medwireNews: Results from the iCount study show that negative beliefs about medicines, unmet material needs, and poor social support are all predictors of low adherence to treatment for individuals with young-onset type 2 diabetes.
The iCount study was set up as an offshoot of the TODAY2 study, which showed that young people with an early diagnosis of type 2 diabetes appear to be rapidly accumulating complications including dyslipidemia, hypertension, broader cardiovascular disease, kidney disease, retinopathy, and poor pregnancy outcomes.
“They are a really medically vulnerable group,” explained Paula Trief (Upstate Medical University, New York, USA) who presented the data at the 82nd ADA Scientific Sessions in New Orleans, Louisiana.
For their longitudinal study, Trief and colleagues measured medication adherence in 381 young people (mean age 26 years) with type 2 diabetes, of whom 212 were taking oral antidiabetic medications and 192 were being treated with insulin.
At study enrollment, an extensive and validated psychosocial assessment was carried out for all participants assessing factors such as attitudes toward diabetes, treatment beliefs, self-management efficacy, diabetes distress, depression, anxiety, and level of treatment support. The cohort was followed-up over time and a broad assessment of adherence based on a cutoff was made 1 year later.
During the year, regular assessments such as unannounced phone pill counts were made on a 3-monthly basis for the oral medication group. In the insulin group adherence data were collected by self-report.
Of 171 patients in the oral medication group assessed at 12 months, 112 had low treatment adherence, defined as less than 80%, at baseline. Factors increasing this likelihood included having more concerns about antidiabetic medications, such as their necessity, whether they could cause harm, and the possibility for overuse; and insecurities over healthcare coverage, with odds ratios (ORs) of 1.4 and 4.9, respectively.
Over the year, mean adherence rates declined from 57.9% at baseline to 51.4% in those taking oral medications. And factors significantly predicting low adherence at 12 months included housing insecurity, having at least two material insecurities, and have beliefs that antidiabetic medications are harmful or overused. Once baseline adherence had been taken into account, only housing insecurity and reporting at least two material insecurities remained significant risk factors.
In the group being treated with insulin (157 assessed at 12 months), 57 had low adherence at baseline and these individuals were significantly more likely to believe that medications are overused (OR=1.9) and harmful (OR=2.4), feel less supported in the self-management of their condition (OR=0.5), and report at least one material insecurity (OR=2.9).
The average adherence rates in the insulin treated group did not change significantly over the year, from 70.8% at baseline to 69.3% at 12 months. The same factors predicting low adherence at baseline predicted low adherence at 12 months, with the addition of higher diabetes distress and food insecurities. After taking into account adherence at baseline, only beliefs about medications being harmful or overused remained significant.
“There are some clinical implications and I think they are that the patient’s beliefs about medicines really need to be explored,” said Trief.
“That could be as simple as saying, ‘please tell me what you think about taking the medicines that I have recommended? What concerns do you have?’,” rather than asking “do you have any concerns?” she said.
She highlighted that another factor that really needs to be taken into account with this group is social and material needs. “One of the reasons we think this is important is because it says more about the environment that this very vulnerable group are in and less about them. It’s not enough to tell them to remember to take their medications.”
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