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Individuals with disabilities and type 2 diabetes tend to have worse clinical outcomes. To identify modifiable factors that may improve these outcomes, the investigators evaluated the role of medication adherence. A retrospective, cohort study was conducted using data from the Korean National Health Insurance Service (K-NHIS) database.
Type 2 diabetes mellitus (T2DM) is a well-established risk factor for cardiovascular disease (CVD). In recent years, self-care has become a central component of diabetes management, with growing emphasis on medication adherence, physical activity, and lifestyle modifications to reduce CVD risk and improve long-term outcomes. As a result, limited capacity for self-care has been increasingly recognized as a major contributor to health disparities.
Approximately 25% of individuals with disabilities have T2DM, and those with physical or mental impairments often face substantial barriers to effective self-management. These challenges-including limited mobility and reduced access to health information-can lead to poor glycemic control and heightened cardiovascular risk.
However, most prior studies have primarily focused on describing the elevated risk of CVD in individuals with disabilities. Whether suboptimal medication adherence mediates the association between disability and cardiovascular outcomes remains unclear.
Therefore, this study aims to compare medication adherence between patients with and without disabilities and to assess whether differences in adherence contribute to disparities in the incidence of CVD.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Disability | Individuals were classified as having a disability if they were officially registered as of the index date. Physical disability included conditions such as limb impairment, brain lesion, visual or auditory impairment, speech impairment, facial disfigurement, and epilepsy. Mental disability included intellectual disability, autism spectrum disorder, and psychiatric disorders. |
| |
| No disability | Individuals who were not officially registered with any physical or mental disability as of the index date. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| No adherence group | Behavioral | Patients with poor adherence was defined as medication possession ratio(MPR) <50%. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Major adverse cardiac and cerebrovascular events (MACCE) | Composite of MI, ischemic stroke, hemorrhagic stroke, and all-cause mortality | 10 years after diagnosed T2DM |
| Measure | Description | Time Frame |
|---|---|---|
| Diabetic neuropathy | Nerve damage resulting from DM | 10 years after diagnosed T2DM |
| Diabetic foot without amputation | Diabetic foot complications, such as ulcers, infections, or gangrene, without any lower-extremity amputation |
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Inclusion Criteria:
Exclusion Criteria:
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Patients newly diagnosed with T2DM and without prior major cardiovascular or malignant conditions.
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| ID | Term |
|---|---|
| D003924 | Diabetes Mellitus, Type 2 |
| D055118 | Medication Adherence |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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| Adherence group | Behavioral | Patients with good adherence was defined as medication possession ratio(MPR) ≥50%. |
|
| 10 years after diagnosed T2DM |
| Diabetic foot with amputation | Diabetic foot complications who have undergone lower-limb amputation | 10 years after diagnosed T2DM |
| Proliferative diabetic retinopathy | Advanced stage of diabetic retinopathy, marked by the formation of new blood vessels (neovascularization) on the retina or optic disc, which can lead to vitreous hemorrhage, tractional retinal detachment, and vision loss. | 10 years after diagnosed T2DM |
| Non-proliferative diabetic retinopathy | Early stage of diabetic retinal disease, characterized by microaneurysms, intraretinal hemorrhages, and hard exudates without the presence of neovascularization. | 10 years after diagnosed T2DM |
| D004700 | Endocrine System Diseases |
| D010349 | Patient Compliance |
| D010342 | Patient Acceptance of Health Care |
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
| D001519 | Behavior |