Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus

Abstract

BackgroundResearch suggests adherence to treatment recommendations is low. In type 2 diabetes, which is a chronic condition slowly leading to serious vascular, nephrologic, neurologic and ophthalmological complications, it can be assumed that enhancing adherence to treatment recommendations may lead to a reduction of complications. Treatment regimens in type 2 diabetes are complicated, encompassing lifestyle adaptations and medication intake. ObjectivesTo assess the effects of interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Search methodsStudies were obtained from searches of multiple electronic bibliographic databases supplemented with hand searches of references. Selection criteriaRandomised controlled and controlled clinical trials, before-after studies and epidemiological studies, assessing changes in adherence to treatment recommendations, as defined in the objectives section, were included. Data collection and analysisTwo teams of reviewers independently assessed the trials identified for inclusion. Three teams of two reviewers assessed trial quality and extracted data. The analysis for the narrative part was performed by one reviewer (EV), the meta-analysis by two reviewers (EV, JW). Main resultsTwenty-one studies assessing interventions aiming at improving adherence to treatment recommendations, not to diet or exercise recommendations, in people living with type 2 diabetes in primary care, outpatient settings, community and hospital settings, were included. Outcomes evaluated in these studies were heterogeneous, there was a variety of adherence measurement instruments. Nurse led interventions, home aids, diabetes education, pharmacy led interventions, adaptation of dosing and frequency of medication taking showed a small effect on a variety of outcomes including HbA1c. No data on mortality and morbidity, nor on quality of life could be found. 1 Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus (Review)

A New Taxonomy for Describing and Defining Adherence to Medications

“…The data shown in this figure are incomplete for the year 2009, as papers were included up to 1 April 2009. Since the pioneering research in this field, changes have occurred in prevailing philosophical paradigms and related concepts [61][62][63] as depicted in Figure 3.…”

Frequency and perceived burden of diabetes self-management activities in employees with insulin-treated diabetes: relationships with health outcomes

“…The main components of a diabetes treatment regimen include selfmonitoring of blood glucose, using medication properly, complying with an appropriate eating plan, engaging in regular exercise, and adjusting medication, food and exercise on the basis of circumstances and blood glucose levels [3]. The aim of blood glucose-lowering treatment is to optimize glycaemic control in order to prevent and minimize long-term diabetes complications [4][5][6] and to enhance the quality of life [7].…”

“…Self-management activities require a great deal of effort [6], may be difficult to incorporate into one's daily life [3], and their results are not always clear immediately [8]. Flexibility in self-management is important, but it may also make large demands on people [9].…”

“…The methods for assessing self-management are diverse [6]. Previous studies sometimes calculated a total score for self-management [13,14], but researchers now agree that different aspects of self-management should be assessed separately because of its multidimensional nature [15][16][17].…”

“…For the different types of selfmanagement activities that were studied, the following aspects were taken into account: the frequency with which people perform self-management activities and the perceived burden of performing this behavior at home, at work, and during social occasions. We hypothesize, based on theories and assumptions regarding self-management [4][5][6]23], that performing self-management activities frequently is related to positive health outcomes. For the burden of selfmanagement, we hypothesize that a higher experienced burden will be related to poorer health.…”