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DIABETES

Medication Adherence and Associated Hemoglobin A_1c in Type 2 Diabetes

Diabetes Clinical Specialist and President, Diabetes Solutions, Aurora, CO

Kathleen King, RN MSN FNP-C

Nurse Practitioner, Department of Internal Medicine, Wayne State University, Detroit, MI

Susan S Warren, RN MPH CDE

Research Interventions Manager, Diabetes Center, Baylor University Medical Center, Dallas, TX

Karen G George, RN MSN CDE

Endocrinology Office, North Texas Health Care Associates, Dallas

Dorothy A Caputo, MA APRN BC-ADM CDE

Director, Center for Continuing and Outreach Education, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ

Karen Mihelich, RN MSN CNP CDE

Nurse Practitioner, Department of Medicine, St. John Hospital and Medical Center, Diabetes Center, Detroit

Elizabeth M Holst, RN CDE

Clinical Coordinator, Diabetes Center, Morristown Memorial Hospital of Atlantic Health Systems, Morristown, NJ

Michael B Nichol, PhD

Associate Professor and Chair, Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA

Sheng G Shi, PhD

Research Associate, Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California

Kevin B Livengood, PharmD MS

Director, Clinical Applications, Pfizer, New York, NY

Steve Walden, PharmD MBA

Senior Manager, Clincal Applications, Pfizer, New York

Teresa J Lubowski, PharmD

Director, Clinical Applications, Pfizer, New York

Reprints: Kevin B Livengood PharmD MS, Pfizer, 150 E. 42nd St., New York, NY 10017-5755, fax 714/524-5047, livenk{at}pfizer.com

BACKGROUND: Tight blood glucose control has been correlated with a reduction in diabetes complications. Adherence to antidiabetic medications is crucial to achieving blood glucose control.

OBJECTIVE: To assess the relationship between good glucose control [glycosylated hemoglobin (HbA_1c) levels] and adherence to prescribed treatment in patients on a stable medication regimen for type 2 diabetes.

METHODS: The Morisky survey, a 4-item questionnaire that predicts patient medication-taking behavior, was used to assess adherence in 301 patients. The relationship of HbA_1c to Morisky score was evaluated, controlling for other variables related to patient demographics and clinical characteristics. Data were analyzed using a general linear model on log (HbA_1c).

RESULTS: Unadjusted mean HbA_1c values (capped at 14.0%) for patients with Morisky scores of 0 or 1, 2, 3, and 4 were 8.92%, 8.67%, 7.74%, and 7.60%, respectively. Of all patients, 13.0%, 14.0%, 24.3%, and 48.8% had scores of 0 or 1, 2, 3, and 4, respectively. Good adherence (Morisky score 3) was associated with a 10% lower total HbA_1c (p = 0.0003) adjusted for all other factors in the model. Duration of diabetes (5–10 y) and presence of diabetes complications were also significantly associated with HbA_1c (p = 0.026 and 0.002, respectively). Adherence was poor in 27% of patients.

CONCLUSIONS: This study found that patients with a higher score on the Morisky scale had a lower associated HbA_1c measurement. The Morisky score may be an efficient tool for identifying patients with poor medication-taking behavior who can then be targeted for directed adherence counseling services.

Key Words: adherence, hemoglobin A_1c, type 2 diabetes

Published Online, July 6, 2004. www.theannals.com, DOI 10.1345/aph.1D612

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