Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2006 Jul;98(7):1071–1077.

Race and medication adherence in Medicaid enrollees with type-2 diabetes.

Rahul A Shenolikar 1, Rajesh Balkrishnan 1, Fabian T Camacho 1, J Timothy Whitmire 1, Roger T Anderson 1
PMCID: PMC2569450  PMID: 16895275

Abstract

OBJECTIVE: The association of medication adherence with race has been inadequately studied previously in type-2 diabetes patients. The study objective was to determine the association between race and medication adherence among type-2 diabetes patients. METHODS: This was a retrospective cohort study, which compared medication adherence among different races of Medicaid insured patients with type-2 diabetes newly starting oral antidiabetic medication. A total of 1,527 African-American patients newly starting antidiabetic medication between July 2001 and June 2002 were compared with 1,128 white patients and 514 patients of other race. Medication adherence was measured as medication possession ratio using prescription refill patterns. Multivariate regression analyses were used to determine the difference in adherence rates adjusting for other covariates. RESULTS: Medication adherence rate was significantly higher for whites [0.59 (0.31)] as compared to African Americans [0.54 (0.31), (p<0.05)]. In multivariate analyses, the adherence rate of African-American patients was found to be significantly lower by 12% as compared to whites after adjusting for other covariates. Metformin users were associated with a 62% decrease in adherence rate as compared with the sulfonylureas group (p<0.05). CONCLUSION: The antidiabetic medication adherence was associated with race. Future research should investigate patient-related factors affecting medication adherence in type-2 diabetes patients.

