Barriers and strategies for oral medication adherence among children and adolescents with Type 2 diabetes

• Published in: Diabetes research and clinical practice 2018-05, Vol.139, p.24-31
• Main Authors: Venditti, E.M., Tan, K., Chang, N., Laffel, L., McGinley, G., Miranda, N., Tryggestad, J.B., Walders-Abramson, N., Yasuda, P., Delahanty, L.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Child; Chronic Disease; Communication Barriers; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - psychology; Female; Follow-Up Studies; Humans; Hypoglycemic Agents - administration & dosage; Male; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Reminder Systems - standards; Reminder Systems - statistics & numerical data
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2018.02.001

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. 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. 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). 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.gov NCT00081328.