Type 2 diabetes

DDP4 inhibitors: call to intervene in suboptimal levels of adherence


Adherence to and persistence with DDP4 inhibitors in patients with type 2 diabetes is suboptimal in the real world, according to a systematic review and meta-analysis.

Comprising 34 cohort studies and 594,138 patients from ten countries, the study found medication adherence was 56.9% at one year and 44.2% at two years.

Persistence with DPP4 inhibitors was found to be 76% at six months, 60% at one year, 53% at two years and, in two studies, 31% at three years.

There was no significant difference between the various DPP4 inhibitors for both medication adherence and persistence rates.

The study found a low rate (3.2%) of switching between medications within the class however the likelihood of switching was highest with saxagliptin and alogliptin.

“The low rate of in-class switching among patients prescribed DPP4 inhibitors may be attributed to the fact that when patients using a DPP4 inhibitor fail to achieve adequate glycemic control, better improvement in glucose control is likely to be gained via addition of another therapeutic class rather than switching within the class or to another class,” the study said.

“Moreover, there is a lack of obvious clinical differences among the individual DPP4 inhibitors, particularly with respect to their effect on outcomes such as HbA1c, weight, hypoglycaemia risk, or adverse drug events such as acute pancreatitis.”

The researchers, including senior investigator Dr Richard Ofori-Aseno from the department of epidemiology and preventive medicine at Monash University, said interventions to improve adherence and persistence among patients with diabetes were essential.

“In particular, interventions addressing key modifiable risk factors for non-adherence and nonpersistence (e.g., health literacy, and quality of the relationship between patient and healthcare providers) are required.”

And interventions need to be tailored to address specific challenges, the study authors said.

“For example, older adults may face issues with polypharmacy, increased susceptibility to adverse events, as well as declining executive cognitive functioning (hence, may benefit from services such as short message service (SMS) reminders).”

“As our analysis also revealed temporal declines in adherence and persistence, continuous monitoring of patients’ drug taking behaviors is necessary to promptly identify and address any issues.”

The study is published in Acta Diabetologica.

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