Adherence Three Core Areas of Focus
1. RAS ANTAGONIST ADHERENCE
The clinical relevance and mechanism of actions of RAS antagonist and tracked medications from these classes are explained in the diabetic treatment measure section of this guide.
2. STATIN THERAPY ADHERENCE
HMGCoA Reductase inhibitors or statins have become key therapeutics agents in the treatment of hypercholesterolemia to reduce the risk and progression of atherosclerotic cardiovascular disease (ASCVD). These medications work on the cholesterol synthesis pathway to decrease the production of endogenous LDL.
The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults supports the benefits of statin use in four major groups31:
- Patients currently with ASCVD
- Patients with primary elevations of LDL-C > or equal to 190 mg/dL
- Diabetic patients age 40 to 74 with LDL-C 70 to 189 mg/dL with clinical ASCVD
- Patients without ASCVD or diabetes with LDL-C 70 to 189 mg/dL and estimated 10-year ASCVD risk > or equal to 7.5%
3. ORAL DIABETIC AGENT ADHERENCE
Oral diabetic medications in this measure include (see Table C):
- Biguanides
- Sulfonylureas
- Thiazolidnediones
- DPP-IV inhibitors
These medications improve glycemic control through various mechanisms of action including:
- Decreasing hepatic glucose production
- Decreasing glucose absorption
- Increasing insulin-mediated glucose uptake
- Increasing insulin secretion
- Decreasing insulin resistance
- Suppressing glucagon release
Detailed recommendations on when to use which agent can be found in the 2013 American Association of Clinical Endocrinologists (AACE) guidelines.32
References
32. American Association of Clinical Endocrinologists' Comprehensive Diabetes Management Algorithm 2013. Endocr Pract. 2013;19 (Suppl 1):1–48. Available at: https://www.aace.com/publications/algorithm. Accessed April 19, 2014.