Sodelovanje in vztrajanje pacientov s sladkorno boleznijo tipa 2 pri zdravljenju z zaviralci dipeptidil peptidaze-4 v Sloveniji

Vodopivec, Klemen (author), Kos, Mitja (mentor)

Učinkovitost zdravljenja z zdravili za zdravljenje sladkorne bolezni tipa 2 je odvisna tudi od ustreznega vztrajanja in sodelovanja pacientov pri zdravljenju. Namen raziskave je ovrednotiti sodelovanje in vztrajanje pacientov s sladkorno boleznijo tipa 2 pri zdravljenju z zaviralci dipeptidil peptidaze-4 v Sloveniji. Uporabili smo anonimizirano zbirko podatkov izdanih zdravil ZZZS za obdobje 2008-2019. Potek zdravljenja smo raziskali na skupini oseb, ki so pričele zdravljenje v letih 2013 in 2014, ki so imele vsaj tri prevzeme zdravila in jih je bilo mogoče spremljati do konca opazovalnega obdobja petih let. Analizo smo izvedli v programskem jeziku R, s programskim paketom AdhereR, ki je namenjen statistični in vizualni analizi sodelovanja in vztrajanja pri zdravljenju. Analizirali smo vztrajanje pri zdravljenju z zaviralci DPP-4, ki je predstavljalo čas od prve izdaje do prekinitve zdravljenja. Prekinitev smo zaznali, če je bila med dvema zaporednima izdajama zdravila po poteku zaloge presežena dovoljena vrzel 60 dni. Vztrajanje smo ovrednotili s Kaplan-Meierjevo analizo preživetja, vpliv različnih dejavnikov na vztrajanje pa z log-rank testom. Sodelovanje pri zdravljenju z zaviralci DPP-4 smo analizirali z metodo PDC (ang. proportion of days covered), ki predstavlja delež dni, ko je bil pacient pokrit z zdravilom; pri tem smo upoštevali časovni okvir od prvega do zadnjega prevzema zdravila (AdhereR algoritem CMA5). Vpliv različnih dejavnikov na sodelovanje smo ovrednotili s testom analize variance (ANOVA). V letih 2013 in 2014 je bil zaviralec DPP-4 na novo izdan 2.844 osebam s povprečno starostjo 63,4 let, od katerih jih je bilo 54% ženskega spola. Po enem letu je vsaj eno prekinitev zdravljenja z zaviralci DPP-4 doživelo 30% oseb, po petih letih pa 71% oseb. Čas, v katerem je polovica oseb doživela vsaj eno prekinitev, je znašal 863 dni. Po prvi prekinitvi je ponovno začelo z zdravljenjem z DPP-4 55% oseb. Povprečna pokritost z zaviralci DPP-4 (PDC) v časovnem okviru od prvega do zadnjega prevzema je znašala 84,7 %, delež oseb s PDC > 80% pa je znašal 72,6%. Če smo sodelovanje ocenili samo med epizodami vztrajanja, je povprečna pokritost (PDC) znašala 92,4%, delež oseb s PDC > 80% pa je znašal 92,2%. Nižja starost in vzhodne statistične regije Slovenije so povezane s slabšim vztrajanjem in sodelovanjem pri zdravljenju, medtem ko spol osebe ni imel statistično značilnega vpliva. Pri uporabi zaviralcev DPP-4 je potrebno posvetiti več pozornosti mlajšim osebam, ter osebam iz vzhodnih regij Slovenije, ter izboljšati predvsem vztrajanje oseb pri zdravljenju.

• Language: Slovenian
• Keywords: Sodelovanje pri zdravljenju, vztrajanje pri zdravljenju, zaviralci DPP-4, AdhereR
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2022
• PID: 20.500.12556/RUL-135291
• Publication date in RUL: 05.03.2022

Secondary language

• Language: English
• Title: Medication adherence and persistance of patients with diabetes type 2 treated with dipeptidyl peptidase-4 inhibitors in Slovenia

Abstract

The effectiveness of treatment with antidiabetic medication depends on the appropriate medication persistence and adherence of patients with diabetes type II. The purpose of this study was to evaluate medication persistence and adherence with dipeptidyl peptidase-4 inhibitors (DPP-4i) among patients with diabetes type II in Slovenia. This nationwide retrospective study was conducted using data from the Slovenian health claims database (years 2008-2019; Health Insurance Institute of Slovenia). The study population represented a cohort of patients with DPP-4i, who started their treatment in 2013 or 2014, who had at least three prescription fills of DPP-4i and for whom the data on any prescription were available until the end of the five-year observational period. The analysis was performed with the AdhereR software. Persistence was defined as the time from first dispensing to discontinuation of treatment, with discontinuation defined as a gap of 60 days or more after the refill date. Medication persistence was evaluated by Kaplan-Meier survival analysis, and the influence of various factors on persistence by the log-rank test. Adherence was evaluated with the proportion of days covered (PDC, algorithm CMA5) and the influence of various factors on adherence by ANOVA. In 2013 and 2014 DPP-4 inhibitors were newly issued to 2,844 people with an average age of 63.4 years, of whom 54% were female. After the first year, 30% of patients experienced at least one discontinuation of treatment and after five years that number was 71%. Half of the patients experienced at least one discontinuation of treatment 863 days after the first dispensing. After the first discontinuation 55% of patients started the treatment again. Mean PDC in the time frame from first to last administration was 84.7%, meaning that patients had access to DPP-4i on average 84.7% of days. The proportion of patients who were adherent is 72.6% (patients with PDC>80% are considered adherent). Adherence was even better if we only evaluated it during episodes of persistence. In this case mean PDC was 92.4% and the proportion of patients who were adherent is 92.2%. Poorer medication persistence and adherence were significantly associated with lower age and eastern geographical regions of Slovenia, but not gender. In order to improve medication adherence and persistence in the treatment of diabetes type II with DPP-4i in Slovenia more attention should be given to younger patients and patients from eastern geographical regions of Slovenia.

• Keywords: Medication adherence, medication persistence, DPP-4 inhibitors, AdhereR