Influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension

Prevalence of adherence to oral antidiabetic drugs in patients with type 2 diabetes: A systematic review and meta-analysis

INTRODUCTION

The treatment of type 2 diabetes requires multidimensional management, with medication adherence a crucial aspect of diabetes control. However, recent rigorous estimates of adherence to oral antidiabetic drugs (OAD) are lacking. The objective of this study is to determine the prevalence of adherence to OAD in type 2 diabetes patients.

METHODS

A systematic search was performed in PubMed, EMBASE, PsycINFO, and CINAHL from July 2013 to April 2023. Cross-sectional studies published in English were included if they met the following criteria: (1) reported the adherence to OAD using a validated measure; and (2) had a sample size of at least 385 patients with type 2 diabetes. The Joanna Briggs Institute critical appraisal for studies reporting prevalence data was used to assess the quality of the included studies. Pooled estimates of the prevalence of adherence to OAD were calculated as a percentage together with 95% confidence interval (95% CI) using a random-effect model. All analyses were conducted using STATA 17.0; PROSPERO (CRD42023414264).

RESULTS

Twenty-six studies involving a total of 69,366 patients met the selection criteria and were included in the meta-analysis. The overall estimated prevalence of adherence to OAD was 55.53% (95%CI: 44.22%-66.85%). Among the included studies, nine were deemed to be of high quality. A sensitivity analysis conducted using only the high-quality studies revealed a prevalence of adherence to OAD at 52.24% (95% CI: 39.63%-64.85%).

CONCLUSIONS

The overall prevalence of adherence to OAD was remarkably low among type 2 diabetes patients worldwide. Healthcare practitioners and policy makers should employ appropriate approaches to improve adherence to OAD.

Cognitive Function and Medication Adherence in Older Adults With H-Type Hypertension: The Mediating Effect of Metamemory

PURPOSE

Medication adherence in adults with H-type hypertension plays a crucial role in lowering blood pressure and treating complications. Cognitive function has been identified as a significant influencing factor for medication adherence, whereas excessive levels of homocysteine can impair cognitive function. Metamemory, which is influenced by cognitive function, also affects medication adherence. However, the complex relationship among these factors remains poorly understood among adults with H-type hypertension. Therefore, we hypothesize that metamemory serves as a mediator for the impact of cognitive function on medication adherence.

METHOD

A total of 232 adults with H-type hypertension were enrolled to provide cognitive function scores, metamemory scores, and medication adherence rates.

RESULTS

A pairwise correlation exists among cognitive function, metamemory, and medication adherence. Metamemory partially mediates (57.5%) the relationship between cognitive function and medication adherence.

CONCLUSION

Our findings suggest that interventions targeting improvements in metamemory may enhance medication adherence among individuals with H-type hypertension. [Journal of Gerontological Nursing, 50(6), 44-52.].

Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review

Introduction

Interest in medication adherence has expanded significantly, especially in relation to the management of hypertension or diabetes in recent years. A scoping review that focuses on medication adherence in the co-morbidity of hypertension and diabetes provides crucial guidance for effective management of these interrelated diseases.

Aim

To conduct a scoping review of factors associated with medication adherence among individuals with co-morbid hypertension and diabetes.

Methods

The evaluation was conducted in accordance with the PRISMA-ScR guidelines to ensure the quality of the study. We searched three databases (Scopus, CINAHL, Medline) and one search engine (Google Scholar) from April 2023 to July 2023 on studies related to medication adherence in co-morbid hypertension and diabetes. Except for reviews there were no restrictions on design, location, and time of study.

Results

In total, 972 studies that were not duplicated were obtained. After eligibility and screening procedures were completed, 31 articles were ultimately included in the scoping review. Medication adherence was significantly affected by patient, condition, therapy, socio-economic and health related factors. Intervention trials revealed that education and counselling by pharmacists, nurses, physicians, diabetes educators, community health workers and the use of telephone to motivate patients significantly improved medication adherence.

Conclusion

This review shows the intricate factors influencing medication adherence in patients with co-morbid hypertension and diabetes, emphasizing the need for tailored interventions involving healthcare professionals, policymakers, and researchers.

