Volume 17, Issue 2 (5-2025)                   IJDO 2025, 17(2): 79-87 | Back to browse issues page


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Vatan Meidanshahi A, Alaei-Shahmiri F, Golgiri F, Mavvaji M A, Dinko B, Shahi R et al . Assessing the Association between Anti-Diabetic Medication Adherence and Glycemic Control in Type 2 Diabetes. IJDO 2025; 17 (2) :79-87
URL: http://ijdo.ssu.ac.ir/article-1-950-en.html
Endocrine Research Center; Institute of Endocrinology and Metabolism; Iran University of Medical Sciences (IUMS); Tehran; Iran.
Abstract:   (39 Views)
Objective: Adherence to anti-diabetic medications in diabetic patients plays a considerable role in glycemic control, prevention of short-term and long-term morbidities, and diabetes-related mortality. The current study aims to evaluate the factors associated with adherence to medications among patients with type 2 diabetes.
Materials and Methods: The current study was conducted on 366 diabetic patients who were referred to the Institute of Endocrinology and Metabolism. The HbA1C was measured at baseline and then after six months. The validated questionnaire on adherence to refills and medication scale (ARMS) was filled, and factors associated with medication adherence were assessed. The higher ARMS scores represented poorer adherence to the medication.
Results: Diabetic patients with adherence to anti-diabetic agents represented significantly lower levels of HbA1C both at baseline (P< 0.001) and the six-month follow-up (P< 0.001) compared to the non-adherent group. In the correlation analyses, the ARMS score was significantly correlated with the A1C levels measured at the baseline (rs= 0.37, P< 0.001) and after 6 months (rs= 0.40, P< 0.001) as well as the duration of diabetes (rs= 0.16, P= 0.003). The subsequent logistic regression analysis highlighted the use of insulin as the main determinant of adherence to medications (OR: 0.59; 95%CI: 0.35-0.99), after controlling for age, gender, diabetes duration and number of medications.
Conclusion: The current study revealed that adherence to the anti-diabetic medication is associated with remarkably improved glycemic control. Diabetes duration and insulin use were inversely correlated with adherence to medication, while there was no association with age, gender, numbers of drugs.
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Type of Study: Research | Subject: Special
Received: 2024/01/20 | Accepted: 2025/03/17 | Published: 2025/05/31

