The association of ADHD and ADHD medication with adherence to pharmacotherapy for type 2 diabetes: a population-based cohort study from seven countries
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) may compromise adherence to pharmacotherapy in adults with type 2 diabetes, but the relationship is unknown. We investigated the association of ADHD and ADHD medication with antidiabetic medication adherence in multinational cohort data.
Methods: Using a common analytical protocol and population-based databases from seven countries, we identified adults initiating non-insulin antidiabetic medication between 2010 and 2020. ADHD was identified by diagnosis or ADHD medication use. We used the proportion of days covered (PDC) to measure antidiabetic medication adherence and defined the primary outcome, poor adherence, as PDC <80% over 1-, 2-, and 5-year follow-up periods. Time-to-first-discontinuation was the secondary outcome. Country-specific estimates were obtained using logistic and Cox regression and pooled using random-effects meta-analyses.
Findings: Among 3,643,197 individuals included, 1,871,870 (51.4%) were female and 88,339 (2.4%) had ADHD (76,973 [87.1%] received ADHD medication). Overall, ADHD was not associated with poor adherence to antidiabetic medication (1-, 2-, and 5-year pooled odds ratios [OR]: 1.01 [95% CI 0.90-1.14], 1.03 [0.91-1.17], and 1.12 [0.95-1.31]); country-specific estimates ranged from 0.79 to 1.32, 0.80 to 1.35, and 0.80 to 1.47 at 1, 2, and 5 years, respectively. Among males, ADHD was associated with poorer adherence (1.09 [95% CI 1.00-1.20], 1.12 [1.00-1.24], and 1.23 [1.11-1.37] at…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 3,643,197 participants or records.
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