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BRIEF REPORT: The burden of diabetes therapy

Implications for the design of effective patient-centered treatment regimens

  • Mini-Symposium On Diabetes Original Articles
  • Published:
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Abstract

BACKGROUND: Management of diabetes, and in particular blood glucose, can be complex and burdensome.

OBJECTIVE: To evaluate patient views of the burdens of therapy and its impact on self-management.

PATIENTS: Veteran patients with type 2 diabetes.

DESIGN: Mailed survey.

MEASUREMENTS: Patients described their views of the burden of diabetes treatments, adherence, and clinical and demographic status. Factors associated with ratings of burden and adherence to therapy were examined using multivariate regression methods.

RESULTS: The response rate was 67% (n=1,653). Patients viewed pills as the least burdensome treatment and insulin as the most burdensome. Ratings of the burden of insulin were lower if a patient had prior experience with therapy. Adherence to prescribed therapy varied substantially; for example, patients followed medication recommendations more closely than other areas of self-management. Multivariate analyses showed that the main predictor of adherence was patients’ ratings of the burden of therapy.

CONCLUSIONS: Injected insulin regimens are viewed as highly burdensome by patients, although this burden is attenuated by experience. Adherence to self-management is strongly and independently correlated with views of treatment burden. The burden of diabetesrelated treatments may be a source of suboptimal glucose control seen in many care settings. Providers should consider the burden of treatment for a particular patient and its impact on adherence as part of a decision-making process to design effective treatment regimens.

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References

  1. Beckles GL, Engelgau MM, Narayan KM, Herman WH, Aubert RE, Williamson DF. Population-based assessment of the level of care among adults with diabetes in the U.S. Diabetes Care. 1998;21:1432–8.

    Article  PubMed  CAS  Google Scholar 

  2. Selby JV, Scanlon D, Lafata JE, Villagra V, Beich J, Salber PR. Determining the value of disease management programs. Jt Comm J Qual Saf. 2003;29:491–9.

    PubMed  Google Scholar 

  3. Krein SL, Hayward RA, Pogach L, BootsMiller BJ. Department of Veterans Affairs’ Quality Enhancement Research Initiative for Diabetes Mellitus. Med Care. 2000;38(suppl 1):I38-I48.

    PubMed  CAS  Google Scholar 

  4. Glasgow RE, Wagner EH, Kaplan RM, Vinicor F, Smith L, Norman J. If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness. Ann Behav Med. 1999;21:159–70.

    Article  PubMed  CAS  Google Scholar 

  5. Wagner EH, Glasgow RE, Davis C, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27:63–80.

    PubMed  CAS  Google Scholar 

  6. Glasgow RE. A practical model of diabetes management and education. Diabetes Care. 1995;18:117–26.

    Article  PubMed  CAS  Google Scholar 

  7. Vijan S, Stuart NS, Fitzgerald JT, et al. Barriers to following dietary recommendations in type 2 diabetes. Diabet Med. 2005;22:32–8.

    Article  PubMed  CAS  Google Scholar 

  8. Mannheimer S, Friedland G, Matts J, Child C, Chesney M. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clin Infect Dis. 2002;34:1115–21.

    Article  PubMed  Google Scholar 

  9. Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16:269–77.

    Article  PubMed  Google Scholar 

  10. Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholz CD, Mukherjee J. Can simple clinical measurements detect patient noncompliance? Hypertension. 1980;2:757–64.

    PubMed  CAS  Google Scholar 

  11. Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G. The rational clinical examination Is this patient taking the treatment as prescribed? JAMA. 1993;269:2779–81.

    Article  PubMed  CAS  Google Scholar 

  12. Hayward RA, Manning WG, Kaplan SH, Wagner EH, Greenfield S. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications, and resource utilization. JAMA. 1997;278:1663–9.

    Article  PubMed  CAS  Google Scholar 

  13. Dillman DA. Mail and Internet Surveys: The Tailored Design Method. 2nd ed. New York, NY: John Wiley & Sons; 1999.

    Google Scholar 

  14. Woolson RF. Comparison of two groups: T-tests and rank tests. In: Woolson RF, ed. Statistical Methods for the Analysis of Biomedical Data. 1st ed. New York, NY: John Wiley & Sons; 1987:145–203.