Effect of Mobile Apps on Medication Adherence of Type 2 Diabetes Mellitus: A Systematic Review of Recent Studies

Medication adherence is a critical aspect of managing type 2 diabetes mellitus (T2DM) and achieving optimal clinical outcomes. Mobile app-based interventions have emerged as a promising tool to enhance adherence and glycemic control in T2DM patients. This systematic review aims to evaluate the effectiveness of mobile app interventions in improving medication adherence and glycated hemoglobin among T2DM patients. A comprehensive search was conducted in PubMed, Cochrane Library, and Google Scholar for studies published between September 2018 and September 2023. Studies were included if they were published in English and investigated the effectiveness of mobile apps in enhancing medication adherence among patients with T2DM. Studies were excluded if they included additional interventions, such as electronic pillboxes, phone calls, or SMS text messages, or if they focused on populations with chronic illnesses other than T2DM. Five studies involving 527 participants from diverse geographic locations were included in the review. The findings from the included studies show that mobile-based app interventions can significantly improve medication adherence in patients with T2DM. From the included studies, the mean HbA1c change for the intervention group was -0.664 (95%CI -0.823 to -0.506), while the mean change in HbA1c for the control group was -0.103 (95%CI -0.305 to 0.099). Studies have demonstrated the potential of mobile app-based interventions to enhance medication adherence and improve glycemic control in T2DM; further research is needed to determine the long-term effects of these interventions.

Socioeconomic factors associated with poor medication adherence in patients with type 2 diabetes

PURPOSE

This study aims to determine initiation and persistence for patients with type 2 diabetes receiving their first prescription of an antidiabetic agent and the associations with socioeconomic factors.

METHODS

A cohort study including 8515 patients with type 2 diabetes who were prescribed their first antidiabetic medication between 2012 and 2019 in Uppsala, Sweden, was followed during 2 years. Medical records were linked to national registers on dispensed drugs and socioeconomic data. Adherence was assessed based on patients' medication claims within 30 days of prescription (initiation) and continued claims after 24 months (persistence). Multivariable logistic regression was used to determine the associations with the socioeconomic factors age, sex, living status, country of birth, education, occupation, and income.

RESULTS

Within 30 days, 92.4% of the patients claimed their first prescription, and 64.0% were still being dispensed the initially prescribed medication after 24 months. Unemployed patients had lower initiation rates, and women had lower persistence rates. Factors associated with both low initiation and persistence were low income, young or old age, birth outside Europe, and being prescribed other diabetes drugs than metformin monotherapy.

CONCLUSION

Socioeconomic factors have different impact on the initiation of a new medication and the persistence to treatment in type 2 diabetes. It is important to acknowledge these differences to develop appropriate interventions to improve medication nonadherence.

Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health

This review explores the impact of gender on medication adherence in the context of metabolic and cardiovascular diseases. Optimal adherence to medication is crucial for achieving treatment goals and preventing adverse outcomes in chronic diseases. The review examines specific conditions such as type 2 diabetes, hypercholesterolemia, arterial hypertension, cardiovascular diseases, and heart failure. In type 2 diabetes, female sex, younger age, new drug prescription, non-white ethnicity, low education level, and low income were identified as predictors of non-adherence. Depressive disorders were also found to influence adherence. In hypercholesterolemia, women exhibited poorer adherence to statin therapy compared to men, with statin-related side effects and patient perception being significant factors. Adherence to anti-hypertensive therapy showed conflicting results, with studies reporting both higher and lower adherence in women. Limited evidence suggests that women may have poorer adherence after acute myocardial infarction and stroke. Regarding heart failure, adherence studies have shown inconsistent findings. The reasons for gender differences in medication adherence are multifactorial and include sociodemographic, disease-related, treatment-related, and psychological factors. This review emphasizes the need for further research to better understand these differences and develop gender-customized interventions that can improve medication adherence and reduce the burden of metabolic and cardiovascular diseases.

Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece-The IACT-Study

BACKGROUND

Evidence has shown that poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease (CVD) events and mortality. The aim of the present work was to examine patients' beliefs/views that affect their level of adherence to the assigned medical treatment in the context of a multi-center study in Greece.

METHODS

Between July 2022 and April 2023, 1988 patients (1180 females) with established cardiovascular disease or relevant cardiometabolic disorders were chosen from seven medical centers in Greece. The 4-item Morisky Medication Adherence Questionnaire gauged medication adherence and investigated patients' beliefs/views regarding treatment.

RESULTS

Among participants, 51.2% showed perfect medication adherence, contrasting with 48.8% displaying poor adherence. Patients with negative medication beliefs were around three times more likely to be non-adherent (OR = 2.73; 95% CI = 2.28-3.28). Non-adherers held concerns about drug efficacy (OR = 2.34; 95% CI = 1.10-4.97) and favored alternative therapies (OR = 2.25; 95% CI = 1.75-2.91).

CONCLUSION

The findings highlight the significance of addressing patient beliefs/views to improve medication adherence. The distinct Mediterranean context, influenced by cultural, socioeconomic, and clinical factors, emphasizes the need for tailored interventions. This underscores the call for contextually sensitive strategies to boost medication adherence and improve health outcomes in this unique region.

