Psychosocial factors predict medication adherence in young adults with youth-onset type 2 diabetes: Longitudinal results from the TODAY2 iCount study

Authors

Paula M. Trief, Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, New York, USA.
Diane Uschner, The Biostatistics Center, George Washington University, Washington, DC, USA.
Seth Kalichman, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA.
Barbara J. Anderson, Department of Pediatrics-Psychology, Baylor College of Medicine, Houston, Texas, USA.
Lida M. Fette, The Biostatistics Center, George Washington University, Washington, DC, USA.
Hui Wen, The Biostatistics Center, George Washington University, Washington, DC, USA.
Jane D. Bulger, Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA.
Ruth S. Weinstock, Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA.

Document Type

Journal Article

Publication Date

2-8-2023

Journal

Diabetic medicine : a journal of the British Diabetic Association

DOI

10.1111/dme.15062

Keywords

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

Abstract

AIM: To identify psychosocial predictors of 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. Unannounced telephone pill counts were completed at T1 (baseline) and T2 (follow-up, approximately 1 year later) to assess adherence to oral hypoglycaemia agents (OHAs). Adherence to insulin was assessed by self-report. Logistic and linear regressions identified factors that predicted 'low adherence' (<80% of pills/insulin) and per cent adherence, adjusted for potential confounders. RESULTS: Of 171 participants with OHA adherence scores at T1 and T2 (65% women, 43% Hispanic and 35% non-Hispanic Black), 65.4% were low adherent. After adjustment (including T1 adherence), concerns about diabetes medicines (adverse effects, dependence) at T1 predicted higher odds of being low adherent (categorical) at T2 (p = 0.019). Housing insecurity (p = 0.045) and reporting ≥2 need insecurities (p = 0.027) at T1 predicted lower per cent adherence (continuous) at T2. Of 157 participants with insulin adherence scores at T1 and T2 (69% women, 38% Hispanic and 38% non-Hispanic Black), 36.3% were low adherent. After adjustment (including T1 adherence), beliefs that medicines are overused predicted higher odds of insulin low adherence at T2 (p = 0.013), and beliefs that medicines are harmful (p = 0.004) and overused (p = 0.010) predicted lower per cent insulin adherence at T2. CONCLUSIONS: Suboptimal medication adherence, common in young adults with youth-onset type 2 diabetes, is predicted by interfering beliefs about medicines and social factors. We must address these beliefs and unmet needs to develop tailored interventions for this vulnerable group.

APA Citation

Trief, Paula M.; Uschner, Diane; Kalichman, Seth; Anderson, Barbara J.; Fette, Lida M.; Wen, Hui; Bulger, Jane D.; and Weinstock, Ruth S., "Psychosocial factors predict medication adherence in young adults with youth-onset type 2 diabetes: Longitudinal results from the TODAY2 iCount study" (2023). GW Authored Works. Paper 2431.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2431

Department

Biostatistics and Bioinformatics