Medication Adherence During Adjunct Therapy With Statins and ACE Inhibitors in Adolescents With Type 1 Diabetes

Elżbieta Niechciał, Carlo L Acerini, Scott T Chiesa, Tracey Stevens, R Neil Dalton, Denis Daneman, John E Deanfield, Timothy W Jones, Farid H Mahmud, Sally M Marshall, H Andrew W Neil, David B Dunger, M Loredana Marcovecchio, Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) Study Group, Adolescent Type 1 Diabetes Cardio-renal Intervention Trial AdDIT Study Group, Carlo L Acerini, Frank Ackland, Binu Anand, Tim Barrett, Virginia Birrell, Fiona Campbell, Marietta Charakida, Tim Cheetham, Scott T Chiesa, John E Deanfield, Chris Cooper, Ian Doughty, Atanu Dutta, Julie Edge, Alastair Gray, Julian Hamilton-Shield, Nick Mann, M Loredana Marcovecchio, Sally M Marshall, H Andrew W Neil, Gerry Rayman, Jonathon M Robinson, Michelle Russell-Taylor, Vengudi Sankar, Anne Smith, Nandu Thalange, Chandan Yaliwal, Paul Benitez-Aguirre, Fergus Cameron, Andrew Cotterill, Jennifer Couper, Maria Craig, Elizabeth Davis, Kim Donaghue, Timothy W Jones, Bruce King, Charles Verge, Phil Bergman, Christine Rodda, Cheril Clarson, Jacqueline Curtis, Denis Daneman, Farid H Mahmud, Etienne Sochett, Elżbieta Niechciał, Carlo L Acerini, Scott T Chiesa, Tracey Stevens, R Neil Dalton, Denis Daneman, John E Deanfield, Timothy W Jones, Farid H Mahmud, Sally M Marshall, H Andrew W Neil, David B Dunger, M Loredana Marcovecchio, Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) Study Group, Adolescent Type 1 Diabetes Cardio-renal Intervention Trial AdDIT Study Group, Carlo L Acerini, Frank Ackland, Binu Anand, Tim Barrett, Virginia Birrell, Fiona Campbell, Marietta Charakida, Tim Cheetham, Scott T Chiesa, John E Deanfield, Chris Cooper, Ian Doughty, Atanu Dutta, Julie Edge, Alastair Gray, Julian Hamilton-Shield, Nick Mann, M Loredana Marcovecchio, Sally M Marshall, H Andrew W Neil, Gerry Rayman, Jonathon M Robinson, Michelle Russell-Taylor, Vengudi Sankar, Anne Smith, Nandu Thalange, Chandan Yaliwal, Paul Benitez-Aguirre, Fergus Cameron, Andrew Cotterill, Jennifer Couper, Maria Craig, Elizabeth Davis, Kim Donaghue, Timothy W Jones, Bruce King, Charles Verge, Phil Bergman, Christine Rodda, Cheril Clarson, Jacqueline Curtis, Denis Daneman, Farid H Mahmud, Etienne Sochett

Abstract

Objective: Suboptimal adherence to insulin treatment is a main issue in adolescents with type 1 diabetes. However, to date, there are no available data on adherence to adjunct noninsulin medications in this population. Our aim was to assess adherence to ACE inhibitors and statins and explore potential determinants in adolescents with type 1 diabetes.

Research design and methods: There were 443 adolescents with type 1 diabetes recruited into the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) and exposed to treatment with two oral drugs-an ACE inhibitor and a statin-as well as combinations of both or placebo for 2-4 years. Adherence was assessed every 3 months with the Medication Event Monitoring System (MEMS) and pill count.

Results: Median adherence during the trial was 80.2% (interquartile range 63.6-91.8) based on MEMS and 85.7% (72.4-92.9) for pill count. Adherence based on MEMS and pill count dropped from 92.9% and 96.3%, respectively, at the first visit to 76.3% and 79.0% at the end of the trial. The percentage of study participants with adherence ≥75% declined from 84% to 53%. A good correlation was found between adherence based on MEMS and pill count (r = 0.82, P < 0.001). Factors associated with adherence were age, glycemic control, and country.

Conclusions: We report an overall good adherence to ACE inhibitors and statins during a clinical trial, although there was a clear decline in adherence over time. Older age and suboptimal glycemic control at baseline predicted lower adherence during the trial, and, predictably, reduced adherence was more prevalent in subjects who subsequently dropped out.

Trial registration: ClinicalTrials.gov NCT01581476.

Conflict of interest statement

Conflict of interest

None in related to the present work.

© 2020 by the American Diabetes Association.

Figures

Figure 1
Figure 1
Adherence during the trial period based on MEMS and pill count Results at each study visit are reported as medians. N of participants are those still active at each follow up study visit with available adherence data. At the first 1-month visit. P for over time changes in each group:

Figure 2

Comparisons between adherence assessed by…

Figure 2

Comparisons between adherence assessed by MEMS and pill count: A) Scatter plot of…

Figure 2
Comparisons between adherence assessed by MEMS and pill count: A) Scatter plot of pill count vs MEMS, r=0.82, p

Figure 3

Percentage of participants showing different…

Figure 3

Percentage of participants showing different levels of adherence, from ≥75% to

Figure 3
Percentage of participants showing different levels of adherence, from ≥75% to
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Figure 2
Figure 2
Comparisons between adherence assessed by MEMS and pill count: A) Scatter plot of pill count vs MEMS, r=0.82, p

Figure 3

Percentage of participants showing different…

Figure 3

Percentage of participants showing different levels of adherence, from ≥75% to

Figure 3
Percentage of participants showing different levels of adherence, from ≥75% to
Similar articles
Cited by
Publication types
MeSH terms
Substances
Associated data
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 3
Figure 3
Percentage of participants showing different levels of adherence, from ≥75% to

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