Routine urine samples can be used to test for medication adherence in patients with type 2 diabetes, according to a study published in the June issue of Diabetes Care. Prashanth Patel, M.B.B.S., from the University Hospitals of Leicester NHS Trust in the United Kingdom, and colleagues use liquid chromatography-tandem mass spectrometry analysis to measure nonadherence to cardiovascular medications in urine samples from 228 patients with type 2 diabetes seen in primary care for an annual diabetes review.
Major cause of morbidity
Cardiovascular disease is a major cause of morbidity and mortality in people with type 2 diabetes (T2DM) and is the largest contributor to health care costs in this population. Although the management of risk factors such as blood pressure, dyslipidemia, and glucose leads to legacy benefits of reduce microvascular and macrovascular complications, up to one-third of people with T2DM fail to derive optimal benefit from therapy because of nonadherence to medication.
Further, poor adherence is associate with increase mortality and number of hospital admissions. Few reliable and practical tools exist to accurately to detect nonadherence to therapy. The researchers find that 28.1% of patients were nonadherent to antidiabetic, antihypertensive, and/or lipid-lowering medications.
Statin nonadherence was highest, while nonadherence to oral hypoglycemic agents was lowest. In nonadherent patients, hemoglobin A1c, albumin to creatinine ratio, and lipid profiles were significantly higher compare to those seen in patients adherent to treatment.
In conclusion, a single urine spot sample can be use to objectively screen for nonadherence in primary care; also the technique demonstrates that nonadherence to cardiovascular therapies is high in people; so with T2DM attending primary care, the authors write. This be use to inform clinical decisions about treatment alteration; also to improve patient outcomes. The difficulty in diagnosing medication adherence reliably; so in a clinically useful manner remains a major unmet clinical need.
This study shows for the first time that a routine urine sample collect in the primary care; hence setting for urine microalbumin screening at the time of annual review; which can be use to objectively detect, using LC-MS/MS, nonadherence to treatment in people with T2DM.
Anecdotally, the test is well accept by patients and helps to initiate a discussion; so about the reasons for nonadherence and ways to overcome them. Further, they confirm that there are high rates of nonadherence in people with T2DM within a primary care setting, as demonstrate previously. The study also demonstrates that nonadherence is associate with poor control of diabetes and lipids.