Association of psychosocial factors with medication adherence in emerging adults with youth-onset type 2 diabetes: The iCount study

Authors

Paula M. Trief, Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, New York, USA.
Seth Kalichman, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA.
Diane Uschner, Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Melinda Tung, Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Kimberly L. Drews, Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Barbara J. Anderson, Department of Pediatrics, Psychology Section, Baylor College of Medicine, Houston, Texas, USA.
Lida M. Fette, Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Hui Wen, Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Jane D. Bulger, Department of Medicine, Division of Endocrinology, State University of New York Upstate Medical University, Syracuse New York, USA.
Ruth S. Weinstock, Department of Medicine, Division of Endocrinology, State University of New York Upstate Medical University, Syracuse New York, USA.

Document Type

Journal Article

Publication Date

12-1-2022

Journal

Pediatric diabetes

Volume

23

Issue

8

DOI

10.1111/pedi.13431

Keywords

medication adherence; psychology; social determinants of health; type 2 diabetes; young adults

Abstract

AIMS: To assess associations of psychosocial factors with medication adherence in young adults with youth-onset type 2 diabetes in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort. METHODS: Participants (mean age 26 years) completed validated psychosocial measures. Adherence to oral hypoglycemia agents (OHAs) was assessed with 3-monthly unannounced phone pill counts; insulin adherence by self-report. Logistic and linear regressions identified factors associated with "low-adherence" (<80% of pills/insulin) controlling for confounders. RESULTS: Of 212 participants taking OHAs (67% female, 39% Hispanic, 36% non-Hispanic Black), 69.8% were low-adherent. After adjustment, beliefs that medicines are necessary was associated with lower odds of low-adherence (p = 0.040, dichotomous). Less self-management support (p = 0.008), no healthcare coverage (p = 0.001), ≥1 (p = 0.008)/≥2 (p = 0.045) need insecurities were associated with higher odds of low-adherence. Factors associated with lower % adherence (continuous) were beliefs that medicines are harmful (p < 0.001)/overused (p = 0.007)/less necessary (p = 0.022), low self-management support (p = 0.003), food insecurity (p = 0.036), no healthcare coverage (p < 0.001), ≥1 (p = 0.003)/≥2 (p = 0.018) need insecurities. Of 192 taking insulin (69% female, 36% Hispanic, 41% non-Hispanic Black, 16% non-Hispanic white), 37.0% were low-adherent. Beliefs that medicines are overused (p = 0.009), that diabetes is not serious (p = 0.010), low diabetes self-efficacy (p = 0.035), high distress (p = 0.027), low self-management support (p = 0.001), food insecurity (p = 0.020), ≥1 (p = 0.011)/≥2 (p = 0.015) insecurities increased odds of insulin low-adherence. CONCLUSIONS: Poor medication adherence, common in young adults with youth-onset type 2 diabetes, is associated with interfering beliefs, diabetes distress and social factors. We must address these factors to develop tailored interventions for this vulnerable group.

APA Citation

Trief, Paula M.; Kalichman, Seth; Uschner, Diane; Tung, Melinda; Drews, Kimberly L.; Anderson, Barbara J.; Fette, Lida M.; Wen, Hui; Bulger, Jane D.; and Weinstock, Ruth S., "Association of psychosocial factors with medication adherence in emerging adults with youth-onset type 2 diabetes: The iCount study" (2022). GW Authored Works. Paper 2199.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2199

Department

Biostatistics and Bioinformatics