Background: Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) participants have youth-onset type 2 diabetes (T2D) and often poor glycemic control. The role of medication adherence is unknown.
Aims: To assess oral diabetes medication adherence in the TODAY2 cohort; To assess participant factors related to adherence.
Methods: Participants provided data at TODAY2 visits and at 3 monthly unannounced phone pill counts. Those taking ≥80% of pills were classified “high adherent,” those taking <80% of pills were defined “low adherent.” If not taking oral medications (meds) they were asked reasons and adjudicated (no need for meds vs. non-adherent). The unadjusted association of each factor with adherence status was assessed by ANOVAs (continuous variables) and Pearson χ-square (categorical variables). Factors with p<0.2 were entered into logistic models for adherence.
Results: Of 381 individuals, 224 were either taking oral meds (n=190) or taking none though meds were recommended (n=34) [mean age 25 yrs, 67% female, 18% white, 34% black, 39% Hispanic, 84% <$36K income]. Per pill counts, 66.1% were low adherent (includes 15.2% adjudicated non-adherent). Unadjusted results: HbA1c was lower in high vs. low adherent groups (9.2% vs. 10.0%, p<0.04). Racial/ethnic differences in adherence (55.3% non-Hispanic whites, 60.2% Hispanics, 85.7% non-Hispanic blacks were low adherent, p<0.002). Of those with/without insurance, 65.5%/91.4% were low adherent (p<0.004). After adjustment, race/ethnicity (p<0.02) and insurance status (p<0.007) remained related to adherence. HbA1c, age, gender, education, income, employment, BMI, T2D duration, family history, and no. of complications did not relate to adherence.
Conclusion: In emerging adults with youth-onset T2D, poor adherence to oral diabetes meds was common, and significantly more likely in those without health insurance and in non-Hispanic blacks. Interventions are needed to improve adherence and outcomes.
P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. S. Kalichman: None. D. Wang: None. K. Drews: None. B. Anderson: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.
National Institutes of Health (R01DK110456)