Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.
Diabetes Care. 2024 Apr 1;47(4):629-637. doi: 10.2337/dc23-1401.
We examined longitudinal associations between emotional distress (specifically, depressive symptoms and diabetes distress) and medication adherence in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing four glucose-lowering medications added to metformin in adults with relatively recent-onset type 2 diabetes mellitus (T2DM).
The Emotional Distress Substudy assessed medication adherence, depressive symptoms, and diabetes distress in 1,739 GRADE participants via self-completed questionnaires administered biannually up to 3 years. We examined baseline depressive symptoms and diabetes distress as predictors of medication adherence over 36 months. Bidirectional visit-to-visit relationships were also examined. Treatment satisfaction, beliefs about medication, diabetes care self-efficacy, and perceived control over diabetes were evaluated as mediators of longitudinal associations.
At baseline, mean ± SD age of participants (56% of whom were White, 17% Hispanic/Latino, 18% Black, and 66% male) was 58.0 ± 10.2 years, diabetes duration 4.2 ± 2.8 years, HbA1c 7.5% ± 0.5%, and medication adherence 89.9% ± 11.1%. Higher baseline depressive symptoms and diabetes distress were independently associated with lower adherence over 36 months (P < 0.001). Higher depressive symptoms and diabetes distress at one visit predicted lower adherence at the subsequent 6-month visit (P < 0.0001) but not vice versa. Treatment assignment did not moderate relationships. Patient-reported concerns about diabetes medications mediated the largest percentage (11.9%-15.5%) of the longitudinal link between emotional distress and adherence.
Depressive symptoms and diabetes distress both predict lower adherence to glucose-lowering medications over time among adults with T2DM. Addressing emotional distress and concerns about anticipated negative effects of taking these treatments may be important to support diabetes treatment adherence.
我们研究了情绪困扰（特别是抑郁症状和糖尿病困扰）与 Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study（GRADE）中药物依从性之间的纵向关联，这是一项大型随机对照试验，比较了四种降低血糖药物与二甲双胍联合用于近期发病的 2 型糖尿病患者。
情绪困扰子研究通过每两年进行一次的自我完成问卷评估了 1739 名 GRADE 参与者的药物依从性、抑郁症状和糖尿病困扰，最长可达 3 年。我们研究了基线抑郁症状和糖尿病困扰对 36 个月药物依从性的预测作用。还检查了双向就诊间关系。治疗满意度、对药物的信念、糖尿病护理自我效能感和对糖尿病的控制感被评估为纵向关联的中介因素。
在基线时，参与者的平均年龄（56%为白人，17%为西班牙裔/拉丁裔，18%为黑人，66%为男性）为 58.0±10.2 岁，糖尿病病程为 4.2±2.8 年，HbA1c 为 7.5%±0.5%，药物依从性为 89.9%±11.1%。基线时较高的抑郁症状和糖尿病困扰与 36 个月内较低的依从性独立相关（P<0.001）。一次就诊时较高的抑郁症状和糖尿病困扰预示着下一次 6 个月就诊时的依从性较低（P<0.0001），但反之则不然。治疗分配并没有调节这些关系。患者对糖尿病药物的担忧报告部分（11.9%-15.5%）解释了情绪困扰与依从性之间的纵向联系。
抑郁症状和糖尿病困扰都预测了 2 型糖尿病成人随时间推移对降低血糖药物的依从性降低。解决情绪困扰和对服用这些治疗药物的预期负面效应的担忧可能对支持糖尿病治疗依从性很重要。
