Association between therapeutic adherence and glycemic control in patients with type 2 diabetes mellitus
DOI:
https://doi.org/10.12957/demetra.2023.70199Abstract
Introduction: Treatment adherence in diabetes mellitus is essential for metabolic control, complication prevention, quality of life improvement and maintenance. Objective: To assess the association between adherence with pharmacological treatment and glycemic control in patients with type 2 diabetes and investigate factors associated with these conditions. Method: This is a cross-sectional study with patients ≥ 18 years old with type 2 diabetes mellitus, treated at a private endocrinology service, using oral antidiabetics for at least 6 months and with a glycated hemoglobin (HbA1c) measurement for a maximum of 12 months. The MMAS-8 (Morisky Medication Adherence Scale) and a questionnaire with sociodemographic and clinical data were used. Results presented as prevalence ratio (PR) and 95% confidence interval (CI), adjusted by logistic regression using the enter method. The level of statistical significance adopted was 5%. Results: A total of 134 patients participated in the study, with a mean age of 56.7 ± 12.9 years, 58.2% of whom were women. Therapeutic adherence was demonstrated by 78.4% of patients, with a positive association with education and a negative association with age and time since diagnosis. Glycemic control was verified by 68.7%, with no statistically significant difference in relation to sex, age, race, education and time since diagnosis. Among patients considered adherent, 77.1% had adequate glycemic control, while among patients considered non-adherent, 37.9% were considered controlled (p<0.001). Conclusion: Pharmacological treatment adherence was associated with glycemic control in patients with type 2 diabetes followed up in a private endocrinology office.
References
American Diabetes Association. Standards of Medical Care in Diabetes [Internet]. Di-abetesCare. 2017 [Acesso em 08 de agosto de 2022]. Disponível em: http://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf
International Diabetes Federation. IDF - Diabetes Atlas Ten edition 2021. 2021. [Acesso em 01 de abril de 2023]. Disponível em: https://diabetesatlas.org/atlas/tenth-edition/
Cobas R, Rodacki M, Giacaglia L, Calliari L, Noronha R, Valerio C, et al. Diagnóstico do diabetes e rastreamento do diabetes tipo 2. Diretriz Oficial da Sociedade Brasileira de Diabetes. 2022: 1-23. https://doi.org/10.29327/557753.2022-2
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. VIGITEL 2021: Vigilância de Fatores de Risco e Proteção para Doenças Crônicas em Inquérito Telefônico. Brasília: Ministério da Saúde; 2022. [Acesso em 01 de abril de 2023]. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/vigitel/vigitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-risco-e-protecao-para-doencas-cronicas
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Estratégias para o cuidado com a pessoa com doença crônica: diabetes mellitus. Brasília/DF, 2013. [Acesso em 02 de agosto de 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_pessoa_diabetes_mellitus_cab36.pdf
World Health Organization. Adherence to long-term therapies. Evidence for action. Geneva: WHO; 2003. [Acesso em 01 de Agosto de 2022]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf?sequence=1
Santos AL, Cecílio HPM, Teston EF, Arruda GO, Peternella FMN, Marcon SS. Complicações microvasculares em diabéticos tipo 2 e fatores associados: inquérito telefônico de morbidade autorreferida. Ciênci saúde coletiva. 2015;20(3):761-70.
https://doi.org/ 10.1590/1413-81232015203.12182014
de Araújo MF, de Freitas RW, Marinho NB, Alencar AM, Damasceno MM, Zanetti ML. Validation of two methods to evaluate adherence to oral anti-diabetic medication. J Nurs Healthcare ChronicIllness. 2011;3:275-82. https://doi.org/10.1111/j.1752-9824.2011.01099.x
Rossi VEC, Silva AL, Fonseca GSS.Adesãoaotratamentomedicamentoso entre pessoas com diabetes mellitus tipo 2. R Enferm Cent O Min. 2015; 5(3):1820-30. https://doi.org/10.19175/recom.v5i3.890
Arrelias CCA, Faria HTG, Teixeira CRS, Santos MA, Zanetti ML. Adesão ao tratamento do diabetes mellitus e variáveis sociodemográficas, clínicas e de controle metabólico. Acta Paul Enferm. 2015;28(4):315-22. https://doi.org/10.1590/1982-0194201500054
Carvalho CV, Rocha LP, Carvalho DP, Silva BT, Oliveira SM, Silveira RB. Adesão de pessoas com diabetes mellitus tipo II ao tratamento medicamentoso. Revenferm UFPE online. 2017;11(9):3042-9. https://doi.org/10.5205/reuol.11088-99027-5-ED.1109201711
Silva MCM, Barnabe AS, Fornari JV, Ferraz RRN. Avaliação do conhecimento dos portadores de diabetes mellitus sobre a importância da manutenção dos níveis glicêmicos para a prevenção da nefropatia diábetica. SaBios: Rev Saúde e Biol. 2013;8(3):49-55.
