Individuals at risk for
developing type 2 diabetes who are prescribed the drug
metformin should stick with it, doctors say. In a large study,
individuals who adhered to a metformin-based diabetes
preventive strategy had a reduced risk of developing diabetes,
they report.
The Diabetes Prevention Program (DPP) investigated the
value of intensive lifestyle intervention (diet and exercise)
or metformin in delaying or preventing type 2 diabetes in
high-risk individuals with impaired glucose tolerance, a
precursor to full-blown diabetes.
Dr. Elizabeth A. Walker, of George Washington University,
Rockville, Maryland, and colleagues examined medication
adherence and health outcomes in the metformin and placebo arms
of the DPP.
A total of 2155 subjects who were randomly assigned to
either the metformin or placebo treatment arms were included in
the analysis.
The overall adherence rates -- that is, the proportion of
patients taking at least 80 percent of the prescribed dose --
were 71 percent in the metformin group and 77 percent in the
placebo group.
Compared to patients who were adherent to placebo, those
adherent to metformin had a 38.2 percent reduced risk of
developing diabetes, the investigators report. In this study,
"the level of medication adherence predicted the primary
outcome of diabetes," they write in the journal Diabetes Care.
Among patients taking metformin, older subjects were more
adherent than younger subjects.
Walker's team reports that the most commonly reported
barriers to taking the medication as prescribed were forgetting
to take doses (22 percent), adverse effects (8 percent), and
disruption of routines (8 percent). Overall, 15 percent of
women and 10 percent of men reported adverse effects in the
metformin group.
These results, the team concludes, "lend support for future
development and evaluation of brief, practical medication
adherence interventions for primary care settings."
SOURCE: Diabetes Care, September 2006.
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