Missed appointments, medication noncompliance linked to increased mortality in type 2 diabetes

Noncompliance with medications and clinic nonattendance are independently linked with increased mortality in patients with type 2 diabetes on insulin therapy, according to a study published in the journal Diabetes Care.

Data on almost 16,000 patients from UK general practice clinics over 30 months were analyzed by a team of researchers from Cardiff University in Wales, Johns Hopkins University in Maryland and Loyola University in Maryland.

The researchers looked for associations between all-cause mortality and medication noncompliance and/or medical appointment nonattendance in the patients.

All patients in the study had type 2 diabetes or had received a prescription for an oral antidiabetic medication and were being treated with insulin.

Noncompliance was defined as missing more than one scheduled visit or having at least one notation in the chart of not taking medications as prescribed.

In addition to these risk factors, the mortality risk increased further when clinic nonattendance was greater than two missed appointments.

The researchers found that the patients identified as clinic nonattenders were more likely to be smokers and younger. They were more likely to have greater morbidity, have more prior primary care contact and higher levels of HbA1c, a form of hemoglobin used to measure average blood glucose over a three-month period.

Medication noncompliers were more likely to be women and smokers. Like clinic nonattenders, medication noncompliers were more likely to have higher HbA1c levels, more prior primary care contacts, and greater morbidity.

Diabetes and heart disease
High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of the blood vessels, according to the National Institutes of Health (NIH).

As a result, people with diabetes are twice as likely to have cardiovascular disease or a stroke as someone who does not have diabetes, according to the NIH. Heart attacks in people with diabetes are more serious and more likely to result in death.

People can help keep their heart and blood vessels healthy by eating a well-balanced diet high in fiber and low in saturated fat. They should also aim for at least 30 minutes of exercise most days of the week and quit smoking.

Finally, maintaining a healthy body weight is important to heart health. Studies show that losing 5 to 7 percent of total body weight can help a person reduce the risk of developing type 2 diabetes.

Sources: Diabetes Care, National Institutes of Health

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