Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptoms

Abstract

BackgroundInsulin analogs are regarded as more convenient to use than human insulin; however, they require a different administration scheme due to their unique pharmacokinetic and pharmacodynamic properties. This study aimed to assess difficulties with adherence to treatment with insulin analogs in patients with type 2 diabetes mellitus (T2DM), who had previously been treated with human insulin. The associations between difficulties with adherence and clinical, demographic, and psychological characteristics were also evaluated.Patients and methodsThe study was conducted on 3,467 consecutively enrolled patients with T2DM (54.4% women), mean age 63.9 years (SD =9.57), who had recently undergone a physician-directed change in treatment from human insulin to insulin analogs. The questionnaires addressed difficulties with switching the therapy, coping styles, well-being, and perception of self-influence on the disease.ResultsNo adherence problems in switching therapy were reported in 56.6% of patients. Specific moderate difficulties were reported in 10.4%–22.1% of patients, major difficulties in 0.7%–6.9% of patients, and very significant difficulties in 0.03%–1.3% of patients. Overall, remembering to modify the insulin dose in the case of additional meals was the most frequently reported difficulty, and problems with identifying hypoglycemic symptoms were the least frequently reported. The increased risk of difficulties was moderately related to low perception of self-influence on diabetes and poor well-being. The intensity of problems was higher among those who were less-educated, lived in rural areas, had complications, and/or reported maladaptive coping styles.ConclusionSwitching from human insulin to an insulin analog did not cause adherence problems in more than half of the patients. In the remaining patients, difficulties in adherence correlated with maladaptive coping styles, low perception of self-influence on disease course, and depressive symptoms.

Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain

“…In our study, the highest percentages of non-adherence occurred when the patient took four or more tablets daily (OR = 1.6). Controversy exists regarding the association between age and treatment adherence [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Some studies have found greater non-adherence in older patients due to forgetfulness, although others have failed to find this association [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

“…From the individualized analysis of each of these variables, based on their measures of association according to the odds ratios obtained (Table 1), we will be able to design strategies focused on reducing non-adherence in these complex patients to improve control of their chronic diseases. Examination of other studies found no consistency regarding the relationship between non-adherence and dependent socioeconomic, demographic and work-family factors [5][6][7][8][9][10][11][12][13][14][15][16], although all the authors agree that non-adherence is associated with greater therapeutic complexity and a poorer doctor-patient relationship [17][18][19][20][21][22][23][24][25].…”

“…With regard to the profiles of variables associated with non-adherence, our working group in Spain concluded years ago that no prototype exists of the non-adherent patient [ 5 , 6 , 7 , 8 ]. However, traditionally, four main factors have been associated with poor treatment adherence: those associated with the dependent variables of the individuals, such as sex, age, cultural level, economic level, and personal beliefs; those associated with the physician–patient relationship, due to the variability among health professionals in empathy, motivational clinical interviewing, effective communication and shared decision-making; those associated with the work and family environment of the patient; and those associated with therapeutic complexity [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

Investigação dos transtornos mentais na adesão à terapia de voz

“…Outro fator associado à baixa adesão pode ser o baixo nível de escolaridade 22,23 . Dado que se assemelha com o presente estudo, pois pacientes do grupo sem adesão à fonoterapia na área de voz possuem menores níveis educacionais em relação a pacientes com adesão ao tratamento proposto, mesmo sem diferenciação estatística entre os grupos quanto ao grau de instrução.…”

Knowledge and Coping Strategies Among Patients Diagnosed With Type 2 Diabetes Mellitus

“…Karlsen, Oftedal and Bru (2012) found that 86% and 78% of patients reported occasionally or frequently using active coping and planning. A different results were concluded in a study on patients with Type 2 diabetes (Kokoszka, 2017) where patients used undifferentiated coping strategies, which means a combination of task-oriented, best solution-oriented, emotion-oriented and avoidance coping.…”