MON-868 - Examining Medication Adherence and Therapeutic Inertia in a Comprehensive Telemedicine Intervention for the Management of Type 2 Diabetes - A Secondary Analysis

Medication non-adherence (NA) and therapeutic inertia (TI) are commonly encountered phenomena contributing to delays in achieving glycemic targets in the care of patients with diabetes. We sought to examine medication non-adherence and therapeutic inertia within a pragmatic telehealth intervention trial for diabetes and hypertension and their effect on overall A1c change.

We conducted this post-hoc, exploratory secondary analysis on randomized trial data from patients with persistently uncontrolled type 2 diabetes and hypertension receiving a 12-month, nurse-delivered telehealth program with monthly encounters that included mobile monitoring, self-management support, and pharmacist-supported medication management. Medication adherence (MA) was assessed by comparing the prescribed medications at the previous trial encounter to reported medications at the current encounter. Inappropriate NA was distinguished from appropriate NA by excluding medication changes from an outside provider or patient driven adjustments made for blood sugar or illness. TI was defined as lack of medication intensification given an above-goal or recently increased HbA1c. This was distinguished from appropriate non-intensification by documented reasoning (e.g. lack of lab/tracking data, pending effect of recent med change, medical contraindication). MA and TI were identified at the encounter level and proportions of encounters with MA or TI were generated for each patient. Our primary analysis involved generation of two linear regression models with independent variables of MA or TI encounter proportions, covariates of age, sex, and race, and dependent variable of HbA1c change. We also conducted sensitivity analyses using proportion of encounters with MA or TI framed as categorical variables by comparing HbA1c change in halves of the sample with lower versus higher encounter proportions.

The analyzed patients had a median age of 53, were 68% female and 76% Black or African American. In our linear regression model, proportion of encounters with MA or TI were not significantly associated with HbA1c change over the 12-month trial duration (MA coefficient -1.07, 95% CI -2.61, 0.46, p=0.168; TI coefficient -0.189, 95% CI -2.12, 1.73, p=0.846). Sensitivity analysis with MA and TI as categorical variables also did not show a statistical association with HbA1c change (Less MA -0.77%, More MA -1.21%, p=0.316; Less TI -0.92%, More TI -1.06%, p=0.745).

Degree of medication adherence or therapeutic inertia were not statistically significantly associated with HbA1c change in this trial. Additional research is needed to determine other potential contributing factors to lack of statistical HbA1c change from this telemedicine intervention and to further inform future interventions utilizing comprehensive telehealth management.

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