title: Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes.
abstract: BACKGROUND
  The purpose of this study was to evaluate the impact of symptomatic hypoglycemia on medication adherence, satisfaction with treatment, and glycemic control in patients with type 2 diabetes based on the treatment goals stated in the Swedish national guidelines.
  
  
  METHODS
  This cross-sectional, multicenter study was carried out between January and August 2009 in 430 consecutive primary health care patients on stable doses of metformin and sulfonylureas for at least 6 months. The patients completed questionnaires covering their experiences of low blood glucose and adherence, as well as barriers to and satisfaction with drug treatment (using the Treatment Satisfaction Questionnaire for Medication). Physicians collected the data from medical records.
  
  
  RESULTS
  Patients who experienced moderate or worse symptoms of hypoglycemia reported poorer adherence to medication (46% versus 67%; P<0.01) and were more likely to perceive barriers such as "bothered by medication side effects" (36% versus 14%; P<0.001) compared with patients with no or mild symptoms. Patients with moderate or worse symptoms of hypoglycemia were less satisfied with their treatment than those with no or mild symptoms as determined by the Treatment Satisfaction Questionnaire for Medication-Global satisfaction (67.0 versus 71.2; P<0.05). Overall, achievement of target glycated hemoglobin (HbA1c) based on the treatment goals stated in the Swedish national guidelines was 40%. Despite poorer adherence, patients who experienced moderate or worse symptoms of hypoglycemia had lower mean HbA1c values than patients with no or mild symptoms (7.0% versus 7.3% [Diabetes Control and Complications Trial standard]; P<0.05).
  
  
  CONCLUSIONS
  Symptomatic hypoglycemia in patients with type 2 diabetes on metformin and sulfonylureas was associated with nonadherence and decreased treatment satisfaction despite lower mean HbA1c values. A broader understanding of patient preferences and self-reported outcomes could improve the management of patients with type 2 diabetes.
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden ; Merck Sharp and Dohme (Sweden) AB, Sollentuna, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Walz
authors.affiliation: Center for Medical Technology Assessment, Linköping University, Linköping, Sweden ; Merck Sharp and Dohme (Sweden) AB, Sollentuna, Sweden.
authors.forename: Billie
authors.initials: B
authors.lastname: Pettersson
authors.affiliation: Department of Internal Medicine, Motala Hospital, Motala, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Rosenqvist
authors.affiliation: Merck Sharp and Dohme (Sweden) AB, Sollentuna, Sweden ; Department of Molecular Medicine and Surgery, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Deleskog
authors.affiliation: Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Journath
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Wändell
keywords: hypoglycemia; nonadherence; patient-reported outcomes; persistence; primary care; sulfonylurea