Introduction and Objective: We examined medication adherence as a predictor of glycemic outcomes and evaluated treatment group differences in the GRADE study.Methods: GRADE participants (T2DM <10 years, HbA1c = 6.8-8.5%, on metformin monotherapy) were randomly assigned to add insulin glargine, glimepiride, liraglutide, or sitagliptin. The Emotional Distress Substudy followed 1,739 participants who self-reported adherence to the assigned medication regimen biannually up to 3 years on a 3-item validated scale (scored 0-100). We examined: a) levels of adherence and differences by treatment group over time; b) adherence as a predictor of primary (HbA1c ≥7.0) and secondary (HbA1c >7.5) glycemic outcomes; and c) treatment group differences in the association between adherence and glycemic outcomes.Results: Across treatment groups, adherence decreased slightly over 3 years (M±SD = -2.0 ± 14.7, p < 0.0001) but was high overall (M±SD = 88.7 ± 10.01). No group differences were observed at 6, 12, or 24 months. However, at 3 years adherence was 5.1% higher for the glimepiride and 3% higher for sitagliptin groups than for liraglutide (both p < 0.05); no other group differences were significant. Across groups, a 10-point decrease in adherence score was associated with 15% and 19% increased risk of reaching primary and secondary glycemic outcomes, respectively (both p < 0.0001). Adherence predicted the primary glycemic outcome conisistently across groups but was somewhat more predictive of reaching the secondary glycemic outcome for those assigned to glargine or liraglutide, as compared to glimepiride or sitagliptin (each p < 0.05). No other group comparisons were significant.Conclusion: Medication adherence was consistently high in GRADE and observed treatment group differences were small, supporting previously reported trial outcomes. Nevertheless, lower adherence robustly predicted worsening glycemic control, highlighting the importance of ongoing assessment.
J.S. Gonzalez: None. H. Wen: None. M.R. Gramzinski: None. N.M. Butera: None. D. Uschner: None. D.J. Wexler: Other Relationship; Novo Nordisk. H. Petrovitch: None. B. Fattaleh: None. E.A. Walker: None. C.J. Hoogendoorn: None. C.A. Presley: None. G. Crespo-Ramos: None. V. Lagari: None. H. Krause-Steinrauf: None. A.L. Cherrington: None.
National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098246; U34DK088043; R01DK104845); The National Heart, Lung, and Blood Institute; The Centers for Disease Control and Prevention
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