Factors associated with adherence in patients with type 2 diabetes mellitus

Natalia Świątoniowska, Krzysztof Dudek, Anna Szymczyk, Beata Jankowska-Polańska

Abstract


Introduction. Only 50 - 75% of patients surveyed adhere to therapeutic recommendations in the treatment of chronic diseases. It is estimated that half of the patients discontinue therapy after one year from the start of treatment. Failure to comply with therapeutic recommendations often leads to complications of diabetes. New methods are now being sought to help diabetics adhere to the recommendations of the therapeutic team. According to the World Health Organization, interventions to improve adherence have a greater impact on health than the development of treatment.
The aim of the study was to analyze the degree of adaptation to the therapeutic recommendations of patients with type 2 diabetes.
Material and methods. 150 patients (96 women) 65.2 ± 11.8 years of age who were treated for exacerbation of type 2 diabetes were examined with their own questionnaire regarding compliance with the therapeutic recommendations and a standardized HBI (Health Behavior Inventory) questionnaire to assess health behaviors.
Results. A high degree of compliance with pharmacological recommendations was presented by 30%, the average 42,7%, and low 27,3% patients. High level of adherence was presented by people aged 50-69 (p<0.001), higher education (p=0.042), in a relationship (p=0.026), living in the countryside (p=0.029). People with a high level of compliance with pharmacological recommendations more often followed behavioral recommendations regarding weight reduction (62.2% vs. 23.4% vs. 31.7%), physical activity (71.1% vs. 45.3% vs. 46.3%) and daily weight control 33.3% vs. 17.2% vs. 4.9%). In the comparative analysis of the level of adherence, depending on the selected variables, it was observed that the higher level of compliance was for people who were diagnosed with comorbidities (compliance with the recommendations 6.6 vs. 5.1 in people without additional diseases), in non-smokers than in those who smoked tobacco ( 6.9 vs. 6.1), in subjects with hemoglobin HbA1C  7% than in HbA1C patients> 7% (7.0 vs. 6.6). The level of adherence to recommendations was the lowest in patients treated with the combination regimen (tablets+insulin; p=0.024). High level of health behaviors was presented more often by women compared to men (108 vs. 103), older people compared to younger ones (age 60-69 HBI=109.1 vs. age up to 49 years HBI=93.3), pensioners compared to economically active people or unemployed (108.3 vs. 101.1 vs. 92.3). In multivariate analysis, the independent predictors of adherence to pharmacological therapeutic recommendations are the absence of co-morbidities and older age (β=0.212, p=0.005).
Conclusions. Patients with diabetes have a moderate level of adherence and the compliance with health behaviors. An independent predictor which has a positive influence on the HBI is the old age (the older the patient, the better the level of adherence). The predictor which reduced the level of adherence and the HBI was the absence of comorbidities.

Keywords


type 2 diabetes mellitus; adherence

Full Text:

PDF

References


Karwowska P. Światowy Dzień Zdrowia 2106. Pokonać cukrzycę. [cyt: 14.04.2018]. Dostępny na URL: http://www.pzh.gov.pl/download/7443/

Zdrojewski T, Topór-Mądry R, Strojek K, Wojtyniak B, Wysocki M i wsp. Raport na temat cukrzycy w Polsce. Światowy Dzień Zdrowia - Cukrzyca 2016 - Warszawa 13.04.2016 - NIZP PZH. Dostępny na URL: http://www.pzh.gov.pl/download/7441/

Szczęch R, Szyndler A, Kolasińska-Malkowska K, Narkiewicz K, Tykarski A. Jak poprawić skuteczność terapii nadciśnienia tętniczego? Doświadczenia programu edukacji pacjentów w ramach Polskiego Projektu 400 Miast. Via Medica. 2006;10(5):525–535.

Broncel M, Jabłonowska E, Wójcik K. Znaczenie złożonych schematów leczenia

w jednej tabletce w wybranych dziedzinach terapeutycznych. Medycyna Rodzinna. 2015;2:79-88.

Kawalec P, Kielar M, Plic A. Koszty leczenia cukrzycy typu 1 i 2 w Polsce. Diabetologia Praktyczna. 2006;7(5):287–294.

Gaciong Z, Kardas P. Nieprzestrzeganie zaleceń terapeutycznych – od przyczyn do praktycznych rozwiązań. [cyt: 02.05.2018]. Dostępny na URL: http://www.polpharma.pl/upload/2016/01/podr-fund.pdf

Bosworth HB, Fortmann SP, Kuntz J et al. Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence. Journal of General Internal Medicine. 2017; 32(1): 93-100.

