Longitudinal association between medication adherence and glycaemic control in Type 2 diabetes

Diabetic Medicine - Tập 30 Số 3 - Trang 338-344 - 2013
James E. Aikens1, John D. Piette2
1Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
2Ann Arbor VA Center for Clinical Management Research Department of Internal Medicine University of Michigan Ann Arbor MI USA

Tóm tắt

AbstractAimDespite the widespread assumption that adherence drives glycaemic control, there is little published support for this in Type 2 diabetes. The study objective was to determine whether self‐reported medication adherence predicts future glycaemic control in Type 2 diabetes, after accounting for baseline control.MethodsMedication adherence (4‐item Morisky scale), glycaemic control (HbA1c%), and other variables were assessed in 287 adult primary care patients prescribed oral medication (40% also on insulin) for Type 2 diabetes. Glycaemic control was reassessed 6 months later. Regression analyses examined concurrent and future glycaemic control as a function of baseline medication adherence after adjustment for baseline glycaemia and other potential confounders.ResultsOnly half of patients reported high adherence. Cross‐sectional adjusted analysis replicated prior reports of an adherence‐HbA1c association (P = 0.011). Even after adjusting for baseline HbA1c, each one‐point increase in baseline Morisky total score was associated with a 1.8 mmol/mol (or 0.16%) increase in HbA1c measured 6 months later. Additionally, baseline endorsement of forgetting to take medication was associated with a 4.7 mmol/mol (or 0.43%) increase in 6‐month HbA1c (P = 0.005). This effect persisted after adjusting for psychological distress and did not vary by key demographic and medical features.ConclusionsEven after stringent adjustment for baseline glycaemic control, self‐reported adherence to diabetes medication predicts long‐term glycaemic control. The Morisky scale is an easy‐to‐use clinical tool to identify patients whose glycaemic control will subsequently worsen, regardless of age, gender and psychological distress.

Từ khóa


Tài liệu tham khảo

10.2337/diacare.27.5.1218

10.1016/j.clinthera.2011.01.019

Lawrence DB, 2006, Relationship of oral antihyperglycemic (sulfonylurea or metformin) medication adherence and hemoglobin A1c goal attainment for HMO patients enrolled in a diabetes disease management program, J Manag Care Pharm, 12, 466

10.1353/hpu.0.0062

10.2337/dc07-1924

Rozenfeld Y, 2008, Oral antidiabetic medication adherence and glycemic control in managed care, Am J Manag Care, 14, 71

10.1007/s00592-007-0006-7

10.1093/qjmed/hcm031

10.2337/diacare.27.12.2800

10.1046/j.1463-1326.2003.00297.x

10.1345/aph.1D612

10.1001/archinte.167.17.1853

10.1097/01.mlr.0000108742.26446.17

10.1016/S1262-3636(07)70011-3

10.2337/dc06-2516

10.1177/0145721705274927

10.1097/01.mlr.0000129496.05898.02

10.1097/00005650-198601000-00007

10.2190/CPYJ-2HBF-RGCN-64V2

10.1370/afm.238

10.1177/016327879601900205

10.2337/diacare.18.6.754

10.1046/j.1525-1497.2001.016009606.x

US Bureau of the Census, 2002, Methodology and scores of the socioeconomic status, working paper no. 15, Fed Regist, 67, 6931

10.2337/dc12-0181

10.2337/dc09-0071

10.1111/j.1464-5491.2008.02590.x

10.1111/j.1365-2125.2006.02800.x

Krousel‐Wood M, 2009, New medication adherence scale versus pharmacy fill rates in seniors with hypertension, Am J Manag Care, 15, 59

Saini SD, 2009, Effect of medication dosing frequency on adherence in chronic diseases, Am J Manag Care, 15, e22

10.2337/diacare.24.2.202

10.1016/j.ahj.2011.06.007

10.1097/HCO.0b013e328347c150

Possidente CJ, 2005, Motivational interviewing: a tool to improve medication adherence?, Am J Health Syst Pharm, 62, 1311, 10.1093/ajhp/62.12.1311

Thông tin
Thông tin xuất bản

Diabetic Medicine

Tập 30 Số 3

338-344

Thông tin tác giả