title: Quality of life associated with treatment adherence in patients with type 2 diabetes: a cross-sectional study.
abstract: BACKGROUND
  Despite certain contradictions, an association has been identified between adherence to drug treatment and the quality of life in patients with type 2 diabetes. The contradictions observed emphasize the importance of using different methods to measure treatment adherence, or the association of psychological precursors of adherence with quality of life. For this reason, we have used an indirect method to measure adherence (pill count), as well as two adherence behaviour precursors (attitude and knowledge), to assess the association between adherence and the quality of life in type 2 diabetes patients.
  
  
  METHODS
  A cross-sectional comparative study on a random sample of 238 type 2 diabetic patients was carried out over one year in four family medicine units of the Mexican Institute of Social Security (IMSS) in Aguascalientes, Mexico. Treatment adherence was measured using the indirect method of pill count to assess adherence behaviour, obtaining information at two home visits. In the first we recorded the medicine prescribed and in the second, we counted the medicine remaining to determine the proportion of the medicine taken. We also assessed two adherence behaviour precursors: the patients' knowledge regarding their medical prescription measured through a structured questionnaire; and attitudes to treatment adherence using a Likert scale. Quality of life was measured through the WHOQOL-100 (the WHO Quality of Life questionnaire). Information concerning both knowledge and attitude was obtained through interviews with the patients. A multiple linear regression model was constructed to establish the relationship between each quality of life domain and the variables related to adherence, controlling for covariates.
  
  
  RESULTS
  There was no association between quality of life and treatment adherence behaviour. However, the combination of strong knowledge and a positive attitude was associated with five of the six quality of life domains.
  
  
  CONCLUSIONS
  The results suggest that it is important to explore psychological precursors of treatment adherence behaviour in type 2 diabetic patients. Indeed, we consider that it will be useful to carry out interventions that change negative attitudes towards treatment adherence and that promote medical prescription knowledge, which may help to improve the quality of life of such patients.
authors.affiliation: Unidad de Investigación Epidemiológica y en Servicios de Salud, Hospital General de Zona N1, Instituto Mexicano del Seguro Social, Aguascalientes, Aguascalientes, México. yolandamtz@uiessags.com
authors.forename: Yolanda V
authors.initials: YV
authors.lastname: Martínez
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Prado-Aguilar
authors.forename: Ramón A
authors.initials: RA
authors.lastname: Rascón-Pacheco
authors.forename: José J
authors.initials: JJ
authors.lastname: Valdivia-Martínez
mesh_terms: D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric