Patient compliance with correct administration of anti-diabetic medication is central to successful glucose control (Rhee et al 2005). The purpose of this analysis was to assess the influence compliance has on glycosylated haemoglobin (HbA1c) levels in Type 2 Diabetes (T2D) patients.
Method:
Data were extracted from the 2012 Adelphi Diabetes Disease Specific Programme®, a cross-sectional survey of 374 primary care physicians and 256 specialists across the EU5. Each participating physician completed a patient record form (PRF) for their next 10 consulting T2D patients (2421 out of 6283 were using insulin). This included the question ‘In your experience, how compliant is this patient with their diabetes treatment?’ and collection of latest HbA1c test values. Physician-perceived compliance was measured using scale ‘Not at all’, ‘Has poor compliance’, ‘Fairly compliant’ and ‘Fully compliant’ (Q1). These patients were also invited to complete a self-completion questionnaire (1473 out of 4057 were using insulin), which included the question ‘It is not unusual for patients to find it difficult to take their diabetes medicine exactly as advised by their doctor. Have you ever experienced this?’ (Q2).
Result:
Mean HbA1c values for insulin-using patients with physician-perceived compliance levels of ‘Not at all’, ‘Has poor compliance’, ‘Fairly compliant’ and ‘Fully compliant’ were 83.2 (9.76%), 70.3 (8.58%), 61.3 (7.76%), and 56.2 mmol/mol (7.29%) respectively. The overall mean for patients observed in Q1 was 61.2 mmol/mol (7.75%) (p-value <0.0001).
Mean HbA1c values for insulin-using patients who experienced difficulty taking medication as advised (‘Yes’ to Q2) was 62.4 mmol/mol (7.86%) and 58.9 mmol/mol (7.54%) for those who did not (‘No’ to Q2). For all patients answering Q2, mean HbA1c was 59.9 mmol/mol (7.63%) (p-value <0.0001).
Conclusion:
These analyses found a direct correlation between physician-perceived patient compliance and actual HbA1c levels of their patients. Similarly, patient-reported difficulty with taking diabetes medication was associated with higher HbA1c levels. These results should be interpreted cautiously as confounding factors may jointly affect HbA1c and compliance. Still, this analysis supports existing/growing evidence regarding the adverse implications of poor compliance and lends support to greater uptake of longer acting and less rigorous treatment regimens.