Brussels, Belgium, 28 September 1999: Analysis of over 13,000 patient records has revealed that an alarming number of individuals with type 2 diabetes stop taking their medication, as reported today in a new study presented at this year's congress of the European Association for the Study of Diabetes (EASD). The research also showed that individuals who stop taking oral anti-diabetic drugs (OADs) make more visits to hospital and have a higher risk of death than those who continue with their treatment. (1)
"We found that many patients do not continue taking their medication," said Tim Howard, President of Galt Associates, who undertook the research. "This has serious implications for their health and survival," he added.
Over 90% of people with diabetes have type 2 diabetes. This condition tends to develop later in life than the less common type 1, or 'insulin-dependent' diabetes, and initially can be associated with limited or no symptoms. Treatment begins with diet and exercise or oral medications and only in the later stages of the disease may patients need regular insulin injections.
Importantly, the results of this study indicate that people need to take a diagnosis of type 2 diabetes more seriously. Individuals with type 2 diabetes frequently develop multiple complications, which can lead to blindness, amputation or cardiovascular problems. The risk of heart disease is increased 24 times in people with diabetes. (2)
In the research reported today, investigators looked at records of 1.9 million patient visits between 1991 and 1997 and selected for study all individuals over 45 years of age with type 2 diabetes.
They found extremely high rates of discontinuation for some types of OADs. For example, 50% of patients receiving acarbose, a drug that lowers blood glucose by interfering with the breakdown of carbohydrates in the gut, had not refilled their prescription in the 12 months after first receiving the drug. In the two other main classes of OADs currently used, metformin (which reduces glucose output from the liver) had a discontinuation rate of 27%, and sulphonylureas (which stimulate insulin production in the pancreas) had a discontinuation rate of 16%.
Individuals who discontinued were 1.9 times as likely to need emergency treatment in hospital than those continuing treatment and the mortality rate among 'discontinuers' was almost 3 times higher than among those remaining on their treatment (a 2.9-fold increase).
The results of this research underline the importance of the doctorpatient relationship in diabetes care. Successful treatment for type 2 diabetes must be highly individualised and different regimens may suit some patients better than others. There is also a strong need for new anti-diabetes drugs, which maintain their effectiveness long-term and are well tolerated.
"It appears that many people with type 2 diabetes do not realise the dangers associated with discontinuing their medication," concluded Tim Howard. "New agents and strategies that encourage patients to continue with their treatment may help to relieve the heavy burden of this disease."
References
- Howard T, Stang P & Lydick E. Increased morbidity and mortality associated with discontinuation of oral antidiabetic therapies. Oral presentation 3 presented at EASD 1999.
- World Health Organization/International Diabetes Federation. The economics of diabetes and diabetes care A report of the Diabetes Health Economics Study Group. Brussels: IDF; 1999. p.22.