Understanding How Stress Affects Poor Medication Adherence in Type 2 Diabetes

Emotional distress has long been recognized as a factor in poor medication adherence in type 2 diabetes (T2D); failing to treat underlying depression is seen as a risk factor in getting patients to stick with a diabetes regimen.

In fact, collaborative care, which addresses a patient’s behavioral health and diabetes care needs within one practice, has gained enough momentum that the proposed 2017 Medicare Physician Fee Schedule calls for letting practices bill for it.

But understanding just how much being depressed affects one’s ability to stick with a medication regimen is harder to gauge. A new study appearing in Diabetes Care sought to examine this by matching patient reports of depression with verifiable measures of adherence.

Researchers studied a diverse group of 104 patients with T2D over 3 months, measuring their medication adherence in 2 ways: first with electronic monitoring and then with self-reports. They also evaluated the patients’ levels of depression in interviews and took blood samples to test glycated hemoglobin (A1C).

Baseline diabetes distress was a significant predictor of adherence based on the electronic monitoring. Over the 3 months, patients’ average adherence was 76.1%, as measured electronically, compared with 83.7% by self-reports. Higher levels of self-reported depression, and that confirmed in interviews, showed a significant bivariate association with electronic (β = −0.29) and self-reported (β = −0.24) nonadherence at follow-up.

The authors found support for the idea that diabetes-related distress and depression are risk factors for nonadherence as their severity increases. Curiously, this effect is driven by the somatic symptoms of depression—the behaviors associated with pain and fatigue—rather than the cognitive problems, such as forgetfulness. The authors said the link merits further investigation.

Reference

Gonzalez JS, Kane NS, Binko DH, Shapira A, Hoogendoorn CJ. Tangled up in blue: unraveling the links between emotional distress and treatment adherence in type 2 diabetes [published October 18, 2016]. Diabetes Care. http://dx.doi.org/10.2337/dc16-1657.