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Medication Regimen Complexity and A1C Goal Attainment in Underserved Adults With Type 2 Diabetes. Ann Pharmacother 2017 Feb;51(2):111-117

Date

01/04/2017

Pubmed ID

28042735

DOI

10.1177/1060028016673652

Scopus ID

2-s2.0-85008498884   13 Citations

Abstract

BACKGROUND: From 2009 to 2012, 51.8% of American adults with diabetes had a hemoglobin A1C (A1C) >7.0%. The complexity of antidiabetic medication regimens may have an impact on glycemic control.

OBJECTIVE: The primary objective was to test the hypothesis that higher diabetes-specific medication regimen complexity index (MRCI) was associated with lower attainment of A1C goal <7.0% in an underserved, predominantly Hispanic population of adults with type 2 diabetes. Secondary analyses included less stringent A1C goals of <8.0% and <9.0% and overall patient-level MRCI.

METHODS: This study was a retrospective, observational, cross-sectional study of individuals with type 2 diabetes from January 2011 to January 2016. Data was obtained from the electronic medical record and MRCI was calculated using the 65-item validated Microsoft Access Version 1.0 medication regimen complexity electronic data capture tool. Logistic regression was used to compute unadjusted and adjusted odds ratios.

RESULTS: A total of 368 patients were included in the analysis. High diabetes-specific MRCI was associated with lower attainment of A1C goal <7.0% (adjusted OR = 0.09; 95% CI = 0.04-0.18) controlling for age, gender, ethnicity, insurance, body mass index, smoking status, hypertension, and hyperlipidemia. Similar results were obtained for the less stringent A1C goals. However, results for overall patient-level MRCI were mixed.

CONCLUSIONS: Higher diabetes-specific medication regimen complexity was associated with poorer glycemic control. Simplifying antidiabetic medication regimens, especially where the treatment guidelines give no preference, could be a step toward achieving treatment goals.

Author List

Yeh A, Shah-Manek B, Lor KB

Author

Kajua B. Lor PharmD Chair, Associate Professor in the School of Pharmacy Administration department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Blood Glucose
California
Clinical Protocols
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Electronic Health Records
Female
Glycated Hemoglobin A
Goals
Humans
Hypoglycemic Agents
Logistic Models
Male
Medication Therapy Management
Middle Aged
Odds Ratio
Practice Guidelines as Topic
Retrospective Studies
Vulnerable Populations