Most patients with Type 2 diabetes will end up needing to add a second-line medication after metformin — the go-to primary drug for glucose management — to control their blood sugar levels. But adherence to these second-line drugs can be hit or miss, reports a new Northwestern Medicine study.
The study was published Dec. 12 in the American Journal of Managed Care.
The study of more than 82,000 patients between 2014 and 2017 found that within one year of their initial prescription, nearly two-thirds of patients either discontinued their medication, switched to a different medication class or intensified their treatment.
The scientists analyzed five non-insulin classes of diabetes medications. In four of the five classes, 38% of patients discontinued their medication. But among patients prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs), half (50%) discontinued treatment.
While the scientists did not have data on reasons why patients discontinued treatment, the particularly high discontinuation rate for GLP-1 RAs may have been due to adverse gastrointestinal side effects — such as nausea, vomiting and diarrhea — which have been observed in patients who take these medications for diabetes control and for weight loss, said corresponding author David Liss, research associate professor of general internal medicine at Northwestern University Feinberg School of Medicine.
Discontinuation risk was lower and intensification risk was higher when an endocrinologist prescribed the medication, compared to when a family medicine or internal medicine physician prescribed the second-line drugs, the study found.
The study retrospectively analyzed patients’ health insurance claims data, meaning the scientists could identify when a patient had been prescribed a medication; if the care provider switched their medication to a new class; or if they increased their dose.
The scientists assumed that patients who experienced a treatment switch or intensification did so after talking with their doctor. But the scientists suspect that many patients made the decision to discontinue their medication without having talked to a doctor.
