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AMBULATORY CARE

Depression in Patients with Type 2 Diabetes: Impact on Adherence to Oral Hypoglycemic Agents

Assistant Professor, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN

Suresh S Madhavan, PhD MBA

Professor and Chair, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV

Mayur M Amonkar, PhD

Manager, Health Outcomes, GlaxoSmithKline, Collegeville, PA

Eugene H Makela, PharmD

Associate Professor, Department of Clinical Pharmacy, West Virginia University, Morgantown

Virginia G Scott, PhD RPh

Associate Professor, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown

Stratford M Douglas, PhD

Associate Professor, Department of Economics, West Virginia University, Morgantown

Betsy L Meredith Elswick, PharmD

Assistant Professor, Department of Clinical Pharmacy, West Virginia University, Morgantown

Reprints: Dr. Kalsekar, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave., Indianapolis, IN 46208-3485, fax 317/940-8520, ikalseka{at}butler.edu

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.

Key Words: adherence, administrative claims data, depression, Medicaid, oral hypoglycemic agents

Published Online, March 21, 2006. www.theannals.com, DOI 10.1345/aph.1G606

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