Electronic pill-boxes in the evaluation of oral hypoglycemic agent compliance

Objective: To compare compliance in type 2 diabetic patients treated with glimepiride once daily or glibenclamide twice to three times daily. Methods: Poorly controlled type 2 diabetic patients aged 35-65 years were randomized to glimepiride 1 mg once daily or to glibenclamide 1.25 mg twice daily. During initial titration, doses ranged from 1 to 6 mg once daily (glimepiride) and from 1.25 mg twice daily to 5 mg 3 times daily (glibenclamide) to achieve fasting blood glucose < 126 mg/dL. The final titration phase doses were continued during the maintenance phase. Both treatments were packed in electronic pill-boxes fitted with a microprocessor to record dates and times of each opening. Compliance was assessed in terms of mean daily compliance (MDC) and the ratio of days with adequate compliance (DAC). Glycemic control was assessed in terms of the adjusted mean final HbA(1c), and the incidence of hypoglycemia. Patient satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire. Results: Compliance over the whole study was generally good, but the MDC was significantly better with glimepiride (87 +/- 16%) than with glibenclamide (80 +/- 17%; P not greater than or equal to 0,0001). The ratios of DAC for glimepiride and glibenclamide were 87 16% and 67 +/- 24% respectively (P < 0.0001). The adjusted final HbA(1c), and the incidence of hypoglycemia were similar in the two groups. Treatment satisfaction on the DTSQc was greater with glimepiride than with glibenclamide (P = 0.0034). Conclusions: Patient compliance and treatment satisfaction with once-daily glimepiride were significantly better than with glibenclamide 2 to 3 times daily.