Medication Prescribing and Adherence Patterns Among Prison Inmates With Diabetes Mellitus

Diabetes is one of the most common and costly medical conditions among prison inmates. Scarce information, however, currently exists about the management of this condition in the correctional setting. The purpose of this study was to describe antidiabetic agent prescribing patterns and adherence among diabetic prison inmates. The study population consisted of 4,061 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between December 1, 1998, and March 31, 1999, and who were diagnosed with either Type 1 or Type 2 diabetes mellitus. Approximately one-third (33%) of the study subjects were prescribed insulin only, 38% were prescribed oral hypoglycemic agents (OHA) only, 13% were prescribed both insulin and OHA, and 13% received no medication. The median adherence rates with drug therapy were 61% for insulin only, and 66% for OHA only. For combination therapy, the median adherence rate was 56% for insulin and 66% for OHA. The authors noted that the rate of insulin-only therapy and OHA and insulin combination therapy among TDCJ inmates was higher than that reported among previous studies of nonincarcerated samples. Alternatively, it was reported that the rate of OHA-only therapy and no therapy was lower among inmates than among their free-world counterparts. It is likely, however, that these differences were driven, in large part, by the underlying differences in the demographic composition of the study samples. It will be important for investigators to examine whether future studies of inmate populations exhibit similar pharmacotherapy and compliance rates, and moreover to assess whether such rates differ substantially from nonincarcerated samples, even after adjusting for sociodemographic factors.