The Magnitude of the Association between Insulin Adherence Based on Prescription Fill Rate Measures and Glycemic Control: A Systematic Review and Meta-Analysis
Author(s)
Nguyen D1, Liang X1, Nguyen S2, Veettil SK3, Tan CJ1, Patikorn C4, Brixner D1, Chaiyakunapruk N1
1Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA, 2Northwestern, Chicago, IL, USA, 3College of Pharmacy, University of Utah, Salt Lake City, UT, USA, 4Department of Pharmacotherapy, College of Pharmacy, University of Utah, Bangkok, 10, Thailand
Presentation Documents
OBJECTIVES: Despite studies measuring association of insulin adherence and glycemic control in type 2 diabetes mellitus (T2DM), the magnitude and significance of association remains unclear. This study aims to summarize evidence on the association between insulin adherence and glycemic control in adults with T2DM.
METHODS: A search in Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and PubMed from inception until October 2022 was performed. Full-text studies were included if insulin adherence, measured by prescription fills, and glycemic control were reported. Two reviewers independently assessed studies for eligibility and extracted data. A random effects model using the Dersimonian and Laird method was performed to assess the association of adherence on hemoglobin A1C (HbA1C). Heterogeneity was evaluated using the I² statistical test. Pre-specified sensitivity analyses were completed based upon 1) population overlap, 2) study quality, 3) small sample size (25th percentile), 4) unclear adherence definitions, and 5) prescription fill history collection method.
RESULTS: There were a total of 11 articles found. Three cohort studies and one RCT involving a total 6,133 patients compared the HbA1C difference between insulin adherent and non-adherent patients. Compared to non-adherent patients, adherent patients had a HbA1C mean difference (MD) of -0.56% (95% confidence interval (CI) -0.84%, -0.28%, I2 = 46.16%). Five cohort studies and one RCT with a total of 12,330 patients evaluated a change in adherence on HbA1C. An increase in adherence of 1% was associated with an HbA1C MD of -0.05% (95% CI -0.08%, -0.02%, I2 = 71.45%). Sensitivity analyses revealed the findings were robust.
CONCLUSIONS: Insulin adherence was significantly associated with an HbA1C reduction. Improvements in insulin adherence may result in an improved HbA1C. Given the focus on insulin affordability, insulin adherence may be used to assess clinical effectiveness of these policies given that fill data is more readily available than HbA1C measurements.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
PCR2
Topic
Clinical Outcomes, Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance, Performance-based Outcomes
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), Drugs