Self-reported Barriers to Adherence and Persistence to Treatment With Injectable Medications for Type 2 Diabetes

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• 作者：C. Victor Spain ; DVM ; PhD¹ ; ^{cvs2@cornell.edu" class="auth_mail" title="E-mail the corresponding author} ; Jonathon J. Wright ; BS² ; Rebecca M. Hahn ; MPH² ; Ashley Wivel ; MD³ ; Alan A. Martin ; MSc⁴
• 关键词：adherence ; discontinuation ; injectable medication ; persistence ; type 2 diabetes
• 刊名：Clinical Therapeutics
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：38
• 期：7
• 页码：1653-1664.e1
• 全文大小：266 K

文摘

This study explored the barriers that adult Americans experience when taking injectable medications for type 2 diabetes, from the time of filling the initial prescription through the decision to discontinue the medication.

Methods

An Internet-based survey was conducted in 2 waves among adult patients (N = 2000) who had received a physician prescription for insulin, liraglutide, or exenatide once weekly (QW), regardless of whether the prescription was filled by a pharmacy. In wave 1, patients were surveyed on their medication history and experience and, if relevant, the medication discontinuation process. Those still taking their injectable medication at the time of wave 1 were contacted 6 months later (wave 2, n = 585) to assess any changes in their medication experience.

Findings

Among patients who delayed filling their prescription by ≥1 week, cost was a common reason for delay for refilling of liraglutide (63%) and exenatide QW (49%). The most commonly reported barrier to maintaining injectable medication was injection concerns (42%) such as aversion to needles, pain, or needle size. Lack of perceived need was the most common reason for discontinuation for basal (47%) and prandial/premixed (44%) insulin. For liraglutide, the most common reason for discontinuation was experiencing an adverse event (33%); for exenatide QW, it was injection concerns (38%).

Implications

The diverse barriers we identified underscore the need for better patient–prescriber communication to ensure that newly prescribed injectable medications are consistent with a patient’s ability or willingness to manage them, to appropriately set expectations about medications, and to address new barriers that arise during the course of treatment.