Document Detail

Real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review.
MedLine Citation:
PMID:  23323988     Owner:  NLM     Status:  MEDLINE    
AIMS: To identify real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus.
METHODS: A literature search was conducted in PubMed and EMBASE in November 2011 to identify studies reporting factors associated with adherence/non-adherence to insulin therapy in adults with Type 1 or Type 2 diabetes.
RESULTS: Seventeen studies were identified; six used self-reported measures and 11 used calculated measures of adherence. Most (13/17) were conducted exclusively in the USA. Four categories of factors associated with non-adherence were identified: predictive factors for non-adherence, patient-perceived barriers to adherence, type of delivery device and cost of medication. For predictive factors and patient-perceived barriers, only age, female sex and travelling were associated with non-adherence in more than one study. Fear of injections and embarrassment of injecting in public were also cited as reasons for non-adherence. Conversely, adherence was improved by initiating therapy with, or switching to, a pen device (in four studies), and by changing to an insurance scheme that lowered the financial burden on patients (in two studies).
CONCLUSIONS: Adherence to insulin therapy is generally poor. Few factors or patient-perceived barriers were consistently identified as predictive for non-adherence, although findings collectively suggest that a more flexible regimen may improve adherence. Switching to a pen device and reducing patient co-payments appear to improve adherence. Further real-world studies are warranted, especially in countries other than the USA, to identify factors associated with non-adherence and enable development of strategies to improve adherence to insulin therapy.
M J Davies; J J Gagliardino; L J Gray; K Khunti; V Mohan; R Hughes
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  30     ISSN:  1464-5491     ISO Abbreviation:  Diabet. Med.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-16     Completed Date:  2013-12-02     Revised Date:  2014-03-14    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  512-24     Citation Subset:  IM    
Copyright Information:
© 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.
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MeSH Terms
Diabetes Mellitus, Type 1 / drug therapy*,  epidemiology
Diabetes Mellitus, Type 2 / drug therapy*,  epidemiology
Europe / epidemiology
Health Knowledge, Attitudes, Practice
Hypoglycemic Agents / administration & dosage*
Insulin / administration & dosage*
Medication Adherence / statistics & numerical data*
Self Efficacy
Social Perception
Socioeconomic Factors
United States / epidemiology
Grant Support
RP-DG-1210-10183//Department of Health; RP-PG-0606-1272//Department of Health
Reg. No./Substance:
0/Hypoglycemic Agents; 0/Insulin

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