Full text

PDF
1076

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amos A. F., McCarty D. J., Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14 (Suppl 5):S1–85. [PubMed] [Google Scholar]
  2. Balkrishnan R., Norwood G. J., Anderson A. Outcomes and cost benefits associated with the introduction of inhaled corticosteroid therapy in a medicaid population of asthmatic patients. Clin Ther. 1998 May-Jun;20(3):567–580. doi: 10.1016/s0149-2918(98)80066-0. [DOI] [PubMed] [Google Scholar]
  3. Balkrishnan Rajesh, Rajagopalan Rukmini, Camacho Fabian T., Huston Sally A., Murray Frederick T., Anderson Roger T. Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study. Clin Ther. 2003 Nov;25(11):2958–2971. doi: 10.1016/s0149-2918(03)80347-8. [DOI] [PubMed] [Google Scholar]
  4. Balkrishnan Rajesh, Rajagopalan Rukmini, Shenolikar Rahul A., Camacho Fabian T., Whitmire J. Timothy, Anderson Roger T. Healthcare costs and prescription adherence with introduction of thiazolidinedione therapy in Medicaid type 2 diabetic patients: a retrospective data analysis. Curr Med Res Opin. 2004 Oct;20(10):1633–1640. doi: 10.1185/030079904X4789. [DOI] [PubMed] [Google Scholar]
  5. Beck J. R., Scardino P. T. How useful are models of natural history in clinical decision making and clinical research? J Clin Epidemiol. 1994 Jan;47(1):1–2. doi: 10.1016/0895-4356(94)90028-0. [DOI] [PubMed] [Google Scholar]
  6. Choo P. W., Rand C. S., Inui T. S., Lee M. L., Cain E., Cordeiro-Breault M., Canning C., Platt R. Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. Med Care. 1999 Sep;37(9):846–857. doi: 10.1097/00005650-199909000-00002. [DOI] [PubMed] [Google Scholar]
  7. Cramer Joyce A. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004 May;27(5):1218–1224. doi: 10.2337/diacare.27.5.1218. [DOI] [PubMed] [Google Scholar]
  8. Dailey G., Kim M. S., Lian J. F. Patient compliance and persistence with antihyperglycemic drug regimens: evaluation of a medicaid patient population with type 2 diabetes mellitus. Clin Ther. 2001 Aug;23(8):1311–1320. doi: 10.1016/s0149-2918(01)80110-7. [DOI] [PubMed] [Google Scholar]
  9. Donnan P. T., MacDonald T. M., Morris A. D. Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study. Diabet Med. 2002 Apr;19(4):279–284. doi: 10.1046/j.1464-5491.2002.00689.x. [DOI] [PubMed] [Google Scholar]
  10. Harris M. I., Eastman R. C., Cowie C. C., Flegal K. M., Eberhardt M. S. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999 Mar;22(3):403–408. doi: 10.2337/diacare.22.3.403. [DOI] [PubMed] [Google Scholar]
  11. Hepke Kera L., Martus Mary T., Share David A. Costs and utilization associated with pharmaceutical adherence in a diabetic population. Am J Manag Care. 2004 Feb;10(2 Pt 2):144–151. [PubMed] [Google Scholar]
  12. Hogan Paul, Dall Tim, Nikolov Plamen, American Diabetes Association Economic costs of diabetes in the US in 2002. Diabetes Care. 2003 Mar;26(3):917–932. doi: 10.2337/diacare.26.3.917. [DOI] [PubMed] [Google Scholar]
  13. Krapek Kimberley, King Kathleen, Warren Susan S., George Karen G., Caputo Dorothy A., Mihelich Karen, Holst Elizabeth M., Nichol Michael B., Shi Sheng G., Livengood Kevin B. Medication adherence and associated hemoglobin A1c in type 2 diabetes. Ann Pharmacother. 2004 Jul 6;38(9):1357–1362. doi: 10.1345/aph.1D612. [DOI] [PubMed] [Google Scholar]
  14. Paes A. H., Bakker A., Soe-Agnie C. J. Impact of dosage frequency on patient compliance. Diabetes Care. 1997 Oct;20(10):1512–1517. doi: 10.2337/diacare.20.10.1512. [DOI] [PubMed] [Google Scholar]
  15. Renders C. M., Valk G. D., Griffin S. J., Wagner E. H., Eijk Van J. T., Assendelft W. J. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care. 2001 Oct;24(10):1821–1833. doi: 10.2337/diacare.24.10.1821. [DOI] [PubMed] [Google Scholar]
  16. Rhee Mary K., Slocum Wrenn, Ziemer David C., Culler Steven D., Cook Curtiss B., El-Kebbi Imad M., Gallina Daniel L., Barnes Catherine, Phillips Lawrence S. Patient adherence improves glycemic control. Diabetes Educ. 2005 Mar-Apr;31(2):240–250. doi: 10.1177/0145721705274927. [DOI] [PubMed] [Google Scholar]
  17. Saaddine Jinan B., Engelgau Michael M., Beckles Gloria L., Gregg Edward W., Thompson Theodore J., Narayan K. M. Venkat. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002 Apr 16;136(8):565–574. doi: 10.7326/0003-4819-136-8-200204160-00005. [DOI] [PubMed] [Google Scholar]
  18. Sadler Georgia Robins, Escobar Rita Paola, Ko Celine Marie, White Monique, Lee Shianti, Neal Tiffany, Gilpin Elizabeth A. African-American women's perceptions of their most serious health problems. J Natl Med Assoc. 2005 Jan;97(1):31–40. [PMC free article] [PubMed] [Google Scholar]
  19. Shaya Fadia T., Shin James Y., Mullins Daniel, Fatodu Hugh O., Gu Anna, Saunders Elijah. Medicaid managed care: disparities in the use of thiazolidinediones compared with metformin. J Natl Med Assoc. 2005 Apr;97(4):493–497. [PMC free article] [PubMed] [Google Scholar]
  20. Steiner J. F., Koepsell T. D., Fihn S. D., Inui T. S. A general method of compliance assessment using centralized pharmacy records. Description and validation. Med Care. 1988 Aug;26(8):814–823. doi: 10.1097/00005650-198808000-00007. [DOI] [PubMed] [Google Scholar]
  21. Stratton I. M., Adler A. I., Neil H. A., Matthews D. R., Manley S. E., Cull C. A., Hadden D., Turner R. C., Holman R. R. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000 Aug 12;321(7258):405–412. doi: 10.1136/bmj.321.7258.405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Thackeray Rosemary, Merrill Ray M., Neiger Brad L. Disparities in diabetes management practice between racial and ethnic groups in the United States. Diabetes Educ. 2004 Jul-Aug;30(4):665–675. doi: 10.1177/014572170403000418. [DOI] [PubMed] [Google Scholar]
  23. Wagner E. H., Sandhu N., Newton K. M., McCulloch D. K., Ramsey S. D., Grothaus L. C. Effect of improved glycemic control on health care costs and utilization. JAMA. 2001 Jan 10;285(2):182–189. doi: 10.1001/jama.285.2.182. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES