title: Exploring the role of the patient-physician relationship on insulin adherence and clinical outcomes in type 2 diabetes: Insights from the MOSAIc study.
abstract: BACKGROUND
  The 2-year prospective MOSAIc (Multinational Observational Study assessing Insulin use: understanding the challenges associated with progression of therapy) study is investigating whether patient-, physician-, and health system-related factors affect outcomes in patients with type 2 diabetes (T2D). This baseline subanalysis investigated how aspects of the patient-physician relationship are associated with diabetes-related distress, insulin adherence, and glycemic control.
  
  
  METHODS
  Patients with T2D taking insulin for ≥3 months were recruited at primary care and specialty practice sites in 18 countries. Physicians provided usual care. Clinical history and most recent HbA1c values were collected; patients were surveyed regarding their perception of physician interactions, diabetes-related distress level, and insulin adherence.
  
  
  RESULTS
  The analysis population comprised 4341 patients. Four (of six) domains showed a significant relationship with total diabetes-related distress (P < 0.01). Poor insulin adherence was associated with greater diabetes-related distress (adjusted odds ratio [aOR] 1.14; 95% confidence interval [CI] 1.06-1.22), higher Discrimination (aOR 1.13; 95% CI 1.02-1.27) and Hurried Communication (aOR 1.35; 95% CI 1.20-1.53) scores, and a lower Explained Results score (aOR 0.86; 95% CI 0.77-0.97). Poor insulin adherence was associated with a 0.43% increase in HbA1c, whereas a 1-unit increase in total diabetes-related distress and Hurried Communication scores was associated with a 0.171% and 0.145% increase in HbA1c, respectively.
  
  
  CONCLUSIONS
  Patients distressed about living with T2D, and dissatisfied with aspects of their interactions with physicians, exhibited poor insulin adherence. Perceived physician inattention and lack of engagement (and diabetes-related distress) directly affect insulin adherence and glycemic control.
authors.affiliation: Eli Lilly and Company, Buenos Aires, Argentina.
authors.forename: Bruno
authors.initials: B
authors.lastname: Linetzky
authors.affiliation: Eli Lilly and Company, Indianapolis, USA.
authors.forename: Dingfeng
authors.initials: D
authors.lastname: Jiang
authors.affiliation: University of Michigan Medical School, Ann Arbor, USA.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Funnell
authors.affiliation: Eli Lilly and Company, Indianapolis, USA.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Curtis
authors.affiliation: Behavioral Diabetes Institute, San Diego, USA.|University of California, San Diego, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Polonsky
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: 2型糖尿病; medication adherence; patient-physician relationships; type 2 diabetes; 患者-医生关系; 药物依从性