Poor Understanding of Disease
Management Leads to Non-compliance from Diabetics
Non-compliance from patients with type
2 diabetes may be related to poor understanding
of management guidelines.
The survival and quality of life for individuals
with type 2 diabetes can be substantially improved
by good dietary habits, exercise, blood glucose
control and medication, as outlined by the American
Diabetes Association (ADA). However, an alarming
number of patients fail to meet these goals. Identifying
the reasons for this poor compliance will be crucial
to the development of interventions to improve
disease management.
The Diabetes Outcome in Veterans Study (DOVES)
is a comprehensive study of intermediate outcomes
in insulin-treated veterans of the Southwestern
United States. It is funded by the Health Services
Research and Development Service of the Department
of Veterans Affairs (VA), and is conducted by
the Southwestern Group for Outcomes Research in
Diabetes, a collaboration involving the largest
VA health care systems in New Mexico and Arizona.
The purpose of the DOVES initiative is to investigate
the association between clinical, demographic,
lifestyle, socioeconomic and psychological variables
with clinical outcomes of diabetes, including
glycemic control and disease management.
As part of this analysis, Glen H. Murata, MD,
of the New Mexico VA Health Care System, Albuquerque,
United States, and colleagues have evaluated the
baseline characteristics for 338 stable, insulin-treated
type 2 diabetics (mean age, 65.1±9.7 years,
3.8% females). All subjects received at least
one daily long-acting insulin preparation and
were followed for at least 6 months.
According to Dr. Murata, 73% of subjects had
poor glycemic control, indicated by a hemoglobin
of A1c > 7% (ADA good control criterion, <
7%).
In addition, the study cohort on average showed
only intermediate scores on their understanding
of management and compliance with self-care, and
scored lowest on adherence to diet.
The researchers also found a high prevalence
of obesity (62.1% with BMI>30 kg/m2) and inactivity,
and 22.2% reported smoking. Psychosocial evaluation
revealed that 22.5% of the cohort was mildly depressed,
8.0% was severely depressed, and there was a high
prevalence of self-perceived disabilities for
activities of daily living.
Dr. Murata and colleagues suggest that these
results, "should help identify barriers to
meeting the ADA guidelines for diabetes care,"
and "could lead to screening strategies for
identifying high-risk patients."
J Diabetes Complications 2003 Jul-Aug;17:4:186-91
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