Barriers and strategies for oral medication adherence among children and adolescents with Type 2 diabetes. (May 2018)

• Record Type: Journal Article
• Authors: Venditti, E.M.; Tan, K.; Chang, N.; Laffel, L.; McGinley, G.; Miranda, N.; Tryggestad, J.B.; Walders-Abramson, N.; Yasuda, P.; Delahanty, L.
• Is Part Of: Diabetes research and clinical practice. Volume 139(2018)
• Page Start: 24
• Page End: 31
• Publication Date: 2018-05
• Subjects: Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2018.02.001
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: Examine barriers for taking glucose-lowering oral medications, associated baseline characteristics, strategies used, and the adherence impact in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Methods: We studied youth prescribed oral diabetes medications over two years (N = 611, 583, and 525 at 6, 12, and 24 months). Clinicians documented barriers (e.g. forgetting, routines, other concerns) in the subsample that reported missed doses (N = 423 [69.2%], 422 [72.4%], and 414 [78.9%] at 6, 12, and 24 months, respectively). Adherence strategies were also assessed (e.g. family, schedule, reminder device) using standard questions. Logistic regression was used to analyze associations with medication adherence. Results: Those missing doses were not different from the total sample (61.5% female, 13.9 ± 2.0 years, >80% racial/ethnic minorities). No baseline demographic or clinical predictors of barriers to medication adherence were identified. Among those for whom barriers were assessed, "forgetting" with no reason named (39.3%) and disruptions to mealtime, sleep, and schedule (21.9%) accounted for the largest proportion of responses. Family support was the primary adherence strategy identified by most youth (≥50%), followed by pairing the medication regimen with daily routines (>40%); the latter strategy was associated with significantly higher adherence rates (p = 0.009). Conclusions: Family supported medication adherence was common in this mid-adolescent cohort, but self-management strategies were also in evidence. Findings are similar to those reported among youth with other serious chronic diseases. Prospective studies of multi-component family support and self-management interventions for improving medication adherence are warranted. Trial registration: ClinicalTrials.govNCT00081328 .