Nearly 30% of adults with type 2 diabetes may not take all their medications as instructed, including nearly one-quarter of those prescribed statins, according to findings presented in Diabetes Care.

“If you look at nonadherence, the whole area, this is, I think, one of the biggest unaddressed issues in modern medicine,” Pankaj Gupta, DPB, MSC, FRCPath, FRCP, a consultant metabolic physician at University Hospitals of Leicester NHS Trust  and honorary senior lecturer in cardiovascular sciences at the University of Leicester in the U.K., told Endocrine Today. “We know a lot of patients don’t take their medications. The problem has been the previous lack of a definitive, easy-to-use method [for detecting non-adherence to medication] in the clinics. Our biochemical test overcomes this lacunae and has a clear diagnostic and therapeutic potential. The samples can be transported by ordinary post and thus analyzed in central laboratory. We have set up the first National Centre for Adherence Testing and receive samples form 33 NHS centers across the U.K.”

Gupta, together with Prashanth Patel, MSc, MRCPI, FRCP(Edin), FRCPath, a consultant metabolic physician in chemical pathology and director CSI at University Hospital of Leicester and an honorary lecturer in cardiovascular sciences at the University of Leicester, and colleagues, used, for the first time, liquid chromatography-tandem mass spectrometry to evaluate medication adherence via urine samples from 228 consecutively enrolled participants (mean age, 59.9 years; 46.1% women) who attended an annual diabetes checkup at one of six primary care practices in Leicestershire County in the U.K. from March 2016 to July 2017. According to the researchers, liquid chromatography-tandem mass spectrometry can identify 60 of the most common drugs used for cardiovascular indications.

Three categories of adherence were defined, with nonadherence indicated by no presence of a medication in the urine, partial adherence as presence of at least one but not all medications and total adherence as the presence of all prescribed medications.

The researchers found that 28.1% of the participants were not fully adhering to their medication regimens, including 5.7% who were entirely nonadherent. Nearly one-quarter of participants did not take their prescribed statins (23.7%), according to researchers, and another 9.3% did not take their diabetes medications. The researchers noted that statins were the medication most likely to have a nonadherence reading. “I wouldn’t say I was surprised by these numbers of non-adherent patients. It was sort of expected,” Gupta said. “The only thing I would say is that the results show that the nonadherence pattern is different in different medications, that being highest for statins, which again is not a surprise, but because of the bad press statins have received. The biochemical test can thus help target guidance and advice in a tailored manner.”

Participants who were partially or totally nonadherent had a higher mean HbA1c compared with totally adherent participants (7.7% vs. 7%; P = .001) and a higher mean total cholesterol level (4.4 mmol/L vs. 3.8 mmol/L; P = .001).

Based on previous research using the same testing method for hypertension medication adherence, Gupta said he has seen that results from liquid chromatography-tandem mass spectrometry can help enhance the communication between physicians and their patients and improve adherence. However, he noted that this testing is not universally available and that additional studies must confirm such a positive benefit in people with diabetes.

“In our experience, when we use this test, it often breaks down the barriers of discussing nonadherence with patients,” Gupta said. “It doesn’t depend on the judgement of the clinician or a health care professional to decide if a patient is taking his medication or not. Then you can have an objective discussion with patients about why they are forgetting their medications.”– by Phil Neuffer