Adherence to multiple medications in the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) cohort: effect of additional medications on adherence to primary diabetes medication
-
Rachana Shah
,
Barbara J. Anderson
Abstract
Background
Non-adherence to diabetes medication leads to poor outcomes and increased healthcare costs. Multiple factors affecting adherence in adults with type 2 diabetes (T2D) have been identified, but pediatric data is sparse. We aimed to determine whether initiation of additional oral medications or insulin affects adherence to primary study medication (PSM) in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.
Methods
Six hundred and ninety-nine youth (aged 10–17 years) with recent-onset T2D were randomized in the TODAY study. Participants were categorized as adherent (≥80% taken by pill count) or non-adherent (<80%), and adherence was compared between those on additional medications or not. Subgroup analyses to assess influence of race/ethnicity, gender, medication type, or depression were performed.
Results
At 36 months, 46.3% of participants were taking additional oral medications and 31.9% were on insulin. There was no difference in study medication adherence with additional oral medications (55.1%, 67.1%, and 56.7% at month 36 in those prescribed 0, 1, or 2+ additional medications; p = 0.16). Girls on oral contraceptives (OC) had higher adherence (65.2% vs. 55.8% at month 36; p = 0.0054). Participants on insulin had lower adherence (39.7% vs. 59.3% at 36 months; p < 0.0001). There was decreased adherence in participants with baseline depression (p = 0.008).
Conclusions
Additional oral medications did not influence adherence to diabetes medications in TODAY. Addition of insulin led to reduced adherence. In subgroup analyses, OC use was associated with higher adherence in girls, while baseline depression was associated with lower adherence overall. Further studies examining potentially modifiable risk factors of adherence in pediatric T2D are needed.
Acknowledgments
The TODAY Study Group thanks the following companies for donations in support of the study’s efforts: Becton, Dickinson and Company; Bristol-Myers Squibb; Eli Lilly and Company; GlaxoSmithKline; LifeScan, Inc.; Pfizer; and Sanofi Aventis. We also gratefully acknowledge the participation and guidance of the American Indian partners associated with the clinical center located at the University of Oklahoma Health Sciences Center, including members of the Absentee Shawnee Tribe, Cherokee Nation, Chickasaw Nation, Choctaw Nation of Oklahoma, and Oklahoma City Area Indian Health Service; the opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the respective Tribal and Indian Health Service Institution Review Boards or their members. Materials developed and used for the TODAY standard diabetes education program and the intensive lifestyle intervention program are available to the public at https://today.bsc.gwu.edu/
Author contributions: R.S., S.V.M., and L.E.L.K. researched data, contributed to the discussion, wrote the manuscript, and reviewed/edited the manuscript. B.J.A. researched data, contributed to the discussion, and reviewed/edited the manuscript. L.E. performed the statistical data analysis, contributed to the interpretation of data, and reviewed/edited the manuscript. T.L.C., L.H., A.D.W., R.I., and N.C. researched data, contributed to the interpretation of data, and reviewed the manuscript.
Research funding: This work was completed with funding from NIDDK/NIH, Funder Id: http://dx.doi.org/10.13039/100000062 grant numbers U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254; from the National Center for Research Resources General Clinical Research Centers Program grant numbers M01-RR00036 (Washington University School of Medicine), M01-RR00069 (University of Colorado Denver), M01-RR00084 (Children’s Hospital of Pittsburgh), M01-RR01066 (Massachusetts General Hospital), and M01-RR14467 (University of Oklahoma Health Sciences Center); and from the NCRR Clinical and Translational Science Awards grant numbers UL1-RR024134 (Children’s Hospital of Philadelphia), UL1-RR024153 (Children’s Hospital of Pittsburgh), UL1-RR024992 (Washington University in St Louis), UL1-RR025758 (Massachusetts General Hospital), and UL1-RR025780 (University of Colorado Denver).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Conflict of interest: None of the authors has any conflict of interest to declare.
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2019-0315).
