Depression in patients with type 2 diabetes: Impact on adherence to oral hypoglycemic agents

Iftekhar D. Kalsekar, Sundareswaran Suresh Madhavan, Mayur M. Amonkar, Eugene H. Makela, Virginia G. Scott, Stratford M. Douglas, Betsy L.Meredith Elswick

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59 Scopus citations

Abstract

BACKGROUND: Adherence to oral hypoglycemic agents (OHAs) is important for adequate glycemic control and prevention of future complications in patients with type 2 diabetes. OBJECTIVE: To examine the impact of depression on adherence to OHAs in patients newly diagnosed with type 2 diabetes. METHODS: Patients newly diagnosed with type 2 diabetes during a 4 year period were identified from a Medicaid claims database. Presence of preexisting depression was determined on the basis of ICD-9-CM codes. Adherence to OHAs was computed using prescription refill data for a 12 month follow-up period from the date of the index OHA prescription. Two separate adherence indices (Medication Possession Ratio-1 [MPR-1], Medication Possession Ratio-2 [MPR-2]) were computed. The impact of depression on adherence was assessed after controlling for confounders such as demographics, comorbidity, provider interaction, complexity of regimen, and diabetes severity. RESULTS: A total of 1326 newly diagnosed patients with type 2 diabetes were identified (depressed = 471; nondepressed = 855). Results of the study indicated that patients with depression had significantly lower adherence (MPR-1 86%; MPR-2 66%) to OHAs compared with patients without depression (MPR-1 89%; MPR-2 73%). Multivariate results indicated that depression was a significant predictor of adherence, with depressed patients being 3-6% less adherent to OHAs than nondepressed patients, after controlling for confounding factors. CONCLUSIONS: Depression significantly impacts adherence to OHAs in patients with type 2 diabetes. The study results imply that depression screening and treatment need to be included in the protocol for management of patients with type 2 diabetes.

Original languageEnglish
Pages (from-to)605-611
Number of pages7
JournalAnnals of Pharmacotherapy
Volume40
Issue number4
DOIs
StatePublished - 1 Apr 2006

Keywords

  • Adherence
  • Administrative claims data
  • Depression
  • Medicaid
  • Oral hypoglycemic agents

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    Kalsekar, I. D., Madhavan, S. S., Amonkar, M. M., Makela, E. H., Scott, V. G., Douglas, S. M., & Elswick, B. L. M. (2006). Depression in patients with type 2 diabetes: Impact on adherence to oral hypoglycemic agents. Annals of Pharmacotherapy, 40(4), 605-611. https://doi.org/10.1345/aph.1G606