title: Patients' impatience is an independent determinant of poor diabetes control.
abstract: OBJECTIVE
  Some individuals have a preference for the present rather than for the future. We investigated the impact of this impatient relationship to temporality on adherence to medication and HbA(1c) level in type 2 diabetic patients.
  
  
  METHODS
  An observational, cross-sectional monocenter study in 90 patients consulting for a health check-up at a Center for Preventive Medicine. We used questionnaires assessing adherence to medication, impatience in a fictive monetary choice (preferring a smaller amount now to a higher amount later) and in daily life situations, foresight, locus of control, and social deprivation.
  
  
  RESULTS
  Impatience in the monetary choice was associated with non-adherence to medication (P=0.005). In a multivariate logistic regression model, the risk of observing HbA(1c)≥7% was associated with a long duration of diabetes (OR 5.2, CI 1.7-15.7, P=0.003), monetary impatience (OR=5.1, CI 1.7-15.4, P=0.004), a high "chance and other people" score of the locus of control (OR=5.1, CI 1.7-15.7, P=0.004), a suboptimal foresight (OR 3.9, CI 1.2-12.0, P=0.02). A decision-tree analysis (CHAID algorithm) showed that in this cohort of 90 patients, the 11 people who were adherent to medication, patient in the monetary scenario, had optimal foresight, and gave importance neither to chance nor to other people, had all HbA(1c) below 7%.
  
  
  CONCLUSIONS
  An impatient relationship to temporality was found associated with non-adherence to medication and uncontrolled HbA(1c) in type 2 diabetic patients. Treatment strategies for chronic diseases should be tailored according to this novel dimension of psychology.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, AP-HP, University Paris 13, 93009 Bobigny cedex, France. gerard.reach@avc.aphp.fr
authors.forename: G
authors.initials: G
authors.lastname: Reach
authors.forename: A
authors.initials: A
authors.lastname: Michault
authors.forename: H
authors.initials: H
authors.lastname: Bihan
authors.forename: C
authors.initials: C
authors.lastname: Paulino
authors.forename: R
authors.initials: R
authors.lastname: Cohen
authors.forename: H
authors.initials: H
authors.lastname: Le Clésiau
mesh_terms: D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents