Effect of Cost and Formulation on Persistence and Adherence to Initial Metformin Therapy for Type 2 Diabetes
Abstract
Patients taking metformin adhere to their prescribed regimen, on average, about 65% of the time (1,2). Given metformin’s central role in type 2 diabetes management, optimizing adherence is important. Common causes of nonadherence include cost and side effects. Metformin is inexpensive but causes gastrointestinal side effects in up to 25% of patients (2). Extended-release (ER) formulations reduce side effects but may cost more, and they have not been clearly shown to improve adherence in routine practice (3). As a result, although it is common practice to change from immediate release (IR) formulations to ER once patients develop side effects, there is not a consensus on whether ER formulations should routinely be used when metformin is first prescribed (3). We undertook a retrospective cohort study of how cost and initial choice of formulation affect adherence and persistence to metformin.
The study used merged de-identified claims data from commercial insurance carriers in the U.S. from 1 January 2012 to 31 December 2016 (4). A cohort was identified of patients age 18 years or older who filled an initial 30-day prescription for …
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.
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