Zamanillo Campos, RocíoZaforteza Dezcallar, MaríaBoronat Moreiro, Maria AsunciónLeiva Rus, AlfonsoRipoll Amengual, JoanaKonieczna, JadwigaFiol-deRoque, Maria AntoniaRicci-Cabello, Ignacio2024-10-092024-10-092023-12Zamanillo-Campos R, Zaforteza Dezcallar M, Boronat Moreiro MA, Leiva Rus A, Ripoll Amengual J, Konieczna J, et al. Non-adherence to non-insulin glucose-lowering drugs: Prevalence, predictors and impact on glycemic control and insulin initiation. A longitudinal cohort study in a large primary care database in Spain. Eur J Gen Pract. 2023 Dec 30;29(1).https://hdl.handle.net/20.500.13003/20038https://hdl.handle.net/20.500.12105/23725Background: A better understanding of patient non-adherence to type 2 diabetes medication is needed to design effective interventions to address this issue. Objectives: (1) To estimate the prevalence of non-adherence to diabetes medication; (2) to examine its impact on glycemic control and insulin initiation; (3) to develop and validate a prediction model of non-adherence. Methods: We conducted a longitudinal cohort study based on data from electronic health records. We included adult patients registered within the Health Service of the Balearic Islands (Spain) starting a new prescription of a non-insulin glucose-lowering drug between January 2016 and December 2018. We calculated non-adherence at 12 months follow-up, defined as medication possession ratio (MPR) ≤ 80%. We fitted multivariable regression models to examine the association between non-adherence and glycemic control and insulin initiation and identified predictors of non-adherence. Results: Of 18,119 patients identified, after 12 months follow-up, 5,740 (31.68%) were non-adherent. Compared with non-adherent, adherent patients presented lower HbA1c levels (mean difference = -0.32%; 95%CI = -0.38%; -0.27%) and were less likely to initiate insulin (aOR = 0.77; 95%CI = 0.63; 0.94). A predictive model explained 22.3% of the variation and presented a satisfactory performance (AUC = 0.721; Brier score = 0.177). The most important predictors of non-adherence were: non-Spanish nationality, currently working, low adherence to previous drugs, taking biguanides, smoker and absence of hypertension. Conclusion: Around one-third of the patients do not adhere to their non-insulin glucose-lowering drugs. More research is needed to optimise the performance of the predicting model before considering its implementation in routine clinical practice.enghttp://creativecommons.org/licenses/by-nc/4.0/Diabetes Mellitus, Type 2Glycemic ControlSpainAdultGlucoseInsulinHumansLongitudinal StudiesHypoglycemic AgentsMedication AdherenceCohort StudiesPrimary Health CarePrevalenceRetrospective Studiesresearch articleAtribución-NoComercial 4.0 Internacional37874585291226883810.1080/13814788.2023.22688381751-1402The European journal of general practiceopen accessEstudios de CohortesPrevalenciaControl GlucémicoInsulinaCumplimiento de la MedicaciónEstudios LongitudinalesHipoglucemiantesHumanosDiabetes Mellitus Tipo 2GlucosaAtención Primaria de SaludEstudios RetrospectivosAdultoEspaña1088224600001L2026260223