Issue 163 Item 7 Poor Understanding of Disease Management Leads to Non-complianc

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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