Medication Adherence in Elderly Diabetic Patients: A Cross-Sectional Study From Dakshina Kannada, India

Diabetes Mellitus (DM) has emerged as a major global healthcare problem. The risk of diabetes can be reduced by maintaining blood glycaemic levels, which can be achieved by stringent adherence to the treatment regime. Therefore, there is a continuing need to assess the level of adherence to medication/self-care activities and the factors that are related to non-adherence to medication and self-care. This would facilitate healthcare professionals to identify subjects with low medication adherence and thereby aid them in planning interventions to improve medication and self-care adherence. In this study, we aimed to estimate the proportion of medication adherence among diabetic patients above 60 years of age attending a tertiary care hospital in Southern India. We found that 72% of type 2 diabetes patients were adherent to the medications prescribed to them and there was a discernible effect of gender and literacy on medication adherence. However, more such regional studies need to be conducted with a larger sample size from diverse hospital setups to obtain a clear and unbiased picture of the drug adherence scenario in India.

Development and validation of a nomogram model for medication non-adherence in patients with chronic kidney disease

OBJECTIVE

The high prevalence of medication non-adherence in patients with chronic kidney disease places a tremendous burden on healthcare resources. The study was designed to develop and validate a nomogram model of medication non-adherence in patients with chronic kidney disease in China.

METHODS

A multicenter cross-sectional study was conducted. 1206 chronic kidney disease patients were consecutively enrolled from Be Resilient to Chronic Kidney Disease (registration number: ChiCTR2200062288) between September 2021 and October 2022 in four tertiary hospitals in China. The Chinese version of four-item Morisky Medication Adherence Scale was used to assess the medication adherence of the patients and associated factors consisted of socio-demographic information, self-designed medication knowledge questionnaire, the 10-item Connor-Davidson Resilience Scale, the Beliefs about Medicine questionnaire, the Acceptance Illness Scale, and the Family Adaptation Partnership Growth and Resolve Index. Least Absolute Shrinkage and Selection Operator regression was performed to select significant factors. Concordance index, Hosmer-Lemeshow test and decision curve analysis were estimated.

RESULTS

The prevalence of medication non-adherence was 63.8%. Area under the curves ranged from 0.72 to 0.96 in internal and external validation sets. The predicted probabilities of the model were consistent with those of the actual observations by Hosmer-Lemeshow test (all P > .05). The final model included educational level, occupational status, duration of chronic kidney disease, medication beliefs (perceptions of the need to take medications and concerns about adverse effects), and illness acceptance (adaptation and acceptance of the disease).

CONCLUSIONS

There is a high prevalence of medication non-adherence among Chinese patients with chronic kidney disease. A nomogram model based on five factors has been successfully developed and validated and could be incorporated into long-term medication management.

Psychosocial and behavioral correlates of self-efficacy in treatment adherence in older patients with comorbid hypertension and type 2 diabetes

Background

Adhering to clinical prescriptions is known to protect against the effects of uncontrolled hypertension and of acute and chronic cardiovascular diseases, including diabetes. Contextually, positive associations between self-care behaviors and psychological constructs, such as self-efficacy, are widely acknowledged in the literature. However, still little is known about the psychological factors underlying the patient’s self-efficacy. This study aimed to investigate the psychosocial and behavioral correlates of self-efficacy related to treatment adherence in older patients with comorbid hypertension and type 2 diabetes mellitus.

Participants and procedure

Italian and Polish patients (≥ 65 years; N = 180) consecutively responded to self-report questionnaires measuring psycho-social (i.e., beliefs about medicines, perceived physician’s communication effectiveness, medication-specific social sup-port, self-efficacy) and behavioral factors (i.e., pharmacological adherence, medications refill adherence, intentional non-adherence) related to treatment adherence. Between-group comparisons and regression analyses were performed.

Results

Fisher’s least significant difference (LSD) test showed significant differences between the Italian and Polish groups in all questionnaires (p < .01) with the Italian patients reporting more satisfactory scores. Younger age (β = .08, p = .045), female gender (β = 1.03, p = .042), higher medication refills adherence (β = –.07, p = .024), lower intentional non-adherence (β = –.03, p = .009), positive beliefs about medications (β = .13, p < .001), better quality of communication with the physician (β = .09, p < .001), and stronger perceived medication-specific social support (β = .06, p = .001) were significantly associat-ed with self-efficacy related to treatment adherence.

Conclusions

Future research and interventions should leverage psychosocial and behavioral factors to address self-efficacy contributing to enhancing adherence to clinical prescriptions.

