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Diabetes distress and peripheral neuropathy are associated with medication non-adherence in individuals with type 2 diabetes in primary care

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A Letter to the Editor to this article was published on 21 May 2021

Abstract

Background

Psychosocial factors like diabetes distress and social support, as well as the presence of complications, affect an individual’s self-management ability; however, their role in adherence behaviours is not yet clear. We examined the role of psychosocial factors and complications in non-adherence behaviours in individuals with diabetes in primary care.

Methods

Baseline survey with nine-month follow up through medical records of patients with type 2 diabetes attending primary care. Medication adherence and diabetes distress were assessed using Morisky Green Levine Medication Adherence Scale and Problem Areas in Diabetes, respectively. Appointment adherence was assessed through medical records.

Results

Of the 448 participants studied, 59.8% had medication non-adherence and 21.7% were non-adherent to scheduled appointments. PAID score (odds ratio (OR) 1.01, 95% confidence interval 1.00–1.03, p = 0.013), peripheral neuropathy (OR 1.99, 95%CI 1.18–3.37, p = 0.01), home glucose monitoring (OR 0.46, 95%CI 0.30–0.69, p < 0.001), HbA1c (OR 1.34, 95%CI 1.13–1.61, p = 0.001), and age (OR 0.96, 95%CI 0.93–0.98, p = 0.001) were associated with medication non-adherence. Indian ethnicity (OR 2.93, 95%CI 1.59–5.39, p = 0.001), secondary or higher education (OR 1.94, 95%CI 1.14–3.27, p = 0.014), and HbA1c (OR 1.38, 95%CI 1.18–1.63, p < 0.001) were associated with appointment non-adherence.

Conclusions

Non-adherence behaviours were prevalent and significantly associated with higher HbA1c. Medication non-adherence was more likely in younger individuals, those with higher diabetes distress or peripheral neuropathy. Appointment non-adherence was more likely in individuals of Indian ethnicity or those with higher education. Greater support for these groups may help improve adherence behaviours and outcomes.

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Acknowledgements

The authors would like to acknowledge the help and support of Dr Richard Hui and Dr Kwek Sing Cheer from National University Polyclinics and the staff from Department of Family Medicine Development, National University Polyclinics.

Funding

This study was not funded.

Author information

Authors and Affiliations

  1. National University Polyclinics, Singapore, Singapore

    Zhi Peng Zhang

  2. Ministry of Health Holdings Pte Ltd, Singapore, Singapore

    M. Premikha

  3. Saw Swee Hock School of Public Health, National University of Singapore, 10-03J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore

    Miyang Luo & Kavita Venkataraman

Author notes

  1. Zhi Peng Zhang and M. Premikha have contributed equally to this work and are joint first authors.

    • This article belongs to the topical collection Health Education and Psycho-Social Aspects, managed by Massimo Porta and Marina Trento.

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      1. Zhi Peng Zhang
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      Correspondence to Kavita Venkataraman.

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      Zhang, Z.P., Premikha, M., Luo, M. et al. Diabetes distress and peripheral neuropathy are associated with medication non-adherence in individuals with type 2 diabetes in primary care. Acta Diabetol 58, 309–317 (2021). https://doi.org/10.1007/s00592-020-01609-2

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