title: Medication adherence may be more important than other behaviours for optimizing glycaemic control among low-income adults.
abstract: BACKGROUND
  Patients with type 2 diabetes mellitus (T2DM) are required to perform multiple self-care behaviours to achieve and maintain optimal glycaemic control (HbA1c), which prevents complications and premature mortality. Patients with T2DM and low socioeconomic status (SES) are more likely to have suboptimal HbA1c, often due to being less adherent to recommended self-care activities than their higher-SES counterparts.
  
  
  OBJECTIVE
  Although studies support performing certain diabetes self-care behaviours for optimizing glycaemic control, there is limited research on the relative importance of each behaviour for this purpose. Identifying what behaviours are most important for HbA1c among low-SES patients with T2DM would be particularly useful for informing policy and intervention efforts for this high-risk group.
  
  
  METHODS
  In a cross-sectional study of 314 adults with T2DM and low SES, we used the Summary of Diabetes Self-Care Activities to assess self-care behaviours and multivariate models to test which behaviours were associated with lower HbA1c.
  
  
  CONCLUSIONS
  Only medication adherence was significantly associated with lower HbA1c after adjusting for the other self-care behaviours (β = -0·14, P = 0·028) and further adjusting for demographic and diabetes characteristics (β = -0·16, P = 0·024).
  
  
  BACKGROUND
  Medication adherence may be the most important self-care behaviour for glycaemic control among adults with T2DM and low SES.
  
  
  CONCLUSIONS
  Focused efforts to improve medication adherence among low-SES patient populations may improve glycaemic control.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: C Y
authors.initials: CY
authors.lastname: Osborn
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: L S
authors.identifier: http://orcid.org/0000-0002-0654-4151
authors.initials: LS
authors.lastname: Mayberry
authors.affiliation: Texas A&M Health Science Center, Bryan, TX, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Kim
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015438:Health Behavior; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011203:Poverty; D012648:Self Care / Q000379:methods*; D012959:Socioeconomic Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: glycaemic control; low income; medication adherence; type 2 diabetes