Adherence In Type Research Articles

Effect of single tablet of fixed-dose amlodipine and atorvastatin on blood pressure/lipid control, oxidative stress, and medication adherence in type 2 diabetic patients.

BackgroundOxidized low-density lipoprotein (LDL) plays central roles in the formation and progression of atherosclerotic lesions. Malondialdehyde (MDA)-modified LDL (MDA-LDL) is speculated to be generated as a result of oxidative stress in the human body. Because both amlodipine and atorvastatin have been reported to reduce oxidative stress, it is expected that both drugs would have a favorable influence to reduce oxidative stress.ObjectiveThe objective of this study was to investigate the effects of a single pill of amlodipine (5 mg)/atorvastatin (10 mg) on oxidative stress, blood pressure/lipid control and adherence to medication in patients with type 2 diabetes.MethodsThis combination tablet was administered to 29 patients (16 male), and MDA-LDL, blood pressure, lipid profile, renal/liver function, CPK, hs-CRP, adiponectin, BNP, and HbA1c were measured at baseline, 6, and 12 months, and baPWV and mean IMT were measured at baseline and 12 months. Medication adherence was examined using a questionnaire at 6 months.ResultsMDA-LDL was decreased significantly. LDL-C, TG, and Cr were significantly decreased at 6 and 12 months compared with baseline. eGFR was increased at 6 months, and urinary albumin/creatinine ratio was decreased at 12 months. BNP was decreased at 6 and 12 months, and adiponectin was increased at 12 months. Both mean IMT and baPWV were significantly decreased. The results of the questionnaire showed that 93% of patients were satisfied with this medication. No severe adverse event was observed.ConclusionThis combination tablet controlled both hypertension and dyslipidemia well in type 2 diabetic patients. The deceases in mean IMT and baPWV might suggest the improvement of atherosclerosis by this medication, which could be caused by the reduction of oxidative stress measured by MDA-LDL. In addition, this medication is expected to improve medication adherence.

Treatment Adherence in Type 1 Hereditary Tyrosinaemia (HT1): A Mixed-Method Investigation into the Beliefs, Attitudes and Behaviour of Adolescent Patients, Their Families and Their Health-Care Team.

Type 1 hereditary tyrosinaemia (HT1) is a rare metabolic disorder caused by an enzymatic defect in the metabolism of the amino acid tyrosine. Primary treatment for HT1 is nitisinone (Orfadin) in conjunction with a low-tyrosine/phenylalanine diet. The appropriate use of nitisinone medication and adhering to specialist diet is thus central to the successful management of HT1. To date, no published research has examined adherence (to medication and diet) and factors that influence it in the context of HT1. This study aimed to ascertain the extent to which non-adherence is a problem in this patient population, identify perceived barriers and facilitators to treatment adherence and explore the role of illness beliefs and treatment perceptions in treatment management. The present study used a combination of qualitative interviews and quantitative survey methods with patients, carers and health-care professionals (HCPs). This study found adherence to medication to be high amongst patients with HT1 and their carers who administer it. However, adherence to diet was reported to be much lower. A key factor influencing adherence to diet was age, with adolescents reported to have most difficulty adhering. The results indicate that adherence to dietary instructions becomes more problematic as children with HT1 grow older. Greater involvement in managing their condition and in their consultation at an early stage may have a positive impact on future adherence by increasing their investment and understanding of the treatment regime, potentially making adherence rates more stable and less influenced by moving through different life stages.

Effective interventions to improve medication adherence in Type 2 diabetes: a systematic review.

Medication adherence is associated with improved outcomes in diabetes. Interventions have been established to help improve medication adherence; however, the most effective interventions in patients with Type 2 diabetes remain unclear. The goal of this study was to distinguish whether interventions were effective and identify areas for future research. Medline was searched for articles published between January 2000 and May 2013, and a reproducible strategy was used. Study eligibility criteria included interventions measuring medication adherence in adults with Type 2 diabetes. Twenty seven studies met the inclusion criteria and 13 showed a statistically significant change in medication adherence. Heterogeneity of the study designs and measures of adherence made it difficult to identify effective interventions that improved medication adherence. Additionally, medication adherence may not be solely responsible for achieving glycemic control. Researchers must emphasize tailored interventions that optimize management and improve outcomes, and examine the need for clear indicators of medication adherence.

