PURPOSE: Diabetes self-care and self-monitoring adherence has a positive effect on the metabolic control of the disease. The aim of this study was to analyze the adherence to self-care recommendations and to identify its correlates in adults with type 1 diabetes mellitus. PATIENTS AND METHODS: One hundred and eleven patients with type 1 diabetes were enrolled in an observational cross-sectional study conducted at the Diabetes Center of the University Hospital in Hradec Králové, Czech Republic. Diabetes self-care adherence was measured by the Self Care Inventory-Revised, and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire-status version. Additional data were collected from self-administered questionnaires and medical records. The Mann-Whitney test, Spearman correlations, and multiple linear regressions were used in the statistical analysis. RESULTS: The mean age of patients was 42.4 years; 59.5% of them were females and 53.2% of all patients used an insulin pump. The mean glycosylated hemoglobin (HbA1c) was 66.2 ± 15.3 mmol/mol and the mean insulin dosage was 0.6 ± 0.3 IU insulin/kg/day. The number of hypoglycemic episodes (including severe) that patients had in the last month before taking the survey was 3.6 ± 3.2. Self-care adherence was associated with treatment satisfaction (0.495; P = 0.004) along with frequency of self-monitoring of before meal blood glucose (0.267; P = 0.003). It was not associated with the incidence of hypoglycemic events or any other insulin therapy-related problems or with socio-demographic or clinical characteristics. CONCLUSION: Treatment satisfaction is one of the key factors that need to be targeted to maximize benefits to patients. Self-care adherence in adults with type 1 diabetes did not correlate with socio-demographic and clinical characteristics, nor with adverse events.

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Králové Charles University Prague Hradec Králové Czech Republic

See more in PubMed

American Diabetes Association Standards of medical care in diabetes-2011. Diabetes Care. 2011;34(Suppl 1):S11–S61. PubMed PMC

Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of Type I and Type II diabetes. Diabetologia. 2002;45(7):937–948. PubMed

Toljamo M, Hentinen M. Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus. J Adv Nurs. 2001;34(6):780–786. PubMed

Sabate E, editor. Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization; 2003.

Larsen J, Stovring H, Kragstrup J, Hansen DG. Can differences in medical drug compliance between European countries be explained by social factors: analyses based on data from the European Social Survey, round 2. BMC Public Health. 2009;9:145. PubMed PMC

Simpson SH, Eurich DT, Majumdar SR, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333(7557):15. PubMed PMC

Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62(1):76–87. PubMed PMC

Hughes DA, Bagust A, Haycox A, Walley T. The impact of non-compliance on the cost-effectiveness of pharmaceuticals: a review of the literature. Health Econ. 2001;10(7):601–615. PubMed

Boudes P. Drug compliance in therapeutic trials: a review. Control Clin Trials. 1998;19(3):257–268. PubMed

Asche C, LaFleur J, Conner C. A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clin Ther. 2011;33(1):74–109. PubMed

Barbosa CD, Balp MM, Kulich K, Germain N, Rofail D. A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence. Patient Prefer Adherence. 2012;6:39–48. PubMed PMC

Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics. 2009;124(6):e1171–e1179. PubMed

Naar-King S, Idalski A, Ellis D, et al. Gender differences in adherence and metabolic control in urban youth with poorly controlled type 1 diabetes: the mediating role of mental health symptoms. J Pediatr Psychol. 2006;31(8):793–802. PubMed

Kyngas H, Rissanen M. Support as a crucial predictor of good compliance of adolescents with a chronic disease. J Clin Nurs. 2001;10(6):767–774. PubMed

Kyngäs HA. Predictors of good adherence of adolescents with diabetes (insulin-dependent diabetes mellitus) Chronic Illn. 2007;3(1):20–28. PubMed

Johnson SB. Methodological issues in diabetes research. Measuring adherence. Diabetes Care. 1992;15(11):1658–1667. PubMed

Ruggiero L, Glasgow RE, Dryfoos JM, et al. Diabetes self-management: Self-reported recommendations and patterns in a large population. Diabetes Care. 1997;20(4):568–576. PubMed

Guo J, Whittemore R, He GP. The relationship between diabetes self-management and metabolic control in youth with type 1 diabetes: an integrative review. J Adv Nurs. 2011;67(11):2294–2310. PubMed

La Greca A.The Self Care Inventory-Revised Miami: University of Miami, Department of Psychology; 2005Available from: http://www.psy.miami.edu/faculty/alagreca/SCI-R.pdfAccessed May 21, 2012

Bradley C. Diabetes treatment satisfaction questionnaire. In: Bradley C, editor. Handbook of Psychology and Diabetes: A Guide to Psychological Measurement in Diabetes Research and Practice. Harwood Academic; Publisher: Chur; 1994. pp. 111–132.

