Patient Perspective on Factors Contributing to Nonadherence to Diabetes Regimen

Abstract

This study assessed levels of regimen adherence and reasons for nonadherence to different aspects of diabetes regimen for persons with type I (insulin-dependent, N = 24) and type II (non-insulin-dependent, N = 184) diabetes. Standardized questions revealed few differences between type I and type II participants on either levels of reported adherence or reasons for nonadherence. Subjects reported adhering least well to dietary and physical activity components of the regimen. Open-ended questions revealed that the most common reasons for dietary nonadherence were the situational factors of eating out at restaurants and inappropriate food offers from others. In contrast, negative physical reactions were the most frequently reported reasons for exercise nonadherence. The implications of these findings for diabetes education are discussed.

Diabetes dietary management alters responses to food pictures in brain regions associated with motivation and emotion: a functional magnetic resonance imaging study

“…To reduce the risk of developing both short-and long-term physical complications, patients are encouraged to reduce their energy intake and to adopt a well-balanced, healthy diet that is low in fat and sugar and high in fibre. However, many individuals with diabetes have difficulty following this advice [1]. Moreover, those who do adhere to their dietary recommendations often report feeling deprived and having to deal with cravings for foods [2,3].…”

Barriers to good glycaemic control: the patient's perspective

“…The targets that we set for diabetic patients include some that other patient groups have experienced as near impossible: the act of remembering to take medication is a burden even for the young, whose memories are reliable and who are spurred on by an awareness of the investment they are making for their future health; obese patients attempting to lose weight struggle with their undertaking despite specialist advice, medication, and even sometimes surgery. The tasks set for diabetic patients include both daily medication-taking and losing weight, but to this are added dietary changes, the aspect of self-management, which is generally found most dif®cult by patients, 9 smoking and alcohol restrictions, and home blood glucose monitoring, among others. Taking medication has been found less burdensome than some other tasks, 9 perhaps re¯ecting deeply ingrained beliefs in society about the patient's responsibilities when taking on thè sick role'.…”

“…The tasks set for diabetic patients include both daily medication-taking and losing weight, but to this are added dietary changes, the aspect of self-management, which is generally found most dif®cult by patients, 9 smoking and alcohol restrictions, and home blood glucose monitoring, among others. Taking medication has been found less burdensome than some other tasks, 9 perhaps re¯ecting deeply ingrained beliefs in society about the patient's responsibilities when taking on thè sick role'.…”

What influences patients to change?: a qualitative exploration of health decision-making factors among diabetes patients

“…Diabetics may be required to follow a meal plan, take up exercising, follow a foot-care plan, regulate blood glucose levels, manage other diabetes-related symptoms, and take insulin or an oral hypoglycemic (McNabb, 1997). Each of these different components requires a different skill set or belief system and consequently a person may be adherent with certain portions of the regimen and not others (Ary, Toobert, Wilson, & Glasgow, 1986). Individuals with diabetes indicate that the more difficult components of treatment to manage are diet and exercise (Christensen, Terry, Wyatt, Pichert, & Lorenz, 1983;Glasgow, McCaul, & Schafer, 1987), incidentally facets of the regimen that require the largest time commitment and change in lifestyle.…”

“…Moving from the strictures of the "compliance" debate to the broader concern of how people make health-related decisions, it becomes evident that the role of the patient in health care has been disregarded (Ary, Toobert, Wilson, & Glasgow, 1986;Chubon, 1989;McClean, 1997). Research seems to support the myth of the patient as a passive recipient of medical advice (Stone, 1997).…”