Article note
Trial registration: ClinicalTrials.gov NCT00081328.
©2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Original Articles
- Air occlusion in insulin pumps of children and adolescents with type 1 diabetes
- Gastrointestinal symptoms in pediatric patients with type 1 diabetes mellitus
- Adherence to multiple medications in the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) cohort: effect of additional medications on adherence to primary diabetes medication
- Ghrelin, obestatin and the ghrelin/obestatin ratio as potential mediators for food intake among obese children: a case control study
- Association between neck circumference and non-alcoholic fatty liver disease in Mexican children and adolescents with obesity
- Comparison between metabolically healthy obesity and metabolically unhealthy obesity by different definitions among Mexican children
- Evidence in obese children: contribution of tri-ponderal mass index or body mass index to dyslipidemia, obesity-inflammation, and insulin sensitivity
- Prevalence of metabolic syndrome and its associated factors in overweight and obese adolescents
- Cortisol secretion pattern in overweight/obese and normal-weight infants: a cross-sectional study
- Predictors of non-alcoholic fatty liver disease (NAFLD) among children with obesity
- Relative leptin deficiency in children with severe early-onset obesity (SEOO) – results of the Early-onset Obesity and Leptin – German-Polish Study (EOL-GPS)
- Novel associations of serum adropin and lipopolysaccharide-binding protein versus lipid profiles in childhood obesity
- The trade-off between the olfactory bulb and eyeball volume in precocious puberty
- Gender-based differences in the clustering of metabolic syndrome factors in children and adolescents
- Presentation of 14 alkaptonuria patients from Turkey
- Assessment of health-related quality of life in Egyptian children and adolescents with congenital adrenal hyperplasia
- Case Reports
- Familial hypophosphatemic rickets caused by a PHEX gene mutation accompanied by a NPR2 missense mutation
- Cinacalcet treatment experience in hereditary vitamin D resistant rickets
- Can we effectively predict the occurrence of cerebral edema in children with ketoacidosis in the course of type 1 diabetes? – case report and literature review
Articles in the same Issue
- Frontmatter
- Original Articles
- Air occlusion in insulin pumps of children and adolescents with type 1 diabetes
- Gastrointestinal symptoms in pediatric patients with type 1 diabetes mellitus
- Adherence to multiple medications in the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) cohort: effect of additional medications on adherence to primary diabetes medication
- Ghrelin, obestatin and the ghrelin/obestatin ratio as potential mediators for food intake among obese children: a case control study
- Association between neck circumference and non-alcoholic fatty liver disease in Mexican children and adolescents with obesity
- Comparison between metabolically healthy obesity and metabolically unhealthy obesity by different definitions among Mexican children
- Evidence in obese children: contribution of tri-ponderal mass index or body mass index to dyslipidemia, obesity-inflammation, and insulin sensitivity
- Prevalence of metabolic syndrome and its associated factors in overweight and obese adolescents
- Cortisol secretion pattern in overweight/obese and normal-weight infants: a cross-sectional study
- Predictors of non-alcoholic fatty liver disease (NAFLD) among children with obesity
- Relative leptin deficiency in children with severe early-onset obesity (SEOO) – results of the Early-onset Obesity and Leptin – German-Polish Study (EOL-GPS)
- Novel associations of serum adropin and lipopolysaccharide-binding protein versus lipid profiles in childhood obesity
- The trade-off between the olfactory bulb and eyeball volume in precocious puberty
- Gender-based differences in the clustering of metabolic syndrome factors in children and adolescents
- Presentation of 14 alkaptonuria patients from Turkey
- Assessment of health-related quality of life in Egyptian children and adolescents with congenital adrenal hyperplasia
- Case Reports
- Familial hypophosphatemic rickets caused by a PHEX gene mutation accompanied by a NPR2 missense mutation
- Cinacalcet treatment experience in hereditary vitamin D resistant rickets
- Can we effectively predict the occurrence of cerebral edema in children with ketoacidosis in the course of type 1 diabetes? – case report and literature review
