E M Venditti1, K Tan2, N Chang3, L Laffel4, G McGinley5, N Miranda6, J B Tryggestad7, N Walders-Abramson8, P Yasuda9, L Delahanty10. 1. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. 2. George Washington University Biostatistics Center, Rockville, MD, United States. Electronic address: elghorml@bsc.gwu.edu. 3. Children's Hospital Los Angeles, Los Angeles, CA, United States. 4. Joslin Diabetes Center, Boston, MA, United States. 5. Children's Hospital of Philadelphia, Philadelphia, PA, United States. 6. Baylor College of Medicine, Houston, TX, United States. 7. University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States. 8. Department of Pediatrics, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO, United States. 9. Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States. 10. Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA, United States.
Abstract
AIMS: Examine barriers for taking glucose-lowering oral medications, associated baseline characteristics, strategies used, and the adherence impact in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. METHODS: We studied youth prescribed oral diabetes medications over two years (N = 611, 583, and 525 at 6, 12, and 24 months). Clinicians documented barriers (e.g. forgetting, routines, other concerns) in the subsample that reported missed doses (N = 423 [69.2%], 422 [72.4%], and 414 [78.9%] at 6, 12, and 24 months, respectively). Adherence strategies were also assessed (e.g. family, schedule, reminder device) using standard questions. Logistic regression was used to analyze associations with medication adherence. RESULTS: Those missing doses were not different from the total sample (61.5% female, 13.9 ± 2.0 years, >80% racial/ethnic minorities). No baseline demographic or clinical predictors of barriers to medication adherence were identified. Among those for whom barriers were assessed, "forgetting" with no reason named (39.3%) and disruptions to mealtime, sleep, and schedule (21.9%) accounted for the largest proportion of responses. Family support was the primary adherence strategy identified by most youth (≥50%), followed by pairing the medication regimen with daily routines (>40%); the latter strategy was associated with significantly higher adherence rates (p = 0.009). CONCLUSIONS: Family supported medication adherence was common in this mid-adolescent cohort, but self-management strategies were also in evidence. Findings are similar to those reported among youth with other serious chronic diseases. Prospective studies of multi-component family support and self-management interventions for improving medication adherence are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT00081328.
RCT Entities:
AIMS: Examine barriers for taking glucose-lowering oral medications, associated baseline characteristics, strategies used, and the adherence impact in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. METHODS: We studied youth prescribed oral diabetes medications over two years (N = 611, 583, and 525 at 6, 12, and 24 months). Clinicians documented barriers (e.g. forgetting, routines, other concerns) in the subsample that reported missed doses (N = 423 [69.2%], 422 [72.4%], and 414 [78.9%] at 6, 12, and 24 months, respectively). Adherence strategies were also assessed (e.g. family, schedule, reminder device) using standard questions. Logistic regression was used to analyze associations with medication adherence. RESULTS: Those missing doses were not different from the total sample (61.5% female, 13.9 ± 2.0 years, >80% racial/ethnic minorities). No baseline demographic or clinical predictors of barriers to medication adherence were identified. Among those for whom barriers were assessed, "forgetting" with no reason named (39.3%) and disruptions to mealtime, sleep, and schedule (21.9%) accounted for the largest proportion of responses. Family support was the primary adherence strategy identified by most youth (≥50%), followed by pairing the medication regimen with daily routines (>40%); the latter strategy was associated with significantly higher adherence rates (p = 0.009). CONCLUSIONS: Family supported medication adherence was common in this mid-adolescent cohort, but self-management strategies were also in evidence. Findings are similar to those reported among youth with other serious chronic diseases. Prospective studies of multi-component family support and self-management interventions for improving medication adherence are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT00081328.
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