Flor LS, Campos MR. Prevalência de diabetes mellitus e fatores associados na população adulta brasileira: evidências de um inquérito de base populacional. Rev. bras. epidemiol. 2017;20(1):16-29. https://doi.org/10.1590/1980-5497201700010002
Machado APMC, Santos ACG, Carvalho KKA, Gondim MPL, Bastos NP, Rocha JVS, et al. Avaliação da adesão ao tratamento de pacientes com diabetes mellitus e seus fatores associados. Rev Eletrônica Acervo Saúde. 2019;19:1-10. https://doi.org/10.25248/reas.e565.2019
Vicente NG, Goulart BF, Iwamoto HH, Rodrigues LR. Prevalência de adesão ao tratamento medicamentoso de pessoas com diabetes mellitus. Enferm Global. 2018;52:460-73. http://dx.doi.org/10.6018/eglobal.17.4.302481
Malta DC, Duncan BB, Schmidt MI, Machado IE, Silva AG, Bernal RTI, et al. Prevalência de diabetes mellitus determinada pela hemoglobina glicada na população adulta brasileira, Pesquisa Nacional de Saúde. Rev. bras. epidemiol. 2019;22(Suppl 2):1-13.
https://doi.org/10.1590/1980-549720190006.supl.2
Francisco PMSB, Rodrigues PS, Costa KS, Tavares NUL, Tierling VL, Barros MBA, et al. Prevalência de diabetes em adultos e idosos, uso de medicamentos e fontes de obtenção: uma análise comparativa de 2012 e 2016. Rev. bras. epidemiol. 2019;22(e190061):1-4. https://doi.org/10.1590/1980-549720190061
GBD 2016 Brazil Collaborators. Burden of disease in Brazil, 1990-2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10149):760-75.
https://doi.org/10.1016/S0140-6736(18)31221-2.
Bertoldi AD, Kanavos P, França GV, Carraro A, Tejada CA, Hallal PC, et al.Epidemiology, management, complication sand costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Global. Health. 2013;9(62):1-12. https;// doi: 10.1186/1744-8603-9-62.
Malta DC, Iser BPM, Andrade SSCA, Moura L, Oliveira TP, Bernal RTI. Tendências da prevalência do diabetes melito autorreferido em adultos nas capitais brasileiras, 2006 a 2012. Epidemiol Serv Saúde. 2014;23(4):753-60. https://doi.org/10.5123/S1679-49742014000400017
Silva AB, Engroff P, SgnaolinV, ElyLS, Gomes I. Prevalência de diabetes mellitus e adesão medicamentosa em idosos da Estratégia de Saúde da Família de Porto Alegre/RS. Cad. Saúde Colet. 2016;24(3):308-16 https://doi.org/10.1590/1414-462X201600030017
Gomes GJ, Sartori AM, Pereira LMV, Ueta JM, de Oliveira REM. Tratamento e controle de diabetes mellitus tipo 2 em Unidades de Saúde da Família de um município paulista. Saúde em Redes. 2021;7(1):1-11. https://doi.org/10.18310/2446-4813.2021v7n1p217-227
Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, Chu Y, et al. Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis. Ann Internal Med. 2016;164(11):740-51. https://doi.org/10.7326/M15-2650.
Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32:193–203. https://doi.org/10.2337/dc08-9025.
Faria HTG, Rodrigues FFL, Zanetti ML, Araújo MFM, Damasceno MMC. Factors associated with adherence to treatment of patients with diabetes mellitus. Acta Paul Enferm. 2013;26(3):231-7.
https://doi.org/10.1590/S0103-21002013000300005
King P, Peacock I, Donnelly R.The UK Prospective DiabetesStudy (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48(5):643-8.
https://doi.org/10.1046/j.1365-2125.1999.00092.x
Sayin N, Kara N, Pekel G. Ocular complicationsof diabetes mellitus. World J Diabetes. 2015;6:92–108. https://doi.org/10.4239/wjd.v6.i1.92
Murussi M, Murussi N, Campagnolo N, Silveiro S. Early detection of diabetic nephropathy. Arq Bras Endocrinol Metabol. 2008;52(3):442-51. https://doi.org/10.1177/14791641211058856.