Kardas1 P. (2007). Przyczyny, uwarunkowania i następstwa nieprzestrzegania zaleceń terapeutycznych w warunkach podstawowej opieki zdrowotnej. Clinical and Experimental Medical Letters, supl. B, 1-48.

Albright, T. L., Parchman1 M. i Burge1 S. K. (2001). Predictors of self-care behavior in adults with type 2 diabetes: An RRNeST study. Family Medicine, 33, 354-360.

Krousel-Wood M, Thomas S, Muntner P et al. Medication adherence: A key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol 2004; 19: 357–362.

Fleury, J., Keller, C. i Murdaugh, C. (2000). Social and contextual etiology of coronary heart disease in women. Journal of Womens Health and Gender Based Medicine, 9, 967-978.; [12] King, K. M. i Arthur, H. M. (2003). Coronary heart disease prevention. Views on women’s gender-based perception and meanings. Journal of Cardiovascular Nursing,4, 274-281.

Ostrowska, A. (1999). Styl życia a zdrowie. Warszawa: Wydawnictwo IFiS PAN.

Rodin, J. i Salovey1 P. (1997). Psychologia zdrowia. W: I. Heszen-Niejodek i H. Sęk (red.), Psychologia zdrowia. Warszawa: PWN.

Fitzgerald, J. F., Anderson, R. M. i Davis, W. K. (1995). Genderdifferences in diabetes attitudes and adherence. Diabetes Educator, 21,523-529.

Juczyński Z. Measurement instruments in the promotion and psychology of health. Warsaw: Psychological Test Workshop, Polish Psychological Society, 2001, pp.110–115, 162–167.

Jankowska-Polanska B, Uchmanowicz I, Chudiak A i wsp. Psychometric properties of the Polish version of the eight-item Morisky Medication Adherence Scale in hypertensive adults. Patient Prefer Adherence. 2016;10:1759-66.

Świerzyńska M, Bronisz A, Ocicka-Kozakiewicz A. Wyrównanie metaboliczne cukrzycy typu 2 i ocena realizacji zaleceń terapeutycznych w samoocenie chorych w zależności od sposobu leczenia. Medycyna Rodzinna. 2012; 3: 46-50.

Matej-Butrym A, Butrym M, Jaroszyński A. Samoocena przestrzegania zaleceń lekarskich a gospodarka węglowodanowa u chorych na cukrzycę typu 2. Family Medicine & Primary Care Review. 2015; 17(2): 111–114.

Kowalczyk-Sroka B, Marmurowska-Michałowska H, Cieślik A et al. Healthy behaviours among diabetics and medical staff. Ann UMCS. 2003;58:105–110.

Hadi N. Determinant factors of medication compliance in hypertensive patients of Shiraz, Iran. Arch Iran Med 2004; 7: 292–296.

Elmer PJ, Obarzanek E, Vollmer WM et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006; 144: 485–495.

Karaeren H, Yokuşoğlu M, Uzun S et al. The effect of the content of the knowledge on adherence to medication in hypertensive patients. Anadolu Kardiyol Derg 2009; 9: 183–188.

Rolnick SJ, Pawloski PA, Hedblom BD et al. Patient characteristics associated with medication adherence. Clinical Medicine & Research. 2013; 11(2): 54-65.

Ashur ST, Shah SA, Bosseri S et al. Illness perceptions of Libyans with T2DM and their influence on medication adherence: a study in a diabetes center in Tripoli. Libyan J Med. 2015 Dec 28;10:29797.

Al-Haj Mohd MM, Phung H, Sun J et al. The predictors to medication adherence among adults with diabetes in the United Arab Emirates. J Diabetes Metab Disord. 2016 Aug 9;15:30.

Markowicz A, Molsa M, Tłuczykont M i wsp. Przestrzeganie zaleceń lekarskich (compliance) u chorych na cukrzycę leczonych w opiece ambulatoryjnej. Diabetologia Kliniczna. 2013, 2(5), 165–171.

Adamska K, Jaworska M, Korzon-Burakowska A i wsp. Wpływ edukacji na parametry wyrównania cukrzycy i jakość życia chorych na cukrzycę typu 2 leczonych insuliną. Diabetologia Praktyczna. 2010; 11(2): 46–53.

