Adherence to medical recommendations (compliance) in diabetic patients treated in outpatient care

Abstract

Introduction. Proper treatment aimed at reducing long-
-term complications of diabetes requires a multifactorial
therapy, which often is associated with polypragmasia.
The purpose of this study was to assess compliance in patients with diabetes, depending on the type of
treatment and the number of oral drugs prescribed.
Material and methods. 263 patients including 67 with
type 1 diabetes, mean age 59 ± 16 years, duration
12 ± 9 years, BMI 29 ± 6 kg/m2. Subjects studied out
during a visit to the Diabetes Clinic completed the
questionnaire, which contains general information
about treatment method and the number of active
drugs. Furthermore, patients completed the questionnaire
by Morisky and Green (MG) assessing compliance.
Results. Compliance in patients with type 1 was signifi
cantly higher when compared to type 2 (respectively
0.6 ± 0.9 pts vs 0.9 ± 0.9 pts at MG scale, p = 0.019),
also higher percentage of type 1 patients declared
a high level of compliance (61% vs 28%, p < 0.001).
Type 1 patients with high compliance had signifi cantly
longer duration time of diabetes than patients with
medium and low (21 ± 11.3 y vs 14 ± 9.9 y, p = 0.012),
among patients with type 2 diabetes similar relation
was not observed. Compliance in patients with type
2 was signifi cantly higher among those treated with
insulin (0.7 ± 0.8 pts at MG scale) compared to those
treated with OHA (1.1 ± 1 pts at MG scale, p = 0.006),
moreover higher percentage of patients on insulin
therapy declared high level of compliance (50% vs
29%, p = 0.002). Average PPG in the group with high
compliance is signifi cantly higher in type 1 patients
in relation to type 2 patients (177 ± 33 mg/dl vs
143 ± 43 mg/dl, p < 0.001).

There was no correlation
between compliance and the number of taken tablets.
Conclusions. Patients treated with insulin show a signifi
cantly higher degree of compliance. This is probably
due to the high level of education of patients on
insulin therapy. The lower level of compliance in the
treatment of OHA indicates the need for increased
efforts educate patients on oral agents.