S H O R T R E P O R T
`
`Influence of oral antidiabetic drugs
`compliance on metabolic control in type 2
`diabetes. A survey in general practice
`
`PJ Guillausseau
`
`S U M M A R Y
`Background: To address compliance with oral antidiabetic agents and
`its impact on metabolic control in type 2 diabetic patients treated in
`general practice.
`Methods: Prospective assessment of self-reported compliance with a
`standardized questionnaire in an homogeneous cohort of 11,896 type
`2 diabetic patients treated by their general practitioner with one or two
`oral antidiabetic agents, and analysis of determinants of compliance
`with treatment (age, diabetes duration, educational level, severity of
`complications, frequency of antidiabetic oral agents daily dosing).
`Results: Optimal compliance (no omission) was reported in only 46%
`of cases. In multivariate analysis, HbA1c levels were positively corre-
`lated with age, daily dosing frequency of oral antidiabetic agents and
`low educational level, but not with diabetes duration. Low daily dosing
`was associated with a better metabolic control. HbA1c levels were
`associated with compliance with treatment, with a 1.4% mean differ-
`ence between group with optimal and group with worst compliance.
`Conclusions: These results suggest the interest of reducing daily dos-
`ing frequency of oral antidiabetic agents, in order to improve compli-
`ance with treatment and metabolic control.
`
`Key-words: Type 2 Diabetes z Compliance z Antidiabetic Oral Agents z
`Metabolic Control.
`
`Guillausseau PJ. Influence of oral antidiabetic drugs compliance on
`metabolic control in type 2 diabetes. A survey in general practice.
`Diabetes Metab 2003,29,79-81
`
`R Eu S U M Eu
`Observance thérapeutique et équilibre
`glycémique. Enquête en médecine générale
`Objectif : Evaluer l’observance thérapeutique et son influence éven-
`tuelle sur l’équilibre glycémique chez des diabétiques de type 2 suivis
`en médecine générale.
`Méthodes : Evaluation prospective de l’observance avec un question-
`naire standardisé dans une cohorte homogène de 11 896 diabétiques
`de type 2 traités par leur médecin généraliste avec un ou deux antidia-
`bétiques oraux, analyse des déterminants de l’observance (âge, durée
`du diabète, niveau d’études, complications, fréquence des prises d’an-
`tidiabétiques oraux par jour) et étude de l’impact sur l’équilibre méta-
`bolique évalué par les taux d’HbA1c.
`Résultats : Une observance optimale (aucune omission rapportée)
`n’a été observée que dans 46 % des cas. En analyse multivariée, les
`taux d’HbA1c étaient en corrélation avec l’âge, la fréquence des prises
`quotidiennes d’antidiabétiques oraux et un faible niveau d’études,
`mais non avec la durée du diabète. Une faible fréquence de prises
`quotidiennes d’antidiabétiques oraux était associée avec un meilleur
`équilibre glycémique. Les taux d’HbA1c étaient associés à l’obser-
`vance thérapeutique, avec une différence moyenne de 1,4 % entre le
`groupe dont l’observance était optimale et celui dont l’observance
`était la plus faible.
`Conclusions : Ces résultats suggèrent l’intérêt, pour améliorer l’ob-
`servance thérapeutique et l’équilibre glycémique des diabétiques de
`type 2, de réduire le nombre de prises quotidiennes d’antidiabétiques
`oraux.
`
`Mots-clés : Diabète de type 2 z Observance z Antidiabétiques oraux z
`Contrôle glycémique.
`
`Service de Médecine B, Hôpital Lariboisière, Paris et Université Paris 7 Denis-
`Diderot.
`
`Address correspondence and reprint requests to:
`PJ Guillausseau. Service de Médecine B, Hôpital Lariboisière, 2, rue Ambroise
`Paré, 75010 Paris.
`pierre-jean.guillausseau@lrb.ap-hop-paris.fr
`
`Received: September 22th, 2002; accepted: November 10th, 2002
`
`Diabetes Metab 2003,29,79-81 • © 2003 Masson, all rights reserved
`
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`Page 1 of 3
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`

`
`PJ Guillausseau
`
`P oor patient compliance with drug treatment has
`
`been consistently reported in chronic diseases,
`such as hypertension [1] and type 2 diabetes melli-
`tus [2-4]. Noncompliance is a major health care concern, as it
`may reduce effectiveness of the treatment. In type 2 diabetes,
`several factors have been shown to be associated with a poor
`level of compliance. Some, as age, number, and severity of
`complications, low socioeconomic level and low incomes [4]
`cannot be remedied, but others, as polymedication and mul-
`tiple daily dose regimens [2, 3] may be corrected. The influ-
`ence of inadequate compliance on long term metabolic con-
`trol is controversial. A relationship between low compliance
`and poor metabolic control has only been evidenced in the
`particular setting of an indigent population [4], while most
`studies performed in European and North-American popu-
`lations have remained inconclusive [5-7]. The goal of the
`present study was therefore to assess compliance with oral
`antidiabetic therapy in an homogeneous cohort of patients
`with type 2 diabetes, in the usual conditions of care provided
`in Europe, ie, in general practice.
