‘Wake-up call’ for doctors that patient may not be taking prescribed medication
Most people with type 2 diabetes eventually need to add a second-line drug after metformin, the main drug for blood sugar management, to control their blood sugar levels. But adherence to these second-line drugs can be hit or miss, a new study from Northwestern Medicine reports. American Managed Care Journal.
When a patient stops taking a medication, switches to a different drug, or intensifies treatment (such as increasing the dose, adding a third drug, or starting insulin), doctors and patients spend more time It’s wasted and costs the health care system unnecessary money. Discontinuation may result in the patient not being able to completely treat her type 2 diabetes.
A study of more than 82,000 patients from 2014 to 2017 found that within a year of their initial prescription, nearly two-thirds of patients stopped their medication, switched to a different drug class, or It turned out that the treatment had been strengthened.
Scientists analyzed five classes of diabetes drugs other than insulin. In 4 out of 5 classes, 38% of patients discontinued medication. However, half (50 percent) of patients prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs) discontinued treatment.
“Stopping is a no-no. This is common with all five drugs, but it’s much more common with those prescribed GLP-1 RAs,” said corresponding author David Liss, research associate professor of general internal medicine. the doctor said.
“Perhaps doctors say, ‘We need to start a new drug to control type 2 diabetes,’ but within a year half of people stop taking the drug and don’t start another drug.” .This is not a good thing.”
Previous studies have shown that treatment discontinuation is common with type 2 diabetes drugs, but this is the first large U.S. study to show such a high discontinuation rate for a second-line drug. said Mr. Rhys.
“Our findings demonstrate the need for new prescribing approaches and the need for new prescribing approaches to reduce waste of patient time, clinician time, and health system funds when patients take these drugs.” “It highlights the need for a deeper understanding of the barriers faced,” Lis said.
Association with gastrointestinal side effects
Although scientists do not have data on why patients discontinued treatment, discontinuation rates for GLP-1 RAs were particularly high due to nausea, vomiting observed in patients taking GLP-1 RAs. , may be due to gastrointestinal side effects such as diarrhea. These drugs are for diabetes management and weight loss, Liss said.
Originally approved by the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes, GLP-1 RAs (brand names such as Ozempic and Wegovy) are now also used for weight loss. “We know that these drugs that are in the news right now have gastrointestinal side effects, both for people with diabetes and for patients trying to lose weight,” Lis said.
What happens after cancellation?
For many patients in the study, discontinuing second-line diabetes medications does not immediately lead to hyperglycemic (high blood sugar) symptoms or medical emergencies, Liss said.
“However, discontinuation puts these patients at greater risk of subsequent diabetes-related hospitalizations,” Lis added.
Endocrinologists and internal medicine prescribers
The study found that the risk of discontinuation was lower and the risk of exacerbation was lower when the drug was prescribed by an endocrinologist than when the second-line drug was prescribed by a family physician or internal medicine physician. Lis said this difference may be because endocrinologists have particular expertise in new classes of diabetes drugs, making them better able to discuss the pros and cons of drugs with patients when making prescribing decisions. He said that there is a sex.
The importance of follow-up for new drugs
This study retrospectively analyzed patient health insurance claims data. This means scientists will be able to determine when a patient was prescribed the drug. If your healthcare provider switches your medication to a new class. or if the dosage is increased.
The researchers hypothesized that patients who experienced treatment changes or intensification did so after consulting with their doctors. But scientists suspect that many patients made the decision to stop taking the medication without consulting their doctors.
“Our results may represent a ‘wake-up call’ for clinicians that many patients are not taking their prescribed medications,” Lis said. “Although we do not know whether healthcare providers were aware of the discontinuation events observed in this study, our results demonstrate that the effects of medication, This highlights the need for continued communication regarding side effects and costs over time.
Other Northwestern study authors include Matthew O’Brien, MD, associate professor of general internal medicine, Cassandra Aikman, MD, and Amisha Walia, MD, MS, and Andrew Cooper, MS, associate professor of endocrinology. , and Ronald Ackerman, MD, MPH, Senior Associate Dean for Public Health and Director, Institute of Public Health Medicine.
Funding for this study was provided by a grant from UnitedHealth Group, which also gave the researchers access to the claims data analyzed in the study.