Chung WW, Chua SS, Lai PS et al. The Malaysian Medication Adherence Scale (MALMAS): Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia. PLoS One. 2015 Apr 24;10(4):e0124275.

Zhang Y, Ting RZ, Yang W et al. Depression in Chinese patients with type 2 diabetes: associations with hyperglycemia, hypoglycemia, and poor treatment adherence. J Diabetes. 2015 Nov;7(6):800-8.

Wong MC, Wu CH, Wang HH et al. Association between the 8-item Morisky medication adherence scale (MMAS-8) score and glycaemic control among Chinese diabetes patients. J Clin Pharmacol. 2015 Mar;55(3):279-87.

Dudzińska M, Kowalczyk M, Malicka J i wsp. Ocena zmian w zakresie samokontroli wśród pacjentów z cukrzycą typu 2 po wdrożeniu insulinoterapii – badanie prospektywne. Family Medicine & Primary Care Review. 2013; 15(3): 315–317.

Tatoń J. Edukacja i psychologia terapeutyczna – nowy kierunek ulepszania wyników leczenia i jakości życia przewlekle chorych. Medycyna Metaboliczna 2005; 9: 3–7.

Reeve E, Wiese MD. Benefits of deprescribing on patients' adherence to medications. International Journal of Clinical Pharmacy. 2014; 36(1): 26-9.

Matej-Butrym A, Butrym M, Jaroszyński A. Analiza przyczyn nieprzestrzegania zaleceń lekarskich przez chorych na cukrzycę typu 2. Family Medicine & Primary Care Review. 2011; 13(3): 449–451.

Adamek R, Gromadecka-Sutkiewicz M, Kalupa W i wsp. Palenie tytoniu, alkohol i aktywność fizyczna wśród pacjentów z cukrzycą typu 2. Przegląd Lekarski 2012; 69(10): 944-946.

Łagoda K, Kamińska K, Kobus G i wsp.: Ocena wiedzy pacjentów na temat profilaktyki zespołu stopy cukrzycowej. Przegląd Kardiodiabetologiczny. 2009; 4: 64-70.

Majkowska L, Tejchman K, Ślozowski P i wsp.: Ocena poziomu edukacji chorych na cukrzycę typu2 w Szczecinie i okolicach. Diabetologia Doświadczalna i Kliniczna. 2003; 3: 501-508.

Hawryluk J, Kostrzewa-Zabłocka E. Zespół wypalenia osobowości w cukrzycy typu 2. Zdrowie i dobrostan. 2015; 2: 207-221.

Dudzińska M, Kowalczyk M, Malicka J i wsp. Ocena zmian w zakresie samokontroli wśród pacjentów z cukrzycą typu 2 po wdrożeniu insulinoterapii – badanie prospektywne. Family Medicine & Primary Care Review. 2013; 15(3): 315–317.

Alberti G.: The DAWN (Diabetes Attitudes, Wishes and Needs) study. Practical Diabetes International 2002; 19: 22–24.




DOI: http://dx.doi.org/10.5281/zenodo.2093318

Refbacks

  • There are currently no refbacks.




Copyright (c) 2018 © The Author(s)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616

POL-index 2011 - 2014

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655

BASE 2011 - 2014

https://www.base-search.net/Search/Results?lookfor=Journal+of+Health+Sciences+%28Radom%29&type=all&oaboost=1&ling=1&name=&thes=&refid=dcrespl&newsearch=1

http://elibrary.ru/contents.asp?titleid=37467

http://journal.rsw.edu.pl/index.php/JHS/issue/archive

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844

Find a library that holds this journal: http://worldcat.org/issn/23918306

Journal Language(s): English 

PBN Poland

https://pbn.nauka.gov.pl/sedno-webapp/journals/49068

POL-index

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4

BASE

https://www.base-search.net/Search/Results?join=AND&bool0[]=AND&lookfor0[]=2391-8306&type0[]=all&page=11&l=pl&oaboost=1&refid=dcpagepl

Redaction, Publisher and Editorial Office

Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2  www.ukw.edu.pl Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy http://ojs.ukw.edu.pl/index.php/johs  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

SIC Science citation index (calculated on the basis of TCI and Page Rank) 0

Russian Impact factor 0.16

Indexed in Index Copernicus Journals Master List.

http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase Index.com.

Website: www.infobaseindex.com

Universal Impact Factor 1.78 for year 2012. (http://www.uifactor.org/AppliedJournals.aspx)

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski

(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)