Hashimoto Kana, Urata Koki, Yoshida Ayano, Horiuchi Reiko, Yamaaki Naoto, Yagi Kunimasa, Arai Kunizo
1Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan.
Gran Pharma Inc., 1-5-2 Hon-machi, Kanazawa, 920-0853 Japan.
J Pharm Health Care Sci. 2019 Jan 22;5:2. doi: 10.1186/s40780-019-0132-8. eCollection 2019.
The self-management of type 2 diabetes mellitus (T2DM), which involves adherence to medical instructions on diet and nutritional advice, physical activity, medication regimen, and weight and stress management, is necessary for the treatment of T2DM.In this study, we investigated the relationship between patients' perceptions of their disease and their adherence to their medications. And we attempted to determine whether distinct subphenotypes of behavioral change of medication adherence can be discerned based on a patients' perceptions.
A cross-sectional study using a questionnaire was conducted among 157 patients with T2DM from October 2015 to September 2017. Questionnaires were administered to assess the participants' demographic and clinical characteristics, medication adherence, diabetes knowledge, and perception of being diabetic. Principal component analysis (PCA) and cluster analyses were performed to classify medication adherence patterns in the total cohort. Multiple regression analyses were performed to identify the determinant factors of medication adherence.
PCA showed the interpretable medication adherence of patients with diabetes by using component 1 ("accessibility to medical treatment") and component 2 ("status of taking medicines"). We identified four groups that show significantly different medication adherence by using cluster analysis on the basis of the two components. Multiple regression analysis showed that body mass index (BMI), family history of diabetes, one factor of patient's perception (living an orderly life), and diabetes knowledge were found to be significant predictors of medication adherence in patients with T2DM.
In patients with T2DM, the patient's diabetes perception of "living an orderly life" is associated with medication adherence. A poor adherence group may be able to change their adherence to diabetes treatment by developing the perception of "living an orderly life."
2型糖尿病（T2DM）的自我管理包括遵守饮食和营养建议、体育活动、药物治疗方案以及体重和压力管理等医疗指导，这对于T2DM的治疗至关重要。在本研究中，我们调查了患者对自身疾病的认知与药物治疗依从性之间的关系。并且我们试图确定是否可以根据患者的认知来辨别药物治疗依从性行为改变的不同亚表型。
2015年10月至2017年9月，对157例T2DM患者进行了一项使用问卷的横断面研究。通过问卷调查评估参与者的人口统计学和临床特征、药物治疗依从性、糖尿病知识以及对糖尿病的认知。进行主成分分析（PCA）和聚类分析以对整个队列中的药物治疗依从性模式进行分类。进行多元回归分析以确定药物治疗依从性的决定因素。
PCA通过使用成分1（“获得医疗服务的便利性”）和成分2（“服药状况”）显示了糖尿病患者可解释的药物治疗依从性。基于这两个成分进行聚类分析，我们确定了四组药物治疗依从性有显著差异的患者。多元回归分析表明，体重指数（BMI）、糖尿病家族史、患者认知的一个因素（生活有序）以及糖尿病知识是T2DM患者药物治疗依从性的重要预测因素。
在T2DM患者中，患者对“生活有序”的糖尿病认知与药物治疗依从性相关。依从性差的群体可能通过培养“生活有序”的认知来改变他们对糖尿病治疗的依从性。
