The prevalence and cost of type-2-diabetes mellitus (T2DM) are escalating globally. The comorbidities between T2DM, depression and anxiety are common. Achieving high adherence to therapy, supported by lifestyle adjustment is the gold standard for good diabetes management. This study aimed to explore the impact of mental ill-health on medication adherence behaviors in patients diagnosed with T2DM. Participants were recruited from a single general medical practice in Birmingham, and randomly allocated into group A and group B. All participants had their HbA1c and blood pressure (BP) measured, their medication adherence, depression, and anxiety screened at each consultation. Of 64 patients, those with secondary school education, physically active, unemployed, did not have online access to resources, were mentally healthy and from Pakistani ethnicity, had better diabetes medications adherence. Regression analysis showed a significant statistical difference (p<0.05) in the unintentional diabetes medication adherence and anxiety scores favoring group A. BP showed a significant difference between baseline and endpoint but no difference was observed between groups. The use of Morisky® software has allowed the screening of the underlying cause of medication adherence, depression, and anxiety promptly. The study identified the importance of medication adherence in diabetes and the impact this has on HbA1c and mental health. The study also proposed two algorithms, one for T2DM patients in general and one for patients from the Muslim faith, and showed how clinicians can adapt their consultations to meet the needs of an individual.
Diabetes and mental illness are clinically managed by diverse pathways. However, an association between the two has been observed and evidence is growing that when poorly addressed, therapy adherence is low and outcomes are poor. To date, no intervention has been shown to provide sustained improvements in adherence, outcome, quality of life or provider cost savings. This literature review was undertaken as a foundation to a research project to examine whether there is an opportunity for current independent prescriber pharmacists, with or without further training, could as part of a primary care team, contribute their expertise to achieving better and sustainable outcomes for these conditions, where current treatment models are heavily medication-dependent. It reinforces the idea that these conditions are interlinked but by poorly understood mechanisms and suggests that a new approach is required in order to improve outcomes for this complex patient group.
Objective: The aim of this scoping study was to identify gaps in the current literature and understand the T2DM and MIH comorbidity trends in the local population from the West Midlands, UK to inform future studies.
Methods: This project was a scoping study of two parts; a critical review and a clinical audit. A thematic approach was used to group studies based on their overall study outcome. The clinical audit data was used to compare the local patient population to the patterns identified in the literature reviewed.
Results: The reviewed studies reported a relationship between T2DM control and both depression and anxiety, but did not agree on its significance. The clinical audit of 71 patients diagnosed with T2DM showed that 73% of males presented with poor diabetes control (HbA1c>7) compared to females (46%). Conversely, females exhibited a higher prevalence of MIH (45%) compared to males (31%).
Conclusion: From both this audit of the literature and local data, it remains unclear whether mental-ill health is a major driver for medication non-adherence behaviour and uncontrolled diabetes. Further studies are recommended to further understand this comorbidity.
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