    Google Scholar 

  15. Huber PJ. The behavior of maximum likelihood estimates under nonstandard conditions. Anonymous Proceedings of the Fifth Berkeley Symposium in Mathematical Statistics and Probability, 1967. Berkeley, CA: University of California Press; 1967:221–33.

    Google Scholar 

  16. MacKinnon JG, White H. Some heteroskedasticity consistent covariance matrix estimators with improved finite sample properties. J Econom. 1985;29:305–25.

    Article  Google Scholar 

  17. Greenland S. An application of logistic models to the analysis of ordinal response. Biom J. 1985;27:189–97.

    Article  Google Scholar 

  18. Ruggiero L, Glasgow R, Dryfoos JM, et al. Diabetes self-management. Self-reported recommendations and patterns in a large population. Diabetes Care. 1997;20:568–76.

    Article  PubMed  CAS  Google Scholar 

  19. Glasgow RE, Hampson S, Stryker LA, Ruggiero L. Personal-model beliefs and social-environmental barriers related to diabetes self-management. Diabetes Care. 1997;20:556–61.

    Article  PubMed  CAS  Google Scholar 

  20. de Weerdt I, Visser AP, Kok G, van der Veen EA. Determinants of active self-care behaviour of insulin treated patients with diabetes: implications for diabetes education. Soc Sci Med. 1990;30:605–15.

    Article  PubMed  Google Scholar 

  21. Diehl AK, Bauer RL, Sugarek NJ. Correlates of medication compliance in non-insulin-dependent diabetes mellitus. South Med J. 1987;80:332–5.

    PubMed  CAS  Google Scholar 

  22. Daviss WB, Coon H, Whitehead P, Ryan K, Burkley M, McMahon W. Predicting diabetic control from competence, adherence, adjustment, and psychopathology. J Am Acad Child Adolesc Psychiatry. 1995;34:1629–36.

    Article  PubMed  CAS  Google Scholar 

  23. Harris R, Linn MW. Health beliefs, compliance, and control of diabetes mellitus. South Med J. 1985;78:162–6.

    PubMed  CAS  Google Scholar 

  24. Gonder-Frederick LA, Julian DM, Cox DJ, Clarke WL, Carter WR. Self-measurement of blood glucose. Accuracy of self-reported data and adherence to recommended regimen. Diabetes Care. 1988;11:579–85.

    Article  PubMed  CAS  Google Scholar 

  25. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2004;27:S15-S35.

    Article  Google Scholar 

  26. Donovan JL, Blake DR. Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med. 1992;34:507–13.

    Article  PubMed  CAS  Google Scholar 

  27. Sieber WJ, Kaplan Informed adherence: the need for shared medical decision making. Control Clin Trials. 2000;21:233S-240S.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA

    Sandeep Vijan MD, MS, Rodney A. Hayward MD, David L. Ronis PhD & Timothy P. Hofer MD, MS

  2. Department of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Sandeep Vijan MD, MS, Rodney A. Hayward MD & Timothy P. Hofer MD, MS

  3. Michigan Diabetes Research and Training Center, University of Michigan, Ann Arbor, MI, USA

    Sandeep Vijan MD, MS, Rodney A. Hayward MD & Timothy P. Hofer MD, MS

  4. School of Nursing, University of Michigan, Ann Arbor, MI, USA

    David L. Ronis PhD

Authors
  1. Sandeep Vijan MD, MS
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  2. Rodney A. Hayward MD
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  3. David L. Ronis PhD
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  4. Timothy P. Hofer MD, MS
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Corresponding author

Correspondence to Sandeep Vijan MD, MS.

Additional information

None of the authors has any financial or other conflicts of interests associated with this manuscript.

See editorial by Vinicor, p. 483.

Supported in part by Veterans Affairs Health Services Research Service grant IIR 970781, and by a Veterans Affairs Career Development Award to Dr. Vijan.

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Vijan, S., Hayward, R.A., Ronis, D.L. et al. BRIEF REPORT: The burden of diabetes therapy. J GEN INTERN MED 20, 479–482 (2005). https://doi.org/10.1111/j.1525-1497.2005.0117.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0117.x

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