Real‐world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review
Year: 2013
Type: review
Study design: Systematic Review
Abstract: AIMS: To identify real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus. METHODS: A literature search was conducted in PubMed and EMBASE in November 2011 to identify studies reporting factors associated with adherence/non-adherence to insulin therapy in adults with Type 1 or Type 2 diabetes. RESULTS: Seventeen studies were identified; six used self-reported measures and 11 used calculated measures of adherence. Most (13/17) were conducted exclusively in the USA. Four categories of factors associated with non-adherence were identified: predictive factors for non-adherence, patient-perceived barriers to adherence, type of delivery device and cost of medication. For predictive factors and patient-perceived barriers, only age, female sex and travelling were associated with non-adherence in more than one study. Fear of injections and embarrassment of injecting in public were also cited as reasons for non-adherence. Conversely, adherence was improved by initiating therapy with, or switching to, a pen device (in four studies), and by changing to an insurance scheme that lowered the financial burden on patients (in two studies). CONCLUSIONS: Adherence to insulin therapy is generally poor. Few factors or patient-perceived barriers were consistently identified as predictive for non-adherence, although findings collectively suggest that a more flexible regimen may improve adherence. Switching to a pen device and reducing patient co-payments appear to improve adherence. Further real-world studies are warranted, especially in countries other than the USA, to identify factors associated with non-adherence and enable development of strategies to improve adherence to insulin therapy.
Source: Diabetic Medicine
DOI: 10.1111/dme.12128
Authors: M. J. Davies, J. J. Gagliardino, L. J. Gray, K. Khunti, V. Mohan, R. Hughes
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Embedding structured self management education programmes for Type 2 diabetes in a multi-ethnic primary care setting: developing key areas to support a NIHR Programme Grant submission, A community based primary prevention programme for Type 2 Diabetes integrating identification, lifestyle intervention and community services for prevention.
OpenAlex ID: W2106049537