The Importance of Specialist Treatment, Treatment Satisfaction and Diabetes Education for the Compliance of Subjects with Type 2 Diabetes - Results from a Population-based Survey

Abstract

Aims: This study aims to investigate the degree to which subjects with type 2 diabetes comply with treatment recommendations concerning diet, physical exercise and self-care, the consistency of compliance across different treatment areas, and the association of compliance with individual characteristics of patients and their medical treatment.

Methods: The sample consists of 345 type 2 diabetes patients who had been drawn from two population-based surveys (MONICA) and from a myocardial infarction registry in Southern Germany, and who have participated in a survey in 1997/98. Data were collected by interviews, questionnaires and medical exams. Pearson correlation and logistic regression analysis were applied to test the relationships. A compliance score was established by adding up the components of the treatment regimen.

Results: Only one fifth of the subjects with type 2 diabetes showed good compliance in terms of the applied score. Compliance was highest in weight measuring and foot care, and poorest in following exercise recommendations, glucose testing, and recording the results. Overall, weak correlations were found between the components of the treatment regimen. Participation in diabetes education, regular consultation of physicians specialized in diabetes care, age (<70 years), and satisfaction with treatment were all associated with better compliance.

Conclusions: Correlation between the different components of compliance behaviour was low, indicating that compliance should not be measured by one component only. As compliance with the treatment recommendations was poor, education programs for type 2 diabetic subjects should be propagated and the cooperation with diabetes specialists should be promoted.

Key words

diabetes mellitus - compliance - self-management

References

• 1 Alberti KG, Griess FA. et al . A desktop guide for the management of non-insulin-dependent diabetes mellitus (NIDDM): an update. European NIDDM Policy Group.  Diabetic Medicine. 1994;  11 ((9)) 899-909
• 2 American Diabetes Association . Tests of glycemia in diabetes (Position statement).  Diabetes care. 1997;  20 ((Suppl 1)) 18-20
• 3 Ary DV, Toobert D. et al . Patient perspective on factors contributing to nonadherence to diabetes regimen.  Diabetes Care. 1986;  9 ((2)) 168-172
• 4 Bradley C. Diabetes treatment satisfaction questionnaire (DTSQ). In Bradley C. Chur Handbook of psychology and diabetes: a guide to psychological measurement in diabetes research and management. Harwood Academic Press 1994: 111-132
• 5 Cerkoney KA, Hart LK. The relationship between the health belief model and compliance of persons with diabetes mellitus.  Diabetes Care. 1980;  3 ((5)) 594-598
• 6 Chan YM, Molassiotis A. The relationship between diabetes knowledge and compliance among Chinese with non-insulin dependent diabetes mellitus in Hong Kong.  J Adv Nurs. 1999;  30 ((2)) 431-438
• 7 DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research.  Medical Care. 2004;  42 ((3)) 200-209
• 8 Eaton WW, Mengel M. et al . Psychosocial and psychopathologic influences on management and control of insulin-dependent diabetes.  Int J Psychiatry Med. 1992;  22 ((2)) 105-117
• 9 Evans JM, Newton RW. et al . Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database.  BMJ. 1999;  319 ((7202)) 83-86
• 10 Franciosi M, Pellegrini F. et al . The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies.  Diabetes Care. 2002;  24 ((11)) 1870-1877
• 11 Gallichan M. Self monitoring of glucose by people with diabetes: evidence based practice.  BMJ. 1997;  314 ((7085)) 964-967
• 12 Garay-Sevilla ME, Malacara HJ. et al . The belief in conventional medicine and adherence to treatment in non-insulin-dependent diabetes mellitus patients.  Journal of Diabetes and its Complications. 1998;  12 ((5)) 239-245
• 13 Glasgow RE, MacCaul KD. et al . Self-care behaviors and glycemic control in type I diabetes.  J Chro Dis. 1987;  40 ((5)) 399-412
• 14 Hense H, Filipiak B, Döring A, Stieber J, Liese A, Keil U. Ten-year trends of cardiovascular risk factors in the MONICA Augsburg Region in southern Germany. Results from the 1984/85, 1989/90, and 1994/95 Surveys.  CVD Prevention. 1998;  1 318-327
• 15 Hentinen M, Kyngäs H. Compliance of young diabetics with health regimens.  J Adv Nurs. 1992;  17 ((5)) 530-536
• 16 Hernández-Ronquillo L, Téllez-Zenteno JF. et al . Factors associated with therapy noncompliance in type-2 diabetes patients.  Salud Pública Méx. 2003;  45 ((3)) 191-197
• 17 Icks A, Rathmann W, Rosenbauer J, Giani G. Gesundheitsberichterstattung des Bundes. Diabetes mellitus. Berlin: Robert-Koch Institut 2005
• 18 Karter AJ, Ackerson LM. et al . Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry.  Am J Med. 2001;  111 ((1)) 1-9
• 19 Keil U, Kuulasmaa K. WHO MONICA project: risk factors.  Int J Epidemiol. 1989;  18 ((Suppl 1)) 46-55
• 20 Kyngäs H. Compliance of adolescents with diabetes.  J Ped Nurs. 2000;  15 ((4)) 260-267
• 21 Löwel H, Lewis M, Hörmann A, Keil U. Case finding, data quality analysis, and comparability of myocardial infarction registries. Results of a Southern German register study.  J Clin Epidemiol. 1991;  44 249-260
• 22 Löwel H, Koenig W, Engel S, Hörmann A, Keil U. The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study.  Diabetologia. 2000;  43 218-226
• 23 MacNabb WL. Adherence in diabetes: can we define it and can we measure it?.  Diabetes Care. 1997;  20 ((2)) 215-218
• 24 Mielck A, Reisig V, Rathmann W. Health inequalities among persons with type 2 diabetes: The example of intermittent claudication.  Das Gesundheitswesen. 2005;  67 S137-S143
• 25 Mielck A, Reitmeir P, Rathmann W. Knowledge about diabetes and participation in diabetes training courses: The need for improving health care for diabetes patients with low SES.  Exp Clin Endocrinol Diabetes. 2006;  114 240-248
• 26 Nagy VT, Wolfe GR. Cognitive predictors of compliance in chronic disease patients.  Med Care. 1984;  22 ((10)) 912-921
• 27 Nelson KM, Reiber G. et al . Diet and exercise among adults with type 2 diabetes: findings from the third national health and nutrition examination survey (NHANES III).  Diabetes Care. 2002;  25 ((10)) 1722-1728
• 28 Norris SL, Engelgau MM. et al . Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials.  Diabetes Care. 2001;  24 ((3)) 561-587
• 29 Rathmann W, Icks A, Haastert B. et al . Undiagnosed diabetes mellitus among patients with prior myocardial infarction.  Z Kardiol. 2002;  91 620-625
• 30 Ross M E. Hardiness and compliance in elderly patients with diabetes.  Diabetes Educ. 1991;  17 ((5)) 372-375
• 31 Ruggiero L, Glasgow RE. et al . Diabetes self-management. Self-reported recommendations and patterns in a large population.  Diabetes Care. 1997;  20 ((4)) 568-576
• 32 Schlenk EA, Hart LK. Relationship between health locus of control, health value, and social support and compliance of persons with diabetes mellitus.  Diabetes Care. 1984;  7 ((6)) 566-574
• 33 Schneider SH, Ruderman NB. Exercise and NIDDM.  Diabetes Care. 1990;  13 ((7)) 785-789
• 34 Sherbourne CD, Hays RD. et al . Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study.  J Behav Med. 1992;  15 ((5)) 447-468
• 35 Stratton IM, Adler AI. et al . Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.  BMJ. 2000;  321 405-412
• 36 Toljamo M, Hentinen M. Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus.  J Adv Nurs. 2001;  34 ((6)) 780-786
• 37 van den Arend IJ, Stolk RP. et al . Education integrated into structured general practice care for Type 2 diabetic patients results in sustained improvement of disease knowledge and self-care.  Diabet Med. 2000;  17 190-197

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