title: Comparison between adherence assessments and blood glucose monitoring measures to predict glycemic control in adults with type 1 diabetes: a cross-sectional study.
abstract: BACKGROUND
  Adherence to treatment has been defined as the degree to which a patient's behavior corresponds to medical or health advice; however, the most appropriate method to evaluate adherence to diabetes care has yet to be identified. We conducted analyses to compare adherence assessments and blood glucose monitoring measures with regard to their ability to predict glycemic control in adults with type 1 diabetes.
  
  
  METHODS
  We analyzed four instruments to evaluate adherence: Self-Care Inventory-Revised, a self-administered survey; Diabetes Self-Monitoring Profile (DSMP), administered by trained researchers; a categorical (yes/no/sometimes) adherence self-evaluation; and a continuous (0-100) adherence self-evaluation. Blood glucose monitoring frequency was evaluated by self-report, diary, and meter download.
  
  
  RESULTS
  Participants (n = 82) were aged 39.0 ± 13.1 years with a mean diabetes duration of 21.2 ± 11.1 years; 27 % monitored blood glucose >4 times/day. The DSMP score was the strongest predictor of glycemic control (r = -0.32, P = 0.004) among adherence assessments, while blood glucose monitoring frequency assessed by meter download was the strongest predictor among blood glucose monitoring measures (r = -40, P < 0.001). All the self-report assessments had a significant but weak correlation with glycemic control (r ≤ 0.28, P ≤ 0.02). The final adjusted model identified the assessment of blood glucose monitoring frequency by meter download as the most robust predictor of HbA1c (estimate effect size = -0.58, P = 0.003).
  
  
  CONCLUSIONS
  In efforts to evaluate adherence, blood glucose monitoring frequency assessed by meter download has the strongest relationship with glycemic control in adults with type 1 diabetes.
authors.affiliation: Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil.
authors.forename: Gabriela Heiden
authors.initials: GH
authors.lastname: Telo
authors.affiliation: Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil.
authors.forename: Martina Schaan
authors.initials: MS
authors.lastname: de Souza
authors.affiliation: Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil.
authors.forename: Thais Stürmer
authors.initials: TS
authors.lastname: Andrade
authors.affiliation: Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil ; Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Beatriz D'Agord
authors.initials: BD
authors.lastname: Schaan
keywords: Blood glucose monitoring; Diabetes mellitus, type 1; Medication adherence