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Abstract
Objectives: To determine the prevalence of problems with treatment adherence among type-2 diabetic patients with regards to medication, dietary advice, and physical activity; to identify the associated clinical and psychosocial factors; and to investigate the degree of agreement between patient-perceived and GP-perceived adherence. Methods: Consecutive patients were solicited during visits to 39 GPs. In total, 521 patients self-reported on treatment adherence, anxiety and depression, and disease perception. The GPs reported clinical and laboratory data and patients' adherence. A multivariate analysis identified the factors associated with adherence problems. Results: Problems of adherence to medication, dietary advice, and physical activity recommendations were reported by 17%, 62%, and 47% of the patients, respectively. Six independent factors were found associated with adherence problems: young age, body-mass index (BMI) > 30 kg/m2, glycosylated haemoglobin (HbA1c) > 8%, single life, depression, and perception of medication as a constraint. Agreement between patients’ and GPs’ assessments of treatment problems reached 70%. Conclusion: In type 2 diabetes, problems with dietary advice or physical activity are far more frequent than problems with medication, and not all physicians are fully aware of patients’ problems. More active listening and shared decision-making should enhance adherence and improve outcomes.
Acknowledgements
We would like to thank Terra JL, Laville M, and Colin C who provided methodological advice; Letrilliard L and LeGoaziou MF who participated in the focus group in the context of “Eurobstacles study” by the European General Practice Research Network (EGPRN), and the participant GPs: Altermat P, Biot-Laporte S, Blanc M, Blanc-Vannet P, Bolliet R, Bouzon M, Brys V, Buzy A, Chassagnon H, Comte C, Danière M, Dubois JP, Dupraz C, Erpeldinger S, Esturillo G, Fauche R, Févre JJ, Figon S, Flori M, Fontan E, Fouillard C, Gadot M, Girier P, Hauzanneau P, Imbert P, Jacquet JP, Jouve C, Lagarde B, Le Goaziou MF, Luciani J, Malfoy A, Marissal P, Mas JL, Prothon N, Roulet JP, Rousset JY, Souweine G, Vital-Durand M, Zerbib Y.
Northrup L and Ploin A are acknowledged for reviewing the manuscript.
This study was supported by the Collè ge Lyonnais des Gé né ralistes Enseignants, C/O Dr Lainé , 14 rue Etienne Dolet, 69600 Oullins, France.
Conflicts of interest
The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. This study was funded by the French Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés (CNAMTS), 50 Avenue du Professeur André Lemierre, 75986 Paris Cedex 20, France.
Related reports
Parts of data analyses were presented as preliminary reports during the following workshops:
•DIfficulties of ADherence among type 2 Diabetic patients in primary care (DIAD study). Moreau A, Aroles V, Zerbib Y. EGPRN Research on Diabetes in General Practice Tartu, Estonia, 2005.
•DIfficultés d'Observance des patients Diabétiques de type 2 En Médecine générale (étude DIODEM) Moreau A, Aroles V, Imbert P, Esturillo G. Collège National des Généralistes Enseignants. Paris, France, 2005.
•DIfficulties of ADherence among type 2 diabetes in general practice (DIAD study): from compliance to concordance. Moreau A, Souweine G, Aroles V. WONCA. Paris, France, 2007.