Associations of different adherences in patients with type 2 diabetes mellitus

Andrea Klinovszky,1 István Márton Kiss,1 Orsolya Papp-Zipernovszky,2 Csaba Lengyel,3 Norbert Buzás1 1Department of Health Economics, University of Szeged, Szeged, Hungary; 2Department of Psychology, University of Szeged, Szeged, Hungary; 31st Department of Internal Medicine, University of Szeged, Szeged, Hungary Purpose: The objective of our cross-sectional study is to explore the adherence behavior of patients with type 2 diabetes mellitus (T2DM) by examining the association between the various types of adherence. The success of diabetic therapy partly relies on patient motivation, psychodemographic variables (self-efficacy, health literacy, and health locus of control [HLOC]), and adherence. The aim of our research was to explore the attitudes of T2DM patients toward medication and lifestyle therapy, thus gaining a deeper insight into the role of adherence-determining parameters in disease management. Patients and methods: The sample for the present study consisted of 113 T2DM inpatients (75 women and 38 men) with a mean age of 60.56 years (SD=12.94, range: 20–85 years) diagnosed with T2DM for an average of 13 years (SD=8.23). Participants completed the Diabetes Adherence Questionnaire conceptualized by the research team in accordance with the mapping of psychological and psychosocial parameters. We examined the associations between variables using Spearman’s rank correlation. Multivariate regression analysis was used to examine predictive variables for adherent behavior. In addition, we attempted to examine factors with a negative effect on adherence using factor analysis. Results: Based on our results, a high level of medication adherence negatively correlated with lifestyle adherence. Multivariate regression analysis showed that blood glucose monitoring adherence is mostly predicted by social–external HLOC, diabetes self-efficacy, and internal HLOC, while dietary adherence is predicted by the patient’s self-efficacy and duration of the illness. Additionally, understanding and following the diabetes treatment were significantly associated with dietary adherence and high levels of patient self-efficacy, while health literacy was mostly predicted by internal HLOC. Conclusion: Adherence to medication, diet, glucose monitoring, and physical exercise showed different levels in T2DM patients and were in association with psychodemographic factors. Keywords: type 2 diabetes mellitus, T2DM, medication adherence, lifestyle adherence, self-efficacy, health literacy, health locus of contro