PCV120 - Effects of the Occurrence of a First Cardiovascular Event on Statin Adherence in Type 2 Diabetes: A Matched Cohort Design

Objectives: Adherence to statin therapy is important for an effective reduction in cardiovascular events. We aimed to assess the effect of the occurrence of a first cardiovascular event on adherence rates in type 2 diabetes patients using a matched cohort design. Methods: A matched cohort study was performed within the IADB. nl pharmacy database among type 2 diabetes patients, who initiated statin treatment for primary prevention. Index patients experienced a first event (index date) after initiation whereas reference patients did not. Index and reference patients were matched on gender, age at statin initiation, statin initiation date, adherence level before the index date and follow-up period. Adherence was measured as percentages of days covered and classified into: non-adherent, partial-adherent or full-adherent. Adherence rates were measured from statin initiation until the index date, and from the index date until end of follow-up, for reference patients in both cases the same follow-up period was used. Mean adherence rates between index and reference before and after were compared by the use of an independent samples T-test. Results: From the 855 index patients 375 could be matched to a reference patient. Mean adherence rates before the index date were 79% for both groups. After the index date, mean adherence rates were 81% for index patients and 71% for reference patients (p-value <0.001). Index patients were more likely to become fulladherent and less likely to become non-adherent. 26% of the index patients used more statins after the event than before whereas 20% used less. Conclusions: Patients receiving a statin are likely to become more adherent after the occurrence of a cardiovascular event during statin treatment. One in five of these patients, however become less adherent showing there are still important health and economic benefits to achieve by tailoring the management of individual patients.

A brief psychological intervention to improve adherence in type 2 diabetes

ObjectiveDiabetes perceptions, acceptance and treatment motivation are changeable factors of adherence. This study aimed to test the effects of brief psychological interventions based on diabetes threat and mastery perceptions in terms of adherence, acceptance and motivation. Physicians may find such interventions useful during a 15-minute consultation with diabetes patients. Research design and methodsThis randomized controlled study included 80 patients with type 2 diabetes, recruited from the hospital diabetes department, who were randomly assigned to four intervention groups based on autobiographical recall. Those in the two intervention groups were asked to recall diabetic events based on mastery and threat perceptions, respectively, whereas those in the two control groups recalled non-diabetic events based on positive and negative emotions, respectively. Following this, all participants completed validated self-questionnaires assessing diabetes perceptions, acceptance, treatment motivation and adherence. ResultsPatients in the threat group reported less adherence (P<0.01) and less avoidance (P<0.05), and perceived diabetes as less threatening (P<0.05) than those in the mastery group. Similar results were obtained when the threat group was compared with its matched negative-emotion control group (P<0.05, P<0.05 and P=0.087, respectively). Patients in the mastery group reported feeling a stronger sense of mastery (P<0.05) than those in their positive-emotion control group and greater treatment acceptance than those in the threat group (P<0.01). ConclusionContrary to conventional medical belief, discussing threatening personal events with patients can yield positive results. Health professionals should take threat and mastery perceptions of diabetes into account during regular consultations with a view to improving treatment acceptance and adherence. With this brief intervention of type 2 diabetes patients, it was also more effective to alleviate their emotional difficulties than to enhance their perception of mastery.

