Influence of Supervised Disease Understanding and Diabetes Self-Management on Adherence to Oral Glucose-Lowering Treatment in Patients with Type 2 Diabetes

John Doupis; Theodoros Alexandrides; Moses Elisaf; Andreas Melidonis; Stavros Bousboulas; Anastasia Thanopoulou; Emmanouil M Pagkalos; Iakovos Avramidis; Angelos Pappas; Eleni Arvaniti; Eugenia Karamousouli; Bernd Voss; Nikolaos Tentolouris

doi:10.1007/s13300-019-0648-9

Influence of Supervised Disease Understanding and Diabetes Self-Management on Adherence to Oral Glucose-Lowering Treatment in Patients with Type 2 Diabetes

Diabetes Ther. 2019 Aug;10(4):1407-1422. doi: 10.1007/s13300-019-0648-9. Epub 2019 Jun 20.

Affiliations

¹ Internal Medicine and Diabetes Department, NS Naval Hospital, Athens, Greece. john.doupis@joslin.harvard.edu.
² Division of Endocrinology, Department of Medicine, University General Hospital of Patras, Patras, Greece.
³ School of Health Sciences, Faculty of Medicine, Department of Internal Medicine, University of Ioannina, Ioannina, Greece.
⁴ Diabetic Center, General Hospital "Tzanio", Piraeus, Greece.
⁵ Diabetic Center, General Hospital "Ag. Panteleimon", Piraeus, Greece.
⁶ Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens, Greece.
⁷ Diabetes Department, Thermi Clinic, Thessaloniki, Greece.
⁸ First Medical Department, G. Papanikolaou General Hospital, Thessaloniki, Greece.
⁹ Diabetic Center, Venizelio General Hospital Heraklion, Crete, Greece.
¹⁰ General Hospital of Ioannina "G. Hatzikosta", Ioannina, Greece.
¹¹ MSD, Athens, Greece.
¹² MSD RBSC GmbH, Haar, Germany.
¹³ 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.

Abstract

Introduction: Systematic patient education has been reported to improve adherence to treatment, leading to better clinical outcomes. This cluster randomized real-world study investigated the effect of a systematic education program and telephone support on self-reported adherence to oral glucose-lowering treatment in patients with type 2 diabetes mellitus (T2DM).

Methods: Centers were randomized (1:1) to provide either standard-of-care (control group) or standard-of-care along with the education program and telephone support (empowerment group). Adherence to treatment and satisfaction with treatment were assessed using the four-item Morisky Medication Adherence Scale (MMAS-4) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The study population included 457 patients (258/199 male/female) with T2DM and non-optimal glycemic control, on oral antidiabetic treatment (age 62.7 [11.4]; disease duration 8.5 [6.5] years).

Results: MMAS-4 high adherence rates for the control and empowerment groups were increased by 3.8% and 16.8% at 4 months (Breslow-Day test p = 0.04) and by 8.5% and 18.8% at 8 months of follow-up, respectively (Breslow-Day test p = 0.09), compared to baseline. Intense physical activity was increased in both control and empowerment groups by 2.3% and 13.9% at 4 months (Breslow-Day test p = 0.082) and by 4.0% and 22.5% at 8 months of follow-up (Breslow-Day test p < 0.001). Baseline mean (SD) HbA1c was significantly lower in the control group compared with the empowerment group [7.7% versus 8.0%, p = 0.001] and decreased in both groups at 4 months by 0.7% and 0.9%, respectively. The change from baseline in the mean DTSQ status score at 4 months was greater in the empowerment group, and the effect was sustained at 8 months (control group: 29.1, 30.5, and 30.9; empowerment group: 25.0, 28.7, and 29.4 at baseline, 4 and 8 months, respectively, p < 0.001).

Conclusion: Systematic education combined with telephone support delivered by physicians might be associated with improvement in treatment adherence and treatment satisfaction in patients with T2DM.

Funding: MSD, Greece.

Keywords: Oral glucose-lowering agents; Systematic education program; Telephone support; Treatment adherence; Treatment satisfaction; Type 2 diabetes.