Adherence and renal biopsy feasibility in the Renin Angiotensin-System Study (RASS) primary prevention diabetes trial.
OBJECTIVE
Enhancing adherence in research trials is fundamental to the proper testing of treatment hypotheses.


METHODS
Regimen and follow-up adherence as well as factors associated with adherence in the Renin Angiotensin-System Study (RASS) diabetic nephropathy primary prevention trial were evaluated. Adherence to medication (i.e., pill count), follow-up visits, and follow-up renal biopsies was evaluated.


RESULTS
89.8% of subjects completed the second renal biopsy. 96% of follow-up visits were attended within prescribed time windows. Mean medication adherence was 85.6%. Subgroup analyses revealed greater declines in the least adherent participants over time. Factors associated with greater adherence levels included older age, type 1 diabetes (TIDM) duration, lower HbA1c and blood pressure, GFR, ethnicity, and participants', principal investigators' (PI), and trial coordinators' (TC) baseline predictions of adherence.


CONCLUSIONS
T1DM patients without nephropathy were willing to take experimental medications and undergo repeat renal biopsies. Although overall adherence was excellent, patterns of adherence varied among participants, suggesting the need to better track adherence and to develop customized and targeted approaches for promoting adherence to clinical research regimens. Staff subjective predictions of adherence were imprecise, supporting need for further development of adherence predictors.
Health Psychology, Department of Medicine, University of Minnesota Medical School, USA. Electronic address: robin005@umn.edu.
William N
WN
Robiner
Trudy D
TD
Strand
Michael
M
Mauer
D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001706:Biopsy / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D011322:Primary Prevention
D000959:Antihypertensive Agents; D004656:Enalapril; D019808:Losartan
Adherence; Clinical trial; Diabetes; Kidney biopsy; Psychology; Research