title: Medication adherence and associated hemoglobin A1c in type 2 diabetes.
abstract: BACKGROUND
  Tight blood glucose control has been correlated with a reduction in diabetes complications. Adherence to antidiabetic medications is crucial to achieving blood glucose control.
  
  
  OBJECTIVE
  To assess the relationship between good glucose control [glycosylated hemoglobin (HbA1c) levels] and adherence to prescribed treatment in patients on a stable medication regimen for type 2 diabetes.
  
  
  METHODS
  The Morisky survey, a 4-item questionnaire that predicts patient medication-taking behavior, was used to assess adherence in 301 patients. The relationship of HbA1c to Morisky score was evaluated, controlling for other variables related to patient demographics and clinical characteristics. Data were analyzed using a general linear model on log (HbA1c).
  
  
  RESULTS
  Unadjusted mean HbA1c values (capped at 14.0%) for patients with Morisky scores of 0 or 1, 2, 3, and 4 were 8.92%, 8.67%, 7.74%, and 7.60%, respectively. Of all patients, 13.0%, 14.0%, 24.3%, and 48.8% had scores of 0 or 1, 2, 3, and 4, respectively. Good adherence (Morisky score > or = 3) was associated with a 10% lower total HbA1c (p = 0.0003) adjusted for all other factors in the model. Duration of diabetes (5-10 y) and presence of diabetes complications were also significantly associated with HbA1c (p = 0.026 and 0.002, respectively). Adherence was poor in 27% of patients.
  
  
  CONCLUSIONS
  This study found that patients with a higher score on the Morisky scale had a lower associated HbA1c measurement. The Morisky score may be an efficient tool for identifying patients with poor medication-taking behavior who can then be targeted for directed adherence counseling services.
authors.affiliation: Diabetes Solutions, Aurora, CO, USA.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Krapek
authors.forename: Kathleen
authors.initials: K
authors.lastname: King
authors.forename: Susan S
authors.initials: SS
authors.lastname: Warren
authors.forename: Karen G
authors.initials: KG
authors.lastname: George
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Caputo
authors.forename: Karen
authors.initials: K
authors.lastname: Mihelich
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holst
authors.forename: Michael B
authors.initials: MB
authors.lastname: Nichol
authors.forename: Sheng G
authors.initials: SG
authors.lastname: Shi
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Livengood
authors.forename: Steve
authors.initials: S
authors.lastname: Walden
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Lubowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin