The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences

Abstract

Background. Medication adherence is negatively related to both diabetes distress (DD) and depressive symptoms (DS). Past research suggests gender differences in adherence, DD, and DS. A gap exists in determining if gender differences in adherence are mediated by DD and DS, or if gender moderates differences in adherence by DD/DS. Aims. This study investigated the relationship between gender, DD, DS, and medication adherence and tested for mediating and moderating effects on medication adherence among American Indian adults with type 2 diabetes. Method. The Maawaji idi-oog mino-ayaawin (Gathering for Health) study was a community-based participatory research collaboration with five American Indian tribes. Participants, randomly recruited from clinic records, shared information during computer-assisted personal interviews. This study includes the 166 participants who reported using medications to treat their diabetes. The relationship between gender, DD, DS, and medication adherence are explored. Possible mediating and moderating effects on medication were tested using regression and path analysis. Results. Females had higher levels of DD and DS and lower levels of medication adherence. Higher levels of DD and DS were both associated with lower medication adherence. No evidence was found that gender moderates the relationship between DD or DS and medication adherence. Instead, DD and DS mediated the relationship between gender and medication adherence. Conclusions. Medication adherence differences in male and female patients may be attributable to DD and DS. The present research highlights both DD and DS as targets for clinicians and researchers alike.

Gender Impact on Diabetes Distress Focus at Medical Communication Concerns, Life and Interpersonal Stress

“…According to the overall TDDS criteria for distinguishing diabetes distress, blood glucose control (HbA1c) is the main source of distress, although, given that its overall predictive power was not high (<20%), there may be other factors associated with diabetes distress, and these factors might also have gender differences. In recent years, some studies have found that females were more likely to have diabetes distress [ 11 , 12 ], and, in our study, the risk of diabetes distress was 2.67 times higher (odds ratio) in females than males, which is consistent with the literatures.…”

“…Compared with previous studies, this study did not find a relationship between healthy behaviors, such as eating habits and physical activity, and diabetes distress [ 12 , 25 ]; however, what appears to be consistent with the literature is that behaviors that are more directly related to blood sugar management, such as SMBG and medication compliance, are still significantly associated with diabetes distress [ 11 ]. Thus far, the evidence on whether focus on health behavior implementation can effectively improve diabetes distress is still inconsistent [ 26 ], and the reason may be that diabetes distress is mainly affected by the degree of glycemic control.…”

Diabetes und depressive Störungen

“…So weisen Patienten mit Diabetes, bei denen sich vermehrt depressive Symptome und/oder diabetesbezogene Belastungen finden, häufig problematische Stoffwechsel-und Blutdruckeinstellungen auf. Auch nehmen sie ihre Medikamente oft unzuverlässiger ein oder sie erscheinen mit der Behandlung insgesamt unzufriedener [10,14,[16][17][18].…”

Patient and Provider Perspectives on Medication Non-adherence Among Patients with Depression and/or Diabetes in Diverse Community Settings – A Qualitative Analysis

“…1 Medication non-adherence for patients with one or more chronic illnesses is extremely common, especially among patients who are prescribed medications for the management of chronic conditions such as diabetes and/or depression. [4][5][6][7] Medication non-adherence may be reduced by improving the quality of the patient-provider relationship 8 and improving understanding of adherence barriers. Accordingly, evidence supports adopting a patient-centered approach for improving medication adherence.…”