Cummings Doyle M, Lutes Lesley, Littlewood Kerry, DiNatale Emily, Hambidge Bertha, Schulman Kathleen, Morisky Donald E
East Carolina University, Greenville, NC, USA
East Carolina University, Greenville, NC, USA.
Ann Pharmacother. 2014 Aug;48(8):970-977. doi: 10.1177/1060028014536532. Epub 2014 Jun 5.
Regimen-related emotional distress in patients with type 2 diabetes mellitus (T2DM) is associated with poor glycemic control, but the mediators of this relationship are not well described.
This cross-sectional study at baseline examines these relationships, including the specific role of medication adherence in rural African American women.
At baseline in the EMPOWER randomized trial, the investigators collected the following data: Regimen-Related Distress (RRD; subscale of the validated Diabetes Distress Scale), diabetes medications, medication adherence using the Morisky Medication Adherence Scale, and hemoglobin A (A1C).
The study enrolled 189 rural African American women with T2DM (mean age = 53 ± 11 years, A1C = 9.1% ± 1.8%, body mass index = 37.7% ± 8.2%; 61% on insulin); 56% reported elevated RRD (mean ≥ 3.0), and this was associated with significantly lower medication adherence (4.4 vs 6.4, P < 0.001) and significantly higher A1C (9.5% vs 8.6%, P < 0.001). In multivariate modeling, both elevated RRD (exp β = 2.1; 95% CI = 1.1-4.2; P < 0.05) and lower medication adherence (exp β = 3.3; 95% CI = 1.1-9.6; P < 0.05) were independently associated with higher A1C values. In mediation analysis, medication adherence was a significant mediator of the effects of RRD on A1C.
Among rural African American women with T2DM, elevated levels of RRD were common and were associated with higher A1C values, in part via effects on medication adherence. Complex treatment regimens accompanied by psychological distress may be associated with poorer glycemic control.
2型糖尿病（T2DM）患者中与治疗方案相关的情绪困扰与血糖控制不佳有关，但这种关系的介导因素尚未得到充分描述。
这项基线横断面研究考察了这些关系，包括药物依从性在非洲裔美国农村女性中的具体作用。
在EMPOWER随机试验的基线阶段，研究人员收集了以下数据：与治疗方案相关的困扰（RRD；经过验证的糖尿病困扰量表的子量表）、糖尿病药物、使用Morisky药物依从性量表评估的药物依从性以及糖化血红蛋白（A1C）。
该研究纳入了189名患有T2DM的非洲裔美国农村女性（平均年龄 = 53 ± 11岁，A1C = 9.1% ± 1.8%，体重指数 = 37.7% ± 8.2%；61%使用胰岛素）；56%的人报告RRD升高（平均≥3.0），这与显著更低的药物依从性（4.4对6.4，P < 0.001）和显著更高的A1C（9.5%对8.6%，P < 0.001）相关。在多变量模型中，RRD升高（expβ = 2.1；95%CI = 1.1 - 4.2；P < 0.05）和药物依从性降低（expβ = 3.3；95%CI = 1.1 - 9.6；P < 0.05）均与更高的A1C值独立相关。在中介分析中，药物依从性是RRD对A1C影响的显著介导因素。
在患有T2DM的非洲裔美国农村女性中，RRD水平升高很常见，且与更高的A1C值相关，部分是通过对药物依从性的影响。伴有心理困扰的复杂治疗方案可能与较差的血糖控制有关。
