PMID- 36682933
OWN - NLM
STAT- MEDLINE
DCOM- 20230524
LR  - 20230701
IS  - 1544-3450 (Electronic)
IS  - 1544-3191 (Print)
IS  - 1086-5802 (Linking)
VI  - 63
IP  - 3
DP  - 2023 May-Jun
TI  - Association between medication regimen complexity and glycemic control among 
      patients with type 2 diabetes.
PG  - 769-777
LID - S1544-3191(22)00458-7 [pii]
LID - 10.1016/j.japh.2022.12.028 [doi]
AB  - INTRODUCTION: Type 2 diabetes mellitus (T2DM) and comorbid conditions require 
      patients to take complex medication regimens. Greater regimen complexity has been 
      associated with poorer T2DM management; however, the relationship between overall 
      regimen complexity and glycemic control is unclear. OBJECTIVES: Our objectives 
      were: (1) to examine associations between regimen complexity (with the Medication 
      Regimen Complexity Index [MRCI]) and glycemic control (A1C), and (2) to compare 
      overall MRCI with other measures of regimen complexity (overall and 
      diabetes-specific medication count) and diabetes-specific MRCI. METHODS: This was 
      a secondary data analysis of cross-sectional data from a parent trial. 
      Participants were patients with T2DM taking at least 3 chronic medications 
      followed in safety net clinics in the Chicago area. The MRCI measures complexity 
      based on dosing frequency, route of administration, and special instructions for 
      prescribed medications. MRCI scores were created for overall regimens and 
      diabetes-specific medications. Sociodemographics and outpatient visit utilization 
      were included in models as covariates. Linear regression was used to examine the 
      associations between variables of interest and hemoglobin A1C. RESULTS: 
      Participants (N = 432) had a mean age of 56.9 years, most were female (66.0%), 
      and Hispanic or Latino (73.3%). Regimen complexity was high based on overall 
      medications (mean = 6.6 medications, SD: 3.09) and MRCI (mean = 21.4, SD: 11.3). 
      Higher diabetes-specific MRCI was associated with higher A1C in bivariate and 
      multivariable models. In multivariable models, overall MRCI greater than 14, 
      fewer outpatient health care visits, male gender, and absence of health insurance 
      were independently associated with higher A1C. The variance in A1C explained by 
      MRCI was higher compared to medication count for overall and diabetes-specific 
      regimen complexity. CONCLUSIONS: More complex regimens are associated with worse 
      A1C and measuring complexity with MRCI may have advantages. Deprescribing, 
      increasing insurance coverage, and promoting engagement in health care may 
      improve A1C among underserved populations with complex regimens.
CI  - Copyright (c) 2023 American Pharmacists Association(R). Published by Elsevier Inc. 
      All rights reserved.
FAU - Russell, Andrea M
AU  - Russell AM
FAU - Opsasnick, Lauren
AU  - Opsasnick L
FAU - Yoon, Esther
AU  - Yoon E
FAU - Bailey, Stacy C
AU  - Bailey SC
FAU - O'Brien, Matthew
AU  - O'Brien M
FAU - Wolf, Michael S
AU  - Wolf MS
LA  - eng
GR  - P30 DK092949/DK/NIDDK NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20221231
PL  - United States
TA  - J Am Pharm Assoc (2003)
JT  - Journal of the American Pharmacists Association : JAPhA
JID - 101176252
RN  - 0 (Glycated Hemoglobin)
RN  - 0 (Pharmaceutical Preparations)
SB  - IM
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Cross-Sectional Studies
MH  - *Diabetes Mellitus, Type 2/drug therapy
MH  - Glycated Hemoglobin
MH  - Glycemic Control
MH  - Pharmaceutical Preparations
MH  - Retrospective Studies
PMC - PMC10286117
MID - NIHMS1905814
EDAT- 2023/01/23 06:00
MHDA- 2023/05/22 06:42
PMCR- 2023/06/22
CRDT- 2023/01/22 22:01
PHST- 2022/08/05 00:00 [received]
PHST- 2022/12/02 00:00 [revised]
PHST- 2022/12/28 00:00 [accepted]
PHST- 2023/05/22 06:42 [medline]
PHST- 2023/01/23 06:00 [pubmed]
PHST- 2023/01/22 22:01 [entrez]
PHST- 2023/06/22 00:00 [pmc-release]
AID - S1544-3191(22)00458-7 [pii]
AID - 10.1016/j.japh.2022.12.028 [doi]
PST - ppublish
SO  - J Am Pharm Assoc (2003). 2023 May-Jun;63(3):769-777. doi: 
      10.1016/j.japh.2022.12.028. Epub 2022 Dec 31.