Recent metformin adherence and the risk of hypoglycaemia in the year following intensification with a sulfonylurea.
Diabet Med
; 36(4): 482-490, 2019 04.
Article
em En
| MEDLINE
| ID: mdl-30378161
ABSTRACT
AIM:
To evaluate whether recent low adherence to metformin monotherapy is associated with hypoglycaemia after addition of a sulfonylurea.METHODS:
We assembled a retrospective cohort of veterans who filled a new prescription for metformin between 2001 and 2011 and intensified treatment with a sulfonylurea after ≥1 year of metformin use. We calculated metformin adherence from pharmacy data using the proportion of days covered in the 180-day period before intensification. The primary outcome was hypoglycaemia, defined as a hospitalization or emergency department visit for hypoglycaemia or an outpatient blood glucose measurement <3.3 mmol/l in the year following intensification. Cox proportional hazards models were used to compare the risk of hypoglycaemia between participants with low (<80%) and high (≥80%) adherence. Adherence was also modelled as a continuous variable using restricted cubic splines.RESULTS:
Of 187 267 participants who initiated metformin monotherapy, 49 424 added a sulfonylurea after ≥1 year. The median (interquartile range) rate of treatment adherence was 87 (50-100)% and 43% had adherence <80%. Hypoglycaemia rates per 1000 person-years were 23.1 (95% CI 21.1-25.4) and 24.5 (95% CI 22.7-26.4) in participants with low and high adherence, respectively (adjusted hazard ratio 0.95, 95% CI 0.84-1.08). The risk of hypoglycaemia was similar across all levels of adherence when adherence was modelled as a continuous variable.CONCLUSIONS:
We found no evidence that past low adherence to metformin monotherapy was associated with hypoglycaemia after intensification with a sulfonylurea.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Compostos de Sulfonilureia
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Diabetes Mellitus Tipo 2
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Adesão à Medicação
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Hipoglicemia
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Hipoglicemiantes
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Metformina
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article