Complex Medication Regimens Associated With Poorer Type 2 Diabetes Outcomes

More complex medication regimens were associated with worse outcomes among patients with type 2 diabetes mellitus (T2DM), according to findings published in the Journal of the American Pharmacists Association.

Patients may follow complex medication regimens to manage their T2DM and comorbid conditions, said Andrea M Russell, PhD, postdoctoral research fellow at Northwestern University Feinberg School of Medicine, and coauthors.

“Greater regimen complexity has been associated with poorer T2DM management; however, the relationship between overall regimen complexity and glycemic control is unclear,” researchers said.

The secondary analysis was conducted using cross-sectional data from an existing trial that involved 432 participants. Patients were 56.9 years of age on average and predominantly female (66%) and Hispanic or Latino (73.3%). They received at least 3 chronic medications and were monitored in safety net clinics throughout Chicago.

Dr Russell and coinvestigators measured regimen complexity by counting overall medications and using the Medication Regimen Complexity Index (MRCI), which accounts for dosing frequency, route of administration, and any special instructions associated with a prescription.

Regimen complexity was high, according to the findings. Patients were prescribed 6.6 medications on average (standard deviation [SD] 3.09), and the MCRI also indicated high complexity (M=21.4, SD 11.3).

Higher diabetes-specific MCRI scores (>14) were associated with higher A1c levels. Fewer outpatient health care visits, male gender, and lack of health insurance were also associated with higher A1c.

“More complex regimens are associated with worse A1c,” Dr Russell and coauthors said, “and measuring complexity with MRCI may have advantages.”

Researchers recommended deprescribing, increasing insurance coverage, and promoting patient engagement with the health care system to improve A1c in underserved populations who are on complex regimens.

Reference:
Russell AM, Opsasnick L, Yoon E, Baily SC, O’Brien M, Wolf MS. Association between medication regimen complexity and glycemic control among patients with type 2 diabetes. J Am Pharm Assoc. Published online December 30, 2022. doi:10.1016/j.japh.2022.12.028