Long-term metformin adherence in the Diabetes Prevention Program Outcomes Study
Introduction To investigate long-term metformin adherence in the Diabetes Prevention Program Outcomes Study (DPPOS) by examining: (1) predictors of long-term adherence to study metformin and (2) whether metformin adherence was associated with incident type 2 diabetes.Research design and methods DPPO...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-04-01
|
| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/8/1/e001537.full |
| _version_ | 1818897551996223488 |
|---|---|
| author | Elizabeth Arquin Walker Jeffrey S Gonzalez Mark T Tripputi Margaret J Matulik Maria G Montez Sameh Tadros |
| author_facet | Elizabeth Arquin Walker Jeffrey S Gonzalez Mark T Tripputi Margaret J Matulik Maria G Montez Sameh Tadros |
| author_sort | Elizabeth Arquin Walker |
| collection | DOAJ |
| description | Introduction To investigate long-term metformin adherence in the Diabetes Prevention Program Outcomes Study (DPPOS) by examining: (1) predictors of long-term adherence to study metformin and (2) whether metformin adherence was associated with incident type 2 diabetes.Research design and methods DPPOS was an open-label continuation of the randomized clinical trial (Diabetes Prevention Program (DPP)) in which eligible participants randomized to the metformin group were offered study metformin and followed over 11 years. A brief structured adherence interview was administered semiannually. Metformin adherence was assessed by pill counts. Predictors of metformin adherence were examined in multivariate regression models. Incident diabetes associated with metformin adherence and other variables was assessed in Cox proportional hazards models.Results Of 868 participants eligible to continue taking study metformin, 664 (76%) took at least some metformin over 11 years, with 478 of them reporting problems with adherence. DPPOS cumulative adherence showed significant associations of higher adherence (≥80%) with early adherence at 3 months in DPP (p<0.001) and lower depression scores during DPPOS (p<0.001); significant differences were also seen by race/ethnicity (p<0.004). Predicting adherence by multivariate modeling showed odds of adherence significantly lower for Black participants and for participants reporting more than one barrier. Odds for adherence were significantly higher for those adherent early in DPP and those reporting at least one planned strategy to improve adherence. Higher metformin adherence was significantly associated with a lower diabetes risk (p=0.04), even after adjustment for demographic variables, depression, and anxiety scores.Conclusions In this long-term diabetes prevention study, early metformin adherence and planned strategies to promote adherence improved long-term adherence over 11 years; higher adherence to metformin was related to lower diabetes incidence. Incorporating strategies to promote adherence when initially prescribing metformin and counseling to support adherence over time are warranted. |
| first_indexed | 2024-12-19T19:17:59Z |
| format | Article |
| id | doaj.art-47ce9fb428c9413ab633888b9574fdc0 |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-12-19T19:17:59Z |
| publishDate | 2020-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-47ce9fb428c9413ab633888b9574fdc02022-12-21T20:09:05ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972020-04-018110.1136/bmjdrc-2020-001537Long-term metformin adherence in the Diabetes Prevention Program Outcomes StudyElizabeth Arquin Walker0Jeffrey S Gonzalez1Mark T Tripputi2Margaret J Matulik3Maria G Montez4Sameh Tadros5Medicine, Albert Einstein College of Medicine, Bronx, New York, USAMedicine, Albert Einstein College of Medicine, Bronx, New York, USAThe Biostatistics Center, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USAMedicine, University of Chicago, Chicago, Illinois, USAMedicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USAMedicine, University of California at Los Angeles, Los Angeles, California, USAIntroduction To investigate long-term metformin adherence in the Diabetes Prevention Program Outcomes Study (DPPOS) by examining: (1) predictors of long-term adherence to study metformin and (2) whether metformin adherence was associated with incident type 2 diabetes.Research design and methods DPPOS was an open-label continuation of the randomized clinical trial (Diabetes Prevention Program (DPP)) in which eligible participants randomized to the metformin group were offered study metformin and followed over 11 years. A brief structured adherence interview was administered semiannually. Metformin adherence was assessed by pill counts. Predictors of metformin adherence were examined in multivariate regression models. Incident diabetes associated with metformin adherence and other variables was assessed in Cox proportional hazards models.Results Of 868 participants eligible to continue taking study metformin, 664 (76%) took at least some metformin over 11 years, with 478 of them reporting problems with adherence. DPPOS cumulative adherence showed significant associations of higher adherence (≥80%) with early adherence at 3 months in DPP (p<0.001) and lower depression scores during DPPOS (p<0.001); significant differences were also seen by race/ethnicity (p<0.004). Predicting adherence by multivariate modeling showed odds of adherence significantly lower for Black participants and for participants reporting more than one barrier. Odds for adherence were significantly higher for those adherent early in DPP and those reporting at least one planned strategy to improve adherence. Higher metformin adherence was significantly associated with a lower diabetes risk (p=0.04), even after adjustment for demographic variables, depression, and anxiety scores.Conclusions In this long-term diabetes prevention study, early metformin adherence and planned strategies to promote adherence improved long-term adherence over 11 years; higher adherence to metformin was related to lower diabetes incidence. Incorporating strategies to promote adherence when initially prescribing metformin and counseling to support adherence over time are warranted.https://drc.bmj.com/content/8/1/e001537.full |
| spellingShingle | Elizabeth Arquin Walker Jeffrey S Gonzalez Mark T Tripputi Margaret J Matulik Maria G Montez Sameh Tadros Long-term metformin adherence in the Diabetes Prevention Program Outcomes Study BMJ Open Diabetes Research & Care |
| title | Long-term metformin adherence in the Diabetes Prevention Program Outcomes Study |
| title_full | Long-term metformin adherence in the Diabetes Prevention Program Outcomes Study |
| title_fullStr | Long-term metformin adherence in the Diabetes Prevention Program Outcomes Study |
| title_full_unstemmed | Long-term metformin adherence in the Diabetes Prevention Program Outcomes Study |
| title_short | Long-term metformin adherence in the Diabetes Prevention Program Outcomes Study |
| title_sort | long term metformin adherence in the diabetes prevention program outcomes study |
| url | https://drc.bmj.com/content/8/1/e001537.full |
| work_keys_str_mv | AT elizabetharquinwalker longtermmetforminadherenceinthediabetespreventionprogramoutcomesstudy AT jeffreysgonzalez longtermmetforminadherenceinthediabetespreventionprogramoutcomesstudy AT markttripputi longtermmetforminadherenceinthediabetespreventionprogramoutcomesstudy AT margaretjmatulik longtermmetforminadherenceinthediabetespreventionprogramoutcomesstudy AT mariagmontez longtermmetforminadherenceinthediabetespreventionprogramoutcomesstudy AT samehtadros longtermmetforminadherenceinthediabetespreventionprogramoutcomesstudy |