| Background Recently,the amount of diabetes patients increased rapidly all over the word,diabetes has been one of the main chronic diseases endanger public health.Above 90% of the diabetes patients are type 2 diabetes(non-insulin dependent diabetes),mid-aged elder group get the diabetes more easily,but more and more patients get diabetes at younger ages.Type 2 diabetes is one irreversible metabolic disease,Except dietary and sports therapy,most of the type 2 diabetes need to take the oral hypoglycemic drugs to control blood glucose,so the medication adherence of diabetes is important and should' t be ignore.Related researches show that only 50% patients with chronic disease accept long-term therapy,about 37% diabetes didn't adhere to taking hypoglycemic agent in the first year,the lowest adherence was about 53%.Low medication adherence will affect the medication efficacy,increase the risk to get some related acute or chronic complications,and reduce the quality of life of patients.There are many ways to assess the medication adherence,include drug concentration assessing,questionnaire evaluation,pill-counting and so on,recently,more and more researchers use electronic caps to monitor patient medication adherence,this method can make does-taking behavior quantitative and refined,it's supposed to be the 'gold standard' to monitor the medication adherence and it has irreplaceable advantage compare with the other methods.Objective Eligible type 2 diabetes were enrolled in this research,the aim of this research is to know the basic information of daily dose-taking of patients,and to assess the medication adherence use electronic caps and related questionnaires,to analyze the related influence factors(general information,biochemical data).We intend to provide theoretical basis for the related intervention research and management of diabetes patients in the future.Methods 1.Literature research We learned the dose-taking and medication adherence situation of type 2 diabetes by referring to the related literatures,on this basis to carry out the investigation.2.Cross-sectional investigation(1)In the first stage of this research,according to the inclusion and exclusion criteria,we investigated 762 diabetes patients who agreed the invitation of family physician team from Waigang Community Health Service Center in Jiading section in Shanghai.There were 408 type 2 diabetes accepted the training and participated in the research finally.All of the patients signed the informed consent form.(2)In the second stage of this research,we carried out physician training firstly,then organized enrolled patients to accept related follow-up visit according to the arrangement.Firstly,we collected related clinical and biochemical data(height,weight,blood pressure,fasting blood-glucose,Hb A1 c and so no);Secondly,questionnaire evaluation,included demographic data,the diagnosis and treatment information of diabetes and related scales(8-item morisky medication adherence scale,Beliefs about medication questionnaire,Diabetes quality-of-life scale,Patient health questionnaire-9).The family physicians distributed the electronic pill bottles to these patients according to individualized dose-taking situation,then pharmacist put moderate oral hypoglycemic agents into the bottles(above 10days' dose-taking),after the investigation,we withdraw these monitoring bottles,and to analyze the actual dose taking records.Results 1.408 patients participated into this research,373 of them were collected necessary information,The average adherence(data of electronic caps)was 80.5±24.8%,64.5%(242)of them with high compliance(percentage of dose-taking?80%).Compliance in specific time-window of these patients is 66.1±25.4%.45.6% of 373 diabetes patients took two kinds of oral hypoglycemic agents and 54.4% of these patients need to take the medication three times one day according to doctors' prescription.,The medication adherence of patients who took 3 kinds of hypoglycemic medications and took 3 times one day were low(P<0.05);(2)Medication adherence score was correlated with age(P<0.01),there was obvious difference between different types of medical insurances and education background,the compliance in specific time-window of smokers were low(P<0.01);Medication adherence sore was negative correlated with weight,BMI of patients.The average Hb A1 c of these patients were 6.97±1.15%,the blood glucose level was low of the patients with high medication adherence(P<0.05);The Hb A1 c level of patients who got high medication adherence and ate breakfast at about 7:00 was low(6.76±1.06%,P<0.05);(3)The average score of MMAS-8 was 7.06±1.13,the proportion of low,medium and high adherence were 11.8%,58.3% and 29.9% respectively.The average score of BMQ –specific was 6.02±3.99,and the score of specific-necessity were higher than the specific-concerns obviously(P<0.01),these patients who were low or medium medication adherence(evaluation by MMAS-8)got high score in specific-necessity score of BMQ-specific(P < 0.01).there was no obvious differences in scale assessment outcome(P>0.05);The patients were assessed high adherence(both electronic data and scale outcome)they also controlled blood glucose well(average level of Hb A1c=6.79±1.13%),adversely,those patients whose self-report scores were high adherence but electronic data were low adherence,their blood glucose was high(average level of Hb A1c=7.52±1.5%).There was obvious correlation between the score of DQOL and PHQ-9,but there was no correlation between questionnaire score and medication adherence(P>0.05).Conclusion:(1)This study show that kinds of medication,dose frequency,age,education background,type of medical insurance and unhealthy living habits affect the medication adherence,the medication compliance also in turn affects the control of blood glucose,blood pressure and weight of the type 2 diabetes patients;(2)Compliance in specific time-window is lower than the percentage of dose-taking obviously,it is need to strengthen the health education of type 2 diabetes to take the medication regularly,scale outcome overestimate the actual adherence of patients,he Hb A1 c level of these patients was not ideal who usually overestimate one's medication adherence;the consciousness of keeping long-term medication therapy under specific prescription of T2 D need to be improved,and the concerns of taking medication(beliefs about danger of dependence and disruptive effects)impact the adherence negatively. |
PDF Full Text Request