Assessment of self-care practice amongst patients with type II diabetes attending Adama Hospital Medical College, Ethiopia

INTRODUCTION

There is almost no published data on the assessment of self-management practice among adult type II diabetes patients in Ethiopia. Hence, we aim to assess the level of self-management practice for people with type II diabetes patients attending Adama Hospital Medical College, Ethiopia.

METHOD

The study was conducted from April 1 to August 30, 2021 in type II diabetes mellitus patients at Adama Hospital Medical College. The survey was performed using the diabetes mellitus self-Management questionnaire, which consists of four domains Physical activity, Physician contact, Medication adherence, glucose management and dietary management of the patients. The data was analyzed using Statistical Package for Social Science (SPSS) version 20.0. Descriptive statistics was performed. Fisher's Exact Test was used to determine the presence of association between adherence to self-care behavior and other variables. P-value less than 0.05 determines statistical significance.

RESULT

Majority (63.4%) of respondents do not perform self-monitoring of blood glucose (SMBG). Out of a total of 93 participants, 48 (51.6%) respondents adhered to insulin therapy. Sixty-two (66.7%) adhered to recommended diet management practice, 57 (61.3%) did not adhere to physical activity recommendations and 59 (63.5%) participants adhered to overall self-care practice (DMSQ).

CONCLUSION

Although the importance of self-care practices in the management of diabetes were recognized to be useful and effective for achieving glycemic control and preventing serious diabetes complications, our study found that most patients had not adhered to self-care practice especially in terms of SMBG and physical activity. Overall (DSMQ) adherence to self-care practice was optimal amongst type II diabetes patients in AHMC Chronic care unit.

Patients' Views on the Design of DiabeText, a New mHealth Intervention to Improve Adherence to Oral Antidiabetes Medication in Spain: A Qualitative Study

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) is a long-term condition affecting around 10% of people worldwide. This study aimed to explore T2DM patients' views on DiabeText, a new text messaging intervention to be developed to support adherence to diabetes medication.

METHODS

A total of four focus groups were conducted with a purposive sample of people with T2DM (n = 34). The data were analysed by multiple researchers independently, and coded using thematic analysis.

RESULTS

There were two main themes that emerged: (1) "patients' perspectives on unmet needs for diabetes self-management", and (2) "acceptability and perceived utility of DiabeText". The patients identified a number of barriers for diabetes self-management, including lack of appropriate information and support with diet and physical activity. Support for medication-taking was not perceived as urgently needed, although several barriers were identified (eating outside, traveling, polymedication, dispensation at the pharmacy). The participants anticipated that the proposed intervention would present high levels of patient acceptability and perceived utility as long as its content addresses the barriers that were identified, and includes specific features (short and clear messages, and personalized information).

CONCLUSION

The proposed intervention has the potential to be well accepted and perceived as useful by T2DM patients who require support not only in terms of medication-taking, but more prominently of lifestyle behaviour.

A model to predict adherence to antiretroviral therapy among people living with HIV

OBJECTIVES

Suboptimal adherence to antiretroviral therapy (ART) dramatically hampers the achievement of the UNAIDS HIV treatment targets. This study aimed to develop a theory-informed predictive model for ART adherence based on data from Chinese.

METHODS

A cross-sectional study was conducted in Shenzhen, China, in December 2020. Participants were recruited through snowball sampling, completing a survey that included sociodemographic characteristics, HIV clinical information, Information-Motivation-Behavioural Skills (IMB) constructs and adherence to ART. CD4 counts and HIV viral load were extracted from medical records. A model to predict ART adherence was developed from a multivariable logistic regression with significant predictors selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. To evaluate the performance of the model, we tested the discriminatory capacity using the concordance index (C-index) and calibration accuracy using the Hosmer and Lemeshow test.

RESULTS

The average age of the 651 people living with HIV (PLHIV) in the training group was 34.1±8.4 years, with 20.1% reporting suboptimal adherence. The mean age of the 276 PLHIV in the validation group was 33.9±8.2 years, and the prevalence of poor adherence was 22.1%. The suboptimal adherence model incorporates five predictors: education level, alcohol use, side effects, objective abilities and self-efficacy. Constructed by those predictors, the model showed a C-index of 0.739 (95% CI 0.703 to 0.772) in internal validation, which was confirmed be 0.717 via bootstrapping validation and remained modest in temporal validation (C-index 0.676). The calibration capacity was acceptable both in the training and in the validation groups (p>0.05).

CONCLUSIONS

Our model accurately estimates ART adherence behaviours. The prediction tool can help identify individuals at greater risk for poor adherence and guide tailored interventions to optimise adherence.