Treatment adherence by personalizing the drug dispensing for diabetic patients in social vulnerable situation

Abstract

Objectives: We examined the impact of personalizing antidiabetic agents in treatment adherence and in health outcome of socioeconomic vulnerable patients. Methods: We conducted a randomized controlled trial comparing usual “on demand” drug supply from Primary Health Care (PHC) Centers; with a drug dispensing strategy based on a personalized process. 469 patients with type-2 diabetes (DBT) were assigned to either control (CG) or intervention group (IG) assuring a balance in main risk factors. Primary trial endpoint was treatment compliance; however aspects like health events associated to DBT were also evaluated. Results: Adherence to oral agents in CG was 15.57% and 92.09% in IG (p <0.001). Dose omissions represented the most prevalent form of non-adherence. Weight loss was greater in the intervention group than in the control group throughout the study (5.4% in overall weight reduction at study end). Hospital admissions (16.80% vs 10.23% - p <0.01) and coronary heart events (7.37% vs. 3.72% p 0.03) were higher for CG when compared with IG. Conclusions: Diabetes faces the challenge of lifelong treatment. This task is difficult for every patient but is especially hard in social vulnerable situation. Our initiative demonstrate that for the poor and uninsured population, personalizing drug dispensing showed a high level of treatment compliance, and benefits in terms of health consequences associated to diabetes. This experience might be useful for primary care health teams in order to better control social underserved patients, and also for reducing the economical impact for health system caused by complications due to untreated diabetes