Adherence to Therapies in Patients with Type 2 Diabetes

Adherence to therapy is defined as the extent to which a person’s behavior in taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider. Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a healthy diet and exercise regimen, followed by early medication that generally includes one or more oral hypoglycemic agents and later may include an injectable treatment. To prevent the complications associated with type 2 diabetes, therapy frequently also includes medications for control of blood pressure, dyslipidemia and other disorders, since patients often have more than three or four chronic conditions. Despite the benefits of therapy, studies have indicated that recommended glycemic goals are achieved by less than 50% of patients, which may be associated with decreased adherence to therapies. As a result, hyperglycemia and long-term complications increase morbidity and premature mortality, and lead to increased costs to health services. Reasons for nonadherence are multifactorial and difficult to identify. They include age, information, perception and duration of disease, complexity of dosing regimen, polytherapy, psychological factors, safety, tolerability and cost. Various measures to increase patient satisfaction and increase adherence in type 2 diabetes have been investigated. These include reducing the complexity of therapy by fixed-dose combination pills and less frequent dosing regimens, using medications that are associated with fewer adverse events (hypoglycemia or weight gain), educational initiatives with improved patient–healthcare provider communication, reminder systems and social support to help reduce costs. In the current narrative review, factors that influence adherence to different therapies for type 2 diabetes are discussed, along with outcomes of poor adherence, the economic impact of nonadherence, and strategies aimed at improving adherence.

Interventions to promote treatment adherence in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is associated with increasing levels of morbidity and mortality. Full adherence to treatment recommendations such as pharmacological agents, dietary changes, physical activity and regular self-monitoring of blood glucose is essential to achieve good metabolic control. Cost-effective interventions such as individualised self-management education, cue-dose training and use of adherence aids have a positive impact on adherence to treatment recommendations, resulting in better glycaemic control. The application of these interventions could improve clinical outcomes within the NHS.

Biophysiologic Outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) Trial

BackgroundBehavioral research to improve lifestyle in broadly defined populations of patients with type 2 diabetes is limited. ObjectiveWe evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk. DesignIn this single-site, randomized clinical trial, participants were stratified by good and poor glycemic control (glycated hemoglobin <8% or ≥8%) and absence or presence of kidney disease, (estimated glomerular filtration rate ≥60 or <60 mL/min) and randomized within strata. Measurements were obtained at 0, 3, and 6 months. Participants/settingSelf-referred, community-dwelling adults with type 2 diabetes mellitus. InterventionThe intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring, and results were compared with an attention control group. Main outcome measuresGlycated hemoglobin, fasting serum glucose, lipid levels, blood pressure, weight, body mass index, and waist circumference were evaluated. Statistical analyses performedMean differences within and between randomization groups were compared over time. Intervention effects over time were estimated using random intercept models. ResultsTwo hundred ninety-six subjects were randomized, 256 (86.5%) completed 3-month and 246 (83.1%) completed 6-month assessments. Glycated hemoglobin was reduced in the intervention group by 0.5% at 3 months and 0.6% at 6 months (P<0.001 for each), and the control group by 0.3% (P<0.001) at 3 months and 0.2% (P<0.05) at 6 months; but between-group differences were not significant. In those with baseline glycated hemoglobin ≥8% and estimated glomerular filtration rate ≥60 mL/min, glycated hemoglobin was reduced in the intervention group by 1.5% at 3 months and 1.8% at 6 months (P<0.001 for each), and the control group by 0.9% (P<0.001) at 3 months and 0.8% (P<0.05) at 6 months; but between-group differences were not significant. In random intercept models, the estimated reduction in glycated hemoglobin of 0.29% was not significant. ConclusionsTwo behavioral approaches to improving general lifestyle management in individuals with type 2 diabetes mellitus were effective in improving glycemic control, but no significant between-group differences were observed.

Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study

BackgroundAdherence to prescribed medications is a key dimension of healthcare quality. The aim of this large population-based study was to evaluate self-reported medication adherence and to identify factors linked with poor adherence in patients with type 2 diabetes in France.MethodologyThe ENTRED study 2007, a French national survey of people treated for diabetes, was based on a representative sample of patients who claimed reimbursement for oral hypoglycaemic agents and/or insulin at least three times between August 2006 and July 2007, and who were randomly selected from the database of the two main National Health Insurance Systems. Medication adherence was determined using a six-item self-administered questionnaire. A multinomial polychotomous logistic regression model was used to identify factors associated with medication adherence in the 