Tiktin Margaret, Celik Selda, Berard Lori
a a Endocrinology, Case Western Reserve University , Cleveland , Ohio , USA.
b b Istanbul Faculty of Medicine, Division of Endocrinology and Metabolism, Istanbul University , Istanbul , Turkey.
Curr Med Res Opin. 2016;32(2):277-87. doi: 10.1185/03007995.2015.1119677. Epub 2015 Dec 2.
To identify factors affecting adherence to medications in type 2 diabetes (T2D) care and clinical trials.
Adherence to medication is associated with better patient outcomes, lower healthcare costs, and improved quality and robustness of trial data. In T2D, non-adherence to regimens may compromise glycemic, blood pressure and lipid control, which can, in turn, increase morbidity and mortality rates.
A literature search was performed to identify studies reporting adherence to medications and highlighting specific adherence challenges/approaches in T2D. The search was limited to clinical trials, comparative studies or meta-analyses, reported in English with a freely available abstract.
MEDLINE (31 December 2008 to 31 December 2013).
Studies not reporting adherence to medications or highlighting adherence challenges/approaches in T2D, presenting only self-reported adherence or including fewer than 100 patients were excluded. Eligible reports are discussed narratively.
Factors identified as having a detrimental impact on adherence were smoking, depression and polypharmacy. Conversely, increased convenience (e.g. pen compared with vial and syringe; medication supplied by mail order vs. retail pharmacy) was associated with better patient adherence, as were interventions that increased patient motivation (e.g. individualized, nurse-led consultation) and education.
Medication adherence is influenced by complex and multifactorial issues, which can include smoking, depression, polypharmacy, convenience of obtaining and administering the medication, patient motivation and education. We recommend simplifying treatment regimens, where possible, improving provider-patient communication, and providing support and education to increase medication adherence, with a view to improving patient outcomes and clinical trial data quality.
确定影响2型糖尿病（T2D）护理及临床试验中药物治疗依从性的因素。
药物治疗依从性与更好的患者预后、更低的医疗成本以及试验数据质量和稳健性的提高相关。在2型糖尿病中，不依从治疗方案可能会影响血糖、血压和血脂控制，进而增加发病率和死亡率。
进行文献检索，以确定报告药物治疗依从性并突出2型糖尿病中特定依从性挑战/方法的研究。检索限于以英文报道且有免费摘要的临床试验、比较研究或荟萃分析。
MEDLINE（2008年12月31日至2013年12月31日）。
排除未报告药物治疗依从性或未突出2型糖尿病中依从性挑战/方法、仅呈现自我报告的依从性或患者少于100例的研究。对符合条件的报告进行叙述性讨论。
被确定对依从性有不利影响的因素包括吸烟、抑郁和多种药物联合使用。相反，增加便利性（如笔式注射与瓶装和注射器注射相比；邮购供应药物与零售药店供应药物相比）与更好的患者依从性相关，增加患者动机的干预措施（如个体化的、由护士主导的咨询）和教育也是如此。
药物治疗依从性受复杂的多因素问题影响，这些问题可能包括吸烟、抑郁、多种药物联合使用、获取和使用药物的便利性、患者动机和教育。我们建议尽可能简化治疗方案，改善医护人员与患者的沟通，并提供支持和教育以提高药物治疗依从性，以期改善患者预后和临床试验数据质量。
