ASSESSING THE EFFECT OF MEDICATION ADHERENCE ON CARDIOVASCULAR OUTCOMES IN TYPE 2 DIABETES PATIENTS: A RETROSPECTIVE STUDY IN RAWALPINDI, PAKISTAN

Abstract

Objectives: This retrospective study investigated the association between medication adherence and cardiovascular outcomes in type 2 diabetes (T2D) patients in Rawalpindi, Pakistan.

Methodology: A retrospective study was conducted from May 2024 to May 2025 at Benazir Bhutto Hospital, Holy Family Hospital and Jinnah Memorial Hospital in Rawalpindi. This study included 450 adults with confirmed T2D and at least one cardiovascular event. A sample size of 450 was calculated to detect a 15% difference in event rates between adherent and non-adherent groups (80% power, 5% significance). Participants were selected via stratified random sampling by age (30–70 years), gender, and diabetes duration (≤5, 5–10, >10 years). Data, extracted from medical records, assessed adherence using the Medication Possession Ratio (MPR ≥80% for adherence). Variables included demographics, clinical characteristics, medication regimens, and cardiovascular outcomes (via ICD-10 codes).

Results: Of 450 patients, 74.9% were adherent. Adherence reduced myocardial infarction (18.4% vs. 29.2%, OR=0.65, p=0.020), heart failure (13.1% vs. 35.4%, OR=0.55, p=0.010), and angina (46.6% vs. 56.6%, OR=0.60, p=0.030) risks, but not stroke (9.2% vs. 8.8%, OR=0.90, p=0.720). Older age and longer diabetes duration correlated with lower adherence. Insulin, combination therapy, SGLT2 inhibitors, and DPP-4 inhibitors showed protective effects; metformin is at borderline.

Conclusions: Adherence significantly lowers cardiovascular risks in T2D patients, necessitating targeted interventions for older patients and those with longer diabetes duration. Enhanced access to medications like SGLT2 and DPP-4 inhibitors could further reduce cardiovascular burden. Addressing local barriers through education and policy reforms is crucial for improving health outcomes in Pakistan.s.