Barriers to Treatment Adherence and Hemoglobin A1c in Diabetic Populations




Gray, Avia L.

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Diabetes mellitus is a disease characterized by decreased function or complete dysfunction of islet β cells in the pancreas. Failure to properly manage the disease may result in numerous adverse health complications, which include ketoacidosis, organ failure, cataracts, neuropathy, seizures, limb amputation, pregnancy complications, and even death. With increasing prevalence rates of the disease, it is important for patients with diabetes to adhere to their recommended treatment to avoid these complications. Unfortunately, a substantial amount of diabetic patients fail to adhere to their recommended treatment, which results in elevated blood glucose, and puts them at an increased risk for adverse health effects. One of the main obstacles in evaluating diabetes treatment adherence has been measuring what factors actually reflect adherence and controlled hbA1c. Many barriers may affect adherence; however, using a holistic view of barriers that contribute to non-adherence and uncontrolled glycemic index in diabetic patients may help to identify relevant barriers that prevent adequate health. The purpose of this study is to identify barriers that prevent proper treatment adherence and controlled hbAlc levels in chronic diabetic patients. A total of eighty-five type 1 and type 2 diabetic patients completed the study survey by responding to demographic questions and completing the Medication Adherence Rating Scale (MARS-D), the Barriers to Medication Adherence Questionnaire, the Visual Analogue Scale for Medication Adherence (VAS), the Perceived Stress Scale (PSS), the Interpersonal Support Evaluation List (ISEL-12), the Appraisal of Diabetes Scale (ADS), the EUROHIS Quality of Life Index (EUROHIS-QOL-8), and the Patient Health Questionnaires (PHQ) to assess treatment adherence and to identify potential barriers that affect said adherence. Patients were categorized having either controlled (CBG) or uncontrolled (UBG) blood glucose levels, based on reported current hbAlc levels. The results of the study showed that there were no significant differences in demographic variables. While there was no significant difference in reported treatment adherence as assessed by the patients’ MARS-D and the overall VAS scores, patients with UBG had a significantly lower quality of life score as assessed by the EUROHIS-QOL-8. There were no significant differences in MARS-9, VAS, PSS, ISEL-12, or ADS scores; however, patients with UBG showed congruent trends with previous research in that they did have lower MARS-9 scores, higher PSS scores, lower ISEL-12 scores, and lower ADS scores. Patients with UBG also had a higher incidence of depression, as assessed by the PHQ. While there was no significant difference in the number of UBG patients with anxiety or somatization, there were more patients with anxiety and somatization with UBG than with CBG. Also, patients with UBG showed significantly less adherence to short-acting insulin and non-diabetic medication. There were no significant differences in adherence to long-acting/intermediate-acting insulin and oral diabetic medication. Implications of this study suggest that further research must be done to identify barriers to self-care and adherence for diabetic populations to decrease the number of patients who currently experience serious and even fatal complications of having uncontrolled diabetes.



Diabetes, Treatment adherence, Barriers, Stress, Psychopathology, Social support, Depression, Anxiety, Appraisal, Quality of life, HBA1C, Type 1 diabetes, Type 2 diabetes


Gray, A. L. (2016). <i>Barriers to treatment adherence and hemoglobin A1c in diabetic populations</i> (Unpublished thesis). Texas State University, San Marcos, Texas.


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