Association of psychosocial factors with medication adherence in emerging adults with youth‐onset type 2 diabetes: The i Count study

Abstract

Aims To assess associations of psychosocial factors with 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. Adherence to oral hypoglycemia agents (OHAs) was assessed with 3‐monthly unannounced phone pill counts; insulin adherence by self‐report. Logistic and linear regressions identified factors associated with “low‐adherence” (<80% of pills/insulin) controlling for confounders. Results Of 212 participants taking OHAs (67% female, 39% Hispanic, 36% non‐Hispanic Black), 69.8% were low‐adherent. After adjustment, beliefs that medicines are necessary was associated with lower odds of low‐adherence (p = 0.040, dichotomous). Less self‐management support (p = 0.008), no healthcare coverage (p = 0.001), ≥1 (p = 0.008)/≥2 (p = 0.045) need insecurities were associated with higher odds of low‐adherence. Factors associated with lower % adherence (continuous) were beliefs that medicines are harmful (p < 0.001)/overused (p = 0.007)/less necessary (p = 0.022), low self‐management support (p = 0.003), food insecurity (p = 0.036), no healthcare coverage (p < 0.001), ≥1 (p = 0.003)/≥2 (p = 0.018) need insecurities. Of 192 taking insulin (69% female, 36% Hispanic, 41% non‐Hispanic Black, 16% non‐Hispanic white), 37.0% were low‐adherent. Beliefs that medicines are overused (p = 0.009), that diabetes is not serious (p = 0.010), low diabetes self‐efficacy (p = 0.035), high distress (p = 0.027), low self‐management support (p = 0.001), food insecurity (p = 0.020), ≥1 (p = 0.011)/≥2 (p = 0.015) insecurities increased odds of insulin low‐adherence. Conclusions Poor medication adherence, common in young adults with youth‐onset type 2 diabetes, is associated with interfering beliefs, diabetes distress and social factors. We must address these factors to develop tailored interventions for this vulnerable group.

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

“…We hypothesized that other psychological factors would predict adherence longitudinally, as we did find some cross-sectional (at one time point) associations. 10 In these longitudinal (over time) analyses, moderate-tosevere anxiety symptoms predicted higher odds of improved adherence, but the small number in this category (n = 10) hinders interpretation. While some report associations between other psychological factors and medication adherence, results are inconsistent.…”

“…depression, anxiety and self‐efficacy) 9 would predict medication adherence in the TODAY2 cohort. Associations between several factors and adherence in cross‐sectional analyses were observed 10 . However, cross‐sectional data cannot determine causality or direction of associations, this requires longitudinal data.…”

“…Associations between several factors and adherence in cross-sectional analyses were observed. 10 However, crosssectional data cannot determine causality or direction of associations, this requires longitudinal data. We present analyses identifying psychosocial predictors of medication adherence over time, the first longitudinal study of medication adherence in this vulnerable group.…”

Emerging Adults with Diabetes in Safety-Net Care: Self-Management Influences and Patient-Provider Interactions

“…Current research suggests that factors such as balancing life priorities and diabetes management, economic barriers, the degree of support, and the quality of relationships with health care providers may impact diabetes self-management and perceptions of adult care services among EAWD. 9,[13][14][15] However, further insight into the experiences of EAWD, particularly in underserved communities, is necessary to improve EAWD care. The purpose of this study was to investigate the needs and experiences of underserved EAWD within adult care through exploration of perspectives of EAWD receiving care within a safety-net health care system to gain insight to better serve this population.…”

“…Current research suggests that factors such as balancing life priorities and diabetes management, economic barriers, the degree of support, and the quality of relationships with health care providers may impact diabetes self-management and perceptions of adult care services among EAWD. 9,13-15…”