`
`Patients and methods
`
`In a prospective study, we assessed compliance, as well as
`the factors likely to influence it, in a cohort of 11,896 type 2
`diabetic patients. Patients were treated with one or 2 oral
`antidiabetic agents (sulfonylureas, metformin, α-glucosidase
`inhibitors) by their general practitioner (n = 2,687) in urban
`or rural setting. Compliance was assessed by self-reporting,
`using standardized questionnaires. Compliance was graded
`as no omission, omission 1 to 3 times a month, omission once
`a week, and omission more than once a week. The cohort
`comprised 35- to 85-year old patients of both sexes (57%
`men) with overweight (79.8 ± 14.5 kg) (m ± SD). Known
`diabetes duration was less than 5 years in 41% of cases, 5 to 10
`years in 34%, and in excess of 10 years in 25%. Mean HbA1c
`was 7.4% ± 1.5%. Retinal, renal, vascular, coronary, and/or
`
`80
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`© 2016 Elsevier Masson SAS. Tous droits réservés. - Document téléchargé le 10/02/2016
`
`neurological complications were present in 27% of cases. For
`statistical evaluation, unpaired t-test and multivariate analy-
`sis was used.
`
`Results
`
`Optimal compliance with oral antidiabetic agents (no
`omission) was reported in 5,467 patients (37%), omission 1 to
`3 times a month in 4,389 patients (46%), omission once a
`week in 1,274 patients (11%), and omission more frequent
`than once a week in 659 patients (6%). Multivariate analysis
`indicated that HbA1c levels were positively correlated with
`age (r=0.73, P < 0.0001), frequency of daily doses of oral
`antidiabetic agents (once, twice or three times a day) (r =
`0.59, P < 0.0001), and was negatively correlated with educa-
`tional level (r = -0.38, P < 0.0001). We did not find any corre-
`lation between HbA1c levels and diabetes duration, nor with
`the number or severity of complications. We observed a fa-
`vorable influence of a low daily dosing frequency on compli-
`ance with an oral antidiabetic therapy, with the best compli-
`ance in the case of once-daily dosing (Fig 1). Our results also
`indicated that a low daily dosing frequency was associated
`with a better metabolic control (Fig 2), the best metabolic
`control being achieved with once-daily dosing. HbA1c levels
`were directly correlated with compliance with treatment
`(Fig 3).
`
`Discussion
`
`In a cohort of 11,896 type 2 diabetic patients treated in
`general practice, optimal compliance with oral antidiabetic
`agents was self-reported in only 46% of cases. This figure is
`close to findings of previously reported studies [2-4]. As
`found by others, compliance is affected by the frequency of
`the doses, the lower the daily dosing frequency the higher
`the compliance [2, 3], rather than by the number of tablets
`per dose [8]. A similar favorable result for compliance has
`been reported in patients treated with antihypertensive
`
`Figure 1
`Percentage of type 2 diabetic patients with
`optimal self-reported compliance with
`oral antidiabetic agents (no omission) ac-
`cording to the frequency of daily doses
`(*P < 0.05, **P < 0.01 us once daily dos-
`ing).
`
`Page 2 of 3
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`

`
`Compliance with treatment in type 2 diabetes
`
`Figure 2
`HbA1c levels (%) in type 2 diabetic pa-
`tients according to the frequency of daily
`doses of oral antidiabetic agent (*P <
`0.05, **P < 0.01 vs once daily dosing).
`
`Figure 3
`HbA1c levels (%) in type 2 diabetic pa-
`tients according to their self-reported
`compliance with oral antidiabetic agent
`(**P < 0.01 vs no omission).
`
`drugs [9-11]. We found a strong influence of compliance on
`long-term metabolic control, with a mean difference of 1.4%
`in HbA1c levels (8.5% ± 1.9% vs 7.1% ± 1.4%) between the
`group with optimal and the group with worst compliance.
`An association between compliance and HbA1c levels was
`not observed in type 2 diabetes [5-7], except in one study
`performed in a particular setting [4]. These data suggest the
`utility of reducing daily dosing frequency of oral antidiabetic
`agents, the only modifiable determinant of compliance, in
`order to improve compliance with treatment and metabolic
`control.
`
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`Diabetes Metab 2003,29,79-81 • © 2003 Masson, all rights reserved
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