as a robust tool for adherence assessment.
期刊介绍：
Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
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