title: The use of adherence aids by adults with diabetes: a cross-sectional survey.
abstract: BACKGROUND
  Adherence with medication taking is a major barrier to physiologic control in diabetes and many strategies for improving adherence are in use. We sought to describe the use of mnemonic devices and other adherence aids by adults with diabetes and to investigate their association with control of hyperglycemia, hyperlipidemia and hypertension.
  
  
  METHODS
  Cross sectional survey of diabetic adults randomly selected from Primary Care practices in the Vermont Diabetes Information System. We used linear regression to examine the associations between the use of various aids and physiologic control among subjects who used oral agents for hyperglycemia, hypercholesterolemia, and hypertension.
  
  
  RESULTS
  289 subjects (mean age 65.4 years; 51% female) used medications for all three conditions. Adherence aids were reported by 80%. The most popular were day-of-the-week pill boxes (50%), putting the pills in a special place (41%), and associating pill taking with a daily event such as a meal, TV show, or bedtime (11%). After adjusting for age, sex, marital status, income, and education, those who used a special place had better glycemic control (A1C -0.36%; P = .04) and systolic blood pressure (-5.9 mm Hg; P = .05) than those who used no aids. Those who used a daily event had better A1C (-0.56%; P = .01) than patients who used no aids.
  
  
  CONCLUSIONS
  Although adherence aids are in common use among adults with diabetes, there is little evidence that they are efficacious. In this study, we found a few statistically significant associations with adherence aids and better diabetes control. However, these findings could be attributed to multiple comparisons or unmeasured confounders. Until more rigorous evaluations are available, it seems reasonable to recommend keeping medicines in a special place for diabetic adults prescribed multiple medications.
authors.affiliation: General Internal Medicine, University of Vermont, Burlington, Vermont 05401, USA. benjamin.littenberg@vtmednet.org
authors.forename: Benjamin
authors.initials: B
authors.lastname: Littenberg
authors.forename: Charles D
authors.initials: CD
authors.lastname: MacLean
authors.forename: Laurie
authors.initials: L
authors.lastname: Hurowitz
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000187:drug effects; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D009518:New York; D010349:Patient Compliance / Q000523:psychology*; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014707:Vermont
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents