The association between diabetes metabolic control and drug adherence in an indigent population
The association between diabetes metabolic control and drug adherence in an indigent population
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DOI：
10.2337/diacare.25.6.1015
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发表时间：
2002-06-01
期刊：
影响因子：
16.2
通讯作者：
Voss, JD
中科院分区：
文献类型：
--
作者：
Schectman, JM;Nadkarni, MM;Voss, JD
目的-糖尿病代谢控制和药物治疗依从性之间的关系的研究产生了相互矛盾的结果。由于低社会经济和少数民族人口有较差的糖尿病的结果和更大的障碍，坚持，我们研究了坚持和糖尿病代谢控制之间的关系，在一个大的贫困population.RESEARCH设计和方法-研究人群包括接受医疗保健的患者从一所大学为基础的内科诊所服务的低收入人口在弗吉尼亚州中部农村。样本包括810例2型糖尿病患者，他们在研究期间从诊所药房接受口服糖尿病药物，并至少有一次HbA（1c）测定。多元线性回归被用来研究的关联HbA（1C）水平以及HbA（1C）水平的变化与药物治疗的依从性，人口统计学，和临床characteristics.RESULTS -更好的代谢控制独立相关的更大的药物治疗依从性，增加年龄，白色（与非洲裔美国人）的种族，和较低的药物治疗强度。药物依从性每增加10%，HbA（1c）下降0.16%（P < 0.0001）。控制其他人口统计学和临床变量后，非裔美国人的平均HbA（1c）比白人高0.29%（P = 0.04）。此外，非裔美国人糖尿病药物治疗的强度较低，因为他们测量坚持it. There是没有关联代谢控制和性别，收入，遇到的频率，频率HbA（1c）检测，或continuousofcare.CONCLUSIONS -坚持2型糖尿病的药物治疗方案是密切相关的贫困人口的代谢控制;非裔美国人的依从性较低，代谢控制较差。显然需要做出更大的努力来促进低收入人群的糖尿病自我管理行为，并促进对少数群体的文化敏感和适当的护理。
OBJECTIVE - Studies of the association between diabetes metabolic control and adherence to drug therapy have yielded conflicting results. Because low socioeconomic and minority populations have poorer diabetes outcomes and greater barriers to adherence, we examined the relationship between adherence and diabetes metabolic control in a large indigent population.RESEARCH DESIGN AND METHODS - The study population consisted of patients receiving medical care from a university-based internal medicine clinic serving a low-income population in rural central Virginia. The sample comprised 810 patients with type 2 diabetes who received oral diabetes medications from the clinic pharmacy and had at least one HbA(1c) determination during the study period. Multiple linear regression was used to examine the association of HbA(1c) level as well as change in HbA(1c) level With medication adherence, demographic, and clinical characteristics.RESULTS - Better metabolic control was independently associated with greater medication adherence, increasing age, white (versus African-American) race, and lower intensity of drug therapy. For each 10% increment in drug adherence, HbA(1c) decreased by 0.16% (P < 0.0001). Controlling for other demographic and clinical variables, the mean HbA(1c) of African-Americans was 0.29% higher than that of whites (P = 0.04). Additionally, the intensity of diabetes drug therapy for African-Americans was lower, as was their measured adherence to it. There was no association between metabolic control and gender, income, encounter frequency, frequency of HbA(1c) testing, or continuity of care.CONCLUSIONS - Adherence to medication regimens for type 2 diabetes is strongly associated With metabolic control in an indigent population; African-Americans have lower adherence and worse metabolic control. Greater efforts are clearly needed to facilitate diabetes self-management behaviors of low-income populations and foster culturally sensitive and appropriate care for minority groups.