Weinger K, Butler HA, Welch GW, La Greca AM. Measuring diabetes self-care: a psychometric analysis of the Self-Care Inventory-Revised with adults. Diabetes Care. 2005;28(6):1346–1352. PubMed PMC

La Greca A.Manual for the Self Care Inventory Miami: University of Miami, Department of Psychology; 2004Available from: http://www.psy.miami.edu/faculty/alagreca/SCI_manual_2004_pdfAccessed May 21, 2012

Bradley C.DTSQs and DTSQc User Guidelines London: Royal Holloway University of London, Health Psychology Research; 2010Available from: http://www.healthpsychologyresearch.com/Admin/uploaded/Guidelines/dtsqs&cuserguidelines_rev.17.3.10.pdfAccessed May 21, 2012

Cohen J. A power primer. Psychol Bull. 1992;112(1):155–159. PubMed

Broadbent E, Donkin L, Stroh JC. Illness and treatment perceptions are associated with adherence to medications, diet, and exercise in diabetic patients. Diabetes Care. 2011;34(2):338–340. PubMed PMC

Hoogma RP, Spijker AJ, van Doorn-Scheele M, et al. Quality of life and metabolic control in patients with diabetes mellitus type 1 treated by continuous subcutaneous insulin infusion or multiple daily insulin injections. Neth J Med. 2004;62(10):383–387. PubMed

DeVries JH, Snoek FJ, Kostense PJ, Masurel N, Heine RJ, Dutch Insulin Pump Study Group A randomized trial of continuous subcutaneous insulin infusion and intensive injection therapy in type 1 diabetes for patients with long-standing poor glycemic control. Diabetes Care. 2002;25(11):2074–2080. PubMed

Nicolucci A, Maione A, Franciosi M, et al. EQuality1 Study Group – Evaluation of QUALITY of Life and Costs in Diabetes Type 1 Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections. Diabet Med. 2008;25(2):213–220. PubMed

Bradley C, Speight J. Patient perceptions of diabetes and diabetes therapy: assessing quality of life. Diabetes Metab Res Rev. 2002;18(Suppl 3):S64–S69. PubMed

Goodall TA, Halford WK. Self-management of diabetes mellitus: a critical review. Health Psychol. 1991;10(1):1–8. PubMed

Dibonaventura M, Gabriel S, Dupclay L, Gupta S, Kim E. A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia. BMC Psychiatry. 2012;12:20. PubMed PMC

Miyachi Y, Hayashi N, Furukawa F, et al. Acne management in Japan: study of patient adherence. Dermatology (Basel) 2011;223(2):174–181. PubMed

Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin pump therapy: a meta-analysis. Diabetes Care. 2003;26(4):1079–1087. PubMed

Retnakaran R, Hochman J, DeVries JH, et al. Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of baseline A1c. Diabetes Care. 2004;27(11):2590–2596. PubMed

Pickup J, Mattock M, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ. 2002;324(7339):705. PubMed PMC

Lenhard MJ, Reeves GD. Continuous subcutaneous insulin infusion: a comprehensive review of insulin pump therapy. Arch Intern Med. 2001;161(19):2293–2300. PubMed

Rabiau MA, Knäuper B, Nguyen TK, Sufrategui M, Polychronakos C. Compensatory beliefs about glucose testing are associated with low adherence to treatment and poor metabolic control in adolescents with type 1 diabetes. Health Educ Res. 2009;24(5):890–896. PubMed

Nau DP, Aikens JE, Pacholski AM. Effects of gender and depression on oral medication adherence in persons with type 2 diabetes mellitus. Gend Med. 2007;4(3):205–213. PubMed

Gehi A, Haas D, Pipkin S, Whooley MA. Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study. Arch Intern Med. 2005;165(21):2508–2513. PubMed PMC

Drug holidays: the most frequent type of noncompliance with calcium plus vitamin D supplementation in persistent patients with osteoporosis