Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus

doi:10.1016/j.diabres.2012.05.026

Diabetes Research and Clinical Practice

Volume 97, Issue 3, September 2012, Pages 377-384

https://doi.org/10.1016/j.diabres.2012.05.026 Get rights and content

Abstract

Aims

Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control (PGC) in a cohort of patients with type 2 diabetes mellitus in Germany.

Methods

Baseline data of the DIANA-study, a prospective cohort study of type 2 diabetes mellitus patients in South-West Germany, were analysed. Information on medication adherence and factors related to PGC was obtained by self-administered questionnaire. PGC was defined as HbA_1c ≥ 7.5%. Bivariate and multivariate analyses using log-binomial regression were employed to assess overall and gender-specific associations of non-adherence and PGC.

Results

624 men and 518 women were included in the analyses. In total, 147 men (24%) and 114 women (23%) reported non-adherence to medication. In men, PGC was found in 37% of the participants reporting non-adherence and in 19% reporting adherence (adjusted prevalence ratio (PR) = 1.90, 95%-CI: 1.46–2.49). In women, PGC was found in 19% of the participants reporting non-adherence and in 18% reporting adherence (adjusted PR = 0.97, 95%-CI: 0.65–1.46).

Conclusions

Our results show gender-specific differences in the association of adherence and PGC. This underlines the need for efforts to improve glycaemic control in patients with type 2 diabetes mellitus with a particular focus on men.

Introduction

In Germany, approximately 8% of the total population has type 2 diabetes mellitus (type 2 DM) [1]. Since type 2 DM is a chronic disease requiring long-term treatment and a high quality care in the ambulatory setting, efficient patient self-management is crucial [2]. An important aspect of patients’ self-management is medication adherence, i.e. ‘the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen’ [3].

It was previously reported that medication adherence in diabetes patients ranges widely [4] depending on age [5], lower educational level and less affluent economic status [6], depression [7], [8] and other cognitive/physical impairments as well as on regimen complexity [9], dosing frequency [10], fear of hypoglycaemia or of bothersome side effects [11]. Illness and medication beliefs are also of relevance [12]. Discordant results have been reported for gender as a risk factor for medication adherence [8], [13], [14].

A retrospective cohort study showed that adherence with medication for diabetes treatment decreases over time [15]. Overall, adherence has a strong association with an increased risk of medical complications, e.g. risk of severe cardiovascular diseases, and mortality as well as poor quality of life leading to major health care and economic implications [6], [16].

Studies on non-adherence to prescribed medication in patients with type 2 DM in primary care are limited [6]. Only few studies have investigated the association between adherence and glycaemic control in general practice and studies focusing on gender-related differences in this context are still lacking [17].

We aimed to investigate the total and gender-specific prevalences of self-reported medication adherence and its associations with poor glycaemic control (PGC) (HbA_1c ≥ 7.5%) in a large cohort of type 2 diabetes outpatients in Germany, taking into account a wide range of socio-demographic characteristics and lifestyle factors as well as diabetes- and health services-related factors.

Section snippets

Study design and study population

This analysis is based on data from the baseline examination of the DIANA study (Type 2 Diabetes Mellitus: New Approaches to Optimize Medical Care in General Practice), an epidemiological prospective cohort study with type 2 DM patients conducted in the Ludwigsburg-Heilbronn area located in South-West Germany. The study was initiated in 2008 to address (short- and long-term) diabetes-related outcomes and to evaluate potentials for health care improvements in patients with type 2 DM.

Results

Overall, 624 men (54.6%) and 518 women (45.4%) participated in this study (Table 1). Mean age (±SD) was 68.3 (±10.3 years) (median age: 70 years). Men were on average younger than women (men: 67.2 ± 10.1 years; women: 69.7 ± 10.4 years). The vast majority of patients had completed up to 9 years of school education (73.6%) and were married (71.8%). Generally, more men than women were still married (men: 81.9%; women: 59.7%). Due to the high mean age only about one fourth of the participants were

Discussion

In this cohort of diabetes patients recruited in the primary care setting in Germany, self-reported medication non-adherence was present in 23.8% of patients with no gender-specific differences, which is in accordance with prevalences reported by two reviews [22], [23]. Almost 21% of the patients had PGC defined as HbA_1c ≥ 7.5%, with a higher prevalence among men than among women. Both medication non-adherence and PGC were more common among younger patients and those still employed or not being

Conflict of interest

The authors declare that they have no conflict of interest.

Grant support

This study was supported by a grant of the Federal Ministry of Education and Research (study identification number: 01GX0746).

Results were presented as poster “Medication non-adherence and poor glycaemic control in patients with Type 2 diabetes mellitus: First results of the DIANA-Study” (in German) during the annual meeting of the German College of General Practitioners and Family Physicians from 22 to 24 September 2011 in Salzburg, Austria.

Acknowledgements

We wish to thank all the participants of the DIANA study and our cooperating study partners. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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¹: Equally contributing first authors.

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Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus

Abstract

Aims

Methods

Results

Conclusions

Introduction

Section snippets

Study design and study population

Results

Discussion

Conflict of interest

Grant support

Acknowledgements

Value Health

Diabetes Metab

Gend Med

Nutr Metab Cardiovasc Dis

Clin Ther

Arch Med Res

Ann Epidemiol

Ann Epidemiol

Prevalence of undiagnosed Type-2-diabetes mellitus and impaired fasting glucose in German primary care: data from the German Metabolic and Cardiovascular Risk Project (GEMCAS)

Exp Clin Endocrinol Diabetes

Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors

Diabetes Care

Measurements of medication adherence in diabetic patients with poorly controlled HbA(1c)

Diabet Med

Medication taking and diabetes: a systematic review of the literature

Diabetes Educ

Relationship of depression and diabetes self-care, medication adherence, and preventive care

Diabetes Care

Regimen complexity and medication nonadherence in elderly patients

Ther Clin Risk Manag

Barriers to medication adherence in poorly controlled diabetes mellitus

Diabetes Educ

Polypharmacy and medication adherence in patients with type 2 diabetes

Diabetes Care

Patients’ beliefs about medicines in a primary care setting in Germany

J Eval Clin Pract