Boas LCGV, Foss-Freitas MC, Pace AE. Adesão de pessoas com diabetes mellitus tipo 2 ao tratamento medicamentoso. Ver Bras Enferm. 2014;67(2):268-73. https://doi.org/10.5935/0034-7167.20140036
Fischer EB, Thorpe CT, Devellis BM, Devellis RF. Healthy coping, negative emotions, and diabetes management: a systematic review and appraisal. Diabetes Educator 2007;33(6):1080-103.
https://doi.org/ 10.1177/0145721707309808.
Babenko AY, Mosikian AA, Lebedev DL, Khrabrova EA, Shlyakhto EV. Mental state, psycho emotional status, quality of life and treatment compliance in patients with Type 2 diabetes mellitus. J CompEff Res. 2019;8(2):113-20. https://doi.org/10.2217/cer-2018-0105
Capoccia K, Odegard PS, Letassy N. Medication Adherence With Diabetes Medication: A Systematic Review of the Literature. Diabetes Educ. 2016;42(1):34-71. https://doi.org/10.1177/0145721715619038
Thurston MM, Bourg CA, Phillips BB, Huston SA. Impact of health literacy level on aspects of medication non adherence reported by underserved patients with type 2 diabetes. Diabetes TechnolTher. 2015;17(3):187-93. https://doi.org/10.1089/dia.2014.0220
Bubalo J, Clark RK Jr, Jiing SS, Johnson NB, Miller KA, Clemens Shipman CJ, et al. Medication adherence: Pharmacist perspective. J Am Pharm Assoc. 2010;50(3):394-406. https://doi.org/10.1331/JAPhA.2010.08180
Shoenthaler AM, Schwartz BS, Wood C, Stewart WF. Patient and physician factors associated with adherence to diabetes medications. Diabetes Educ. 2012;38(3):397-408. https://doi.org/10.1177/0145721712440333
Tavares NUL, Bertoldi AD, Mengue SS, Arrais PSD, Luiza VL, Oliveira MA, et al. Fatores associados à baixa adesão ao tratamento farmacológico de doenças crônicas no Brasil. RevSaude Publica. 2016;50(supl 2):1s-10s. https://doi.org/10.1590/S1518-8787.2016050006150
Constantino MI. Long-term complications and mortality in Young-onset diabetes: type 2 diabetes is more hezardous and lethal than type 1 diabetes. Diabetes Care 2013; 36(12):3863-3869. https://doi.org/10.2337/dc12-2455
Egede LE, Gebregziabher M, Dismuke CE, Lynch CP, Axon RN, Zhao Y, et al. Medication non adherence in diabetes: longitudinal effects on costs and potential cost savings from improvement. Diabetes Care. 2012; 35(12):2533-2530. https://doi.org/10.2337/dc12-0572
Egede LE, Gebregziabher M, Echols C, Lynch CP. Longitudinal effects of medication non adherence on glycemic control. Ann Pharmacother. 2014;48(5):562-570. https://doi.org/10.1177/1060028014526362.
Wong MC, Wu CH, Wang HH, Li HW, Hui EM, Lam AT, et al. Association between the 8-item Morisky medication adherence scale (MMAS-8) score and glycaemic control among Chinese diabetes patients. J Clin Pharmocol. 2015;55(3):279-287. https://doi.org/10.1002/jcph.408.
Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016; 22(10):1299-1307. https://doi.org/10.2147/PPA.S106821
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Isabela Rosendo Mendonça, Alexandre Bitencourt Rosendo, Bruna Becker da Silva, Betine Pinto Moehlecke Iser
This work is licensed under a Creative Commons Attribution 4.0 International License.
STATEMENT OF AUTHORSHIP RESPONSIBILITY
Title of the manuscript:
________________________________________________________
1. Statement of responsability
I certify that I have participated in the work above specified and take public responsibility for its content.
I certify that the manuscript represents an original work and that none of the material in the manuscript has been previously published, is included in another manuscript, or is currently under consideration for publication elsewhere, whether in printed form or in electronic media, except that described in the attachment.
In case of acceptance of this text by Demetra: Alimentação, Nutrição & Saude, I declare to be in accordance with the policy of public access and copyright adopted by Demetra, which provides as follows: (a) the authors retain the copyright and grant to the Journal the right of first publication, the work being simultaneously licensed under the Creative Commons Attribution License, which allows the sharing of the work with acknowledgment of authorship and initial publication in this journal; (b) authors are authorized to enter additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal; and (c) authors are permitted and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this may lead to productive changes, as well as increase the impact and citation of the published work.
2. Conflict of Interest Statement
I certify that there is no conflict of interest in connection with the submitted article.
Date, signature and full address of all authors.
