Medical Research: What is the background for this study? What are the main findings?
Dr. Bansilal: Our group has previously published data from FREEDOM, COURAGE and BARI showing that adherence to recommended therapies are low in diabetic (DM) patients. We have spent the last decade developing a potential solution to this- the Fuster-Ferrer polypill. This study was done to better inform the association between levels of medication adherence and long term major adverse cardiovascular events (MACE) in high risk diabetic patients.
We analyzed a U.S. health insurers’ claims data for 19,962 high risk diabetic subjects. Using proportion of days covered (PDC) for 1 year after first refill, we stratified patients as fully adherent (FA≥80%), partially adherent (PA ≥40- ≤79%) or non-adherent (NA <40%) and examined the associations with a primary cardiovascualr outcome measure of death, myocardial infarction, stroke and coronary revascularization. We found that only 34% participants were fully adherent to therapy. When compared to being non-adherent at 2 yrs follow up,, being fully adherent was associated with a 28% lower rate of MACE; being partially adherent was associated with a 21% lower rate of MACE. Efforts towards improving adherence in diabetic subjects may lead to substantial reductions in MACE.
Medical Research: What should clinicians and patients take away from your report?
Dr. Bansilal: Diabetes is as much a cardiovascular disease as an endocrine one. Our endocrinology colleagues, I’m sure, will appreciate the troubling issue of polypharmacy and poor medication adherence in their patients. I was struck by the fact that only 34% of the high risk diabetic participants were adherent to medications. The fact that >80% adherence is associated with a 28% lower risk for major cardiovascular events compared to non-adherence is truly impactful and a goal, I hope clinicians will consider worth striving for. As a physician community interested in improving the outcomes of our diabetic patients, our study drives home the need to employ disruptive and innovative strategies such as emerging technologies, non-physician care models and polypills to get our patients beyond the 80% adherence line to reduce cardiovascular risk.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Bansilal: We are currently initiating a cardiovascular outcomes trial-SECURE for the Fuster-Ferrer polypill in Europe and hope to replicate the benefit of improved adherence prospectively.
MedicalResearch.com Interview with: Sameer Bansilal, MD, MS (2015). Only 1/3 of High Risk Diabetic Patients Comply With Medications