Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

Abstract

We sought to examine whether there are patterns of oral hypoglycemic agent adherence among primary care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p<0.05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c (HbA1c) < 7% (adjusted odds ratio = 14.52, 95% CI [2.54, 82.99]) at 12 weeks in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions.

A brief adherence intervention that improved glycemic control: mediation by patterns of adherence

“…The three-pattern model presented in Figure 2 improved the model fit over the two- and four-pattern models yielding three adherence profile types. The three adherence profile types identified and employed for this analysis were: adherent (n=67), increasing adherence (n=52), and nonadherent (n=61) (de Vries McClintock et al, in press). Table 2 shows the effect of the intervention on glycemic control in models with and without mediation by adherence profile types.…”

“…For the analysis of mediation, we used our prior classifications of patients into latent longitudinal adherence profile (de Vries McClintock et al, in press). To obtain these profiles, we employed recent developments in statistical assessment of treatment effects or of course of depression in primary care, especially the general growth curve mixture model (GGCMM) (Jo & Muthen, 2001; B.…”

“…P. MacKinnon et al, 2002). The first three conditions have been examined in prior work, and meet sufficient criteria for mediation (Bogner et al, 2012; de Vries McClintock et al, in press). For condition 2, patients in the intervention condition were more likely to have an adherent pattern compared to a nonadherent pattern (OR = 11.6, 95% CI [4.08, 32.9]).…”

“…For condition 2, patients in the intervention condition were more likely to have an adherent pattern compared to a nonadherent pattern (OR = 11.6, 95% CI [4.08, 32.9]). Patients in the intervention condition were more likely to have an increasing adherence pattern compared to a nonadherent pattern (OR= 41.31, 95% CI [13.87, 123.03]) (de Vries McClintock et al, in press). For this analysis we are examining whether criteria for condition number 4 is met.…”

Neighborhood Social Environment and Patterns of Depressive Symptoms Among Patients with Type 2 Diabetes Mellitus

“…Diabetes and depression are two of the most common problems seen in primary care settings. Co-morbid depression and diabetes result in poor adherence to medication and dietary regimens, poor glycemic control, reduced quality of life, and increased health care expenditures (de Vries McClintock, Morales, Small, & Bogner, 2014; Lustman & Clouse, 2005). Depression has been specifically linked to prognostic variables in diabetes such as micro- and macro-vascular complications (de Groot et al, 2001) as well as increased risk of mortality (Black, Markides, & Ray, 2003; Egede, Nietert, & Zheng, 2005; Katon et al, 2005; Zhang et al, 2005).…”