References
1. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes research and clinical practice. 2018;138:271-81. [DOI:10.1016/j.diabres.2018.02.023]
2. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes care. 2012;35(12):2650‐64. [DOI:10.2337/dc12-1801]
3. Kirkman MS, Mahmud H, Korytkowski MT. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes mellitus. Endocrinology and Metabolism Clinics. 2018;47(1):81-96. [DOI:10.1016/j.ecl.2017.10.002]
4. Advance Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. New England journal of medicine. 2008;358(24):2560-72. [DOI:10.1056/NEJMoa0802987]
5. Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes care. 2011;34(6):1329-36. [DOI:10.2337/dc10-2377]
6. Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Archives of internal medicine. 2006;166(17):1836-41. [DOI:10.1001/archinte.166.17.1836]
7. Zimmet PZ, Magliano DJ, Herman WH, Shaw JE. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology. 2014;2(1):56-64. [DOI:10.1016/S2213-8587(13)70112-8]
8. Feldman BS, Cohen-Stavi CJ, Leibowitz M, Hoshen MB, Singer SR, Bitterman H, et al. Defining the role of medication adherence in poor glycemic control among a general adult population with diabetes. PLoS One. 2014;9(9):e108145. [DOI:10.1371/journal.pone.0108145]
9. Association AD. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Supplement 1):S34‐S45. [DOI:10.2337/dc19-S004]
10. Moradi S, Sahebi Z, Ebrahim Valojerdi A, Rohani F, Ebrahimi H. The association between the number of office visits and the control of cardiovascular risk factors in Iranian patients with type2 diabetes. PLoS One. 2017;12(6):e0179190. [DOI:10.1371/journal.pone.0179190]
11. Arifulla M, John LJ, Sreedharan J, Muttappallymyalil J, Basha SA. Patients' adherence to anti-diabetic medications in a hospital at Ajman, UAE. The Malaysian journal of medical sciences: MJMS. 2014;21(1):44.
12. Lopez JM, Bailey RA, Rupnow MF, Annunziata K. Characterization of type 2 diabetes mellitus burden by age and ethnic groups based on a nationwide survey. Clinical therapeutics. 2014;36(4):494-506. [DOI:10.1016/j.clinthera.2013.12.016]
13. Tiv M, Viel JF, Mauny F, Eschwege E, Weill A, Fournier C, et al. Medication adherence in type 2 diabetes: the ENTRED study 2007, a French population-based study. PloS one. 2012;7(3):e32412. [DOI:10.1371/journal.pone.0032412]
14. Long JA, Wang A, Medvedeva EL, Eisen SV, Gordon AJ, Kreyenbuhl J, et al. Glucose control and medication adherence among veterans with diabetes and serious mental illness: does collocation of primary care and mental health care matter?. Diabetes Care. 2014;37(8):2261-7. [DOI:10.2337/dc13-0051]
15. Capoccia K, Odegard PS, Letassy N. Medication adherence with diabetes medication: a systematic review of the literature. The Diabetes Educator. 2016;42(1):34-71. [DOI:10.1177/0145721715619038]
16. Guerci B, Chanan N, Kaur S, Jasso-Mosqueda JG, Lew E. Lack of treatment persistence and treatment nonadherence as barriers to glycaemic control in patients with type 2 diabetes. Diabetes Therapy. 2019;10(2):437-49. [DOI:10.1007/s13300-019-0590-x]
17. Duckworth WC, Abraira C, Moritz TE, Davis SN, Emanuele N, Goldman S,et al. The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA Diabetes Trial. Journal of diabetes and its complications. 2011;25(6):355-61. [DOI:10.1016/j.jdiacomp.2011.10.003]
18. Juarez DT, Sentell T, Tokumaru S, Goo R, Davis JW, Mau MM. Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009. Preventing chronic disease. 2012;9:E151. [DOI:10.5888/pcd9.120065]
19. Barati M, Taheri-Kharameh Z, Bandehelahi K, Yeh VM, Kripalani S. Validation of the Short Form of the Adherence to Refills and Medications Scale (ARMS-SF) in Iranian Elders with Chronic Disease. Journal of Clinical & Diagnostic Research. 2018;12(11):FC05- FC08. [DOI:10.7860/JCDR/2018/37584.12305]
20. Mayberry LS, Osborn CY. Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Diabetes care. 2012;35(6):1239-45. [DOI:10.2337/dc11-2103]
21. Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient preference and adherence. 2016:1299-307. [DOI:10.2147/PPA.S106821]
22. Khunti K, Seidu S, Kunutsor S, Davies M. Association between adherence to pharmacotherapy and outcomes in type 2 diabetes: a meta-analysis. Diabetes Care. 2017;40(11):1588-96. [DOI:10.2337/dc16-1925]
23. Egede LE, Gebregziabher M, Hunt KJ, Axon RN, Echols C, Gilbert GE, et al. Regional, geographic, and racial/ethnic variation in glycemic control in a national sample of veterans with diabetes. Diabetes care. 2011;34(4):938-43. [DOI:10.2337/dc10-1504]
24. Mosen DM, Glauber H, Stoneburner AB, Feldstein AC. Assessing the association between medication adherence and glycemic control. Am J Pharm Benefits. 2017;9(3):82-8. [DOI:10.17294/2330-0698.1499]
25. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. New England journal of medicine. 2008;359(15):1577-89. [DOI:10.1056/NEJMoa0806470]
26. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical care. 2005;43(6):521-30. [DOI:10.1097/01.mlr.0000163641.86870.af]
27. Asche C, LaFleur J, Conner C. A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clinical therapeutics. 2011;33(1):74-109. [DOI:10.1016/j.clinthera.2011.01.019]
28. Gonzalez JS, Schneider HE. Methodological issues in the assessment of diabetes treatment adherence. Current diabetes reports. 2011;11:472-9. [DOI:10.1007/s11892-011-0229-4]
29. Larsen R, Kronenberg H. et ad. Williams textbook of endocrinology 12th edition. Elsevier Saunders; 2011.
30. Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabetic Medicine. 2015;32(6):725-37. [DOI:10.1111/dme.12651]
31. Guldberg TL, Vedsted P, Kristensen JK, Lauritzen T. Improved quality of type 2 diabetes care following electronic feedback of treatment status to general practitioners: a cluster randomized controlled trial. Diabetic Medicine. 2011;28(3):325-32. [DOI:10.1111/j.1464-5491.2010.03178.x]
32. Davies MJ, Gagliardino JJ, Gray LJ, Khunti K, Mohan V, Hughes R. Real‐world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: A systematic review. Diabetic Medicine. 2013;30(5):512-24. [DOI:10.1111/dme.12128]
33. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clinical therapeutics. 2001;23(8):1296-310. [DOI:10.1016/S0149-2918(01)80109-0]
34. Pantuzza LL, Ceccato MD, Silveira MR, Junqueira LM, Reis AM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. European journal of clinical pharmacology. 2017:1475-89. [DOI:10.1007/s00228-017-2315-2]
35. Coleman CI, Limone B, Sobieraj DM, Lee S, Roberts MS, Kaur R, et al. Dosing frequency and medication adherence in chronic disease. Journal of Managed Care Pharmacy. 2012;18(7):527-39. [DOI:10.18553/jmcp.2012.18.7.527]
36. Saini SD, Schoenfeld P, Kaulback K, Dubinsky MC, Care AJ. Effect of medication dosing frequency on adherence in chronic diseases.The American Journal of Managed Care.2009;15(6):e22-33.
37. Nagrebetsky A, Griffin S, Kinmonth AL, Sutton S, Craven A, Farmer A. Predictors of suboptimal glycaemic control in type 2 diabetes patients: the role of medication adherence and body mass index in the relationship between glycaemia and age. Diabetes research and clinical practice. 2012;96(2):119-28. [DOI:10.1016/j.diabres.2011.12.003]
38. Cohen HW, Shmukler C, Ullman R, Rivera CM, Walker EA. Measurements of medication adherence in diabetic patients with poorly controlled HbA1c. Diabetic Medicine. 2010;27(2):210-6. [DOI:10.1111/j.1464-5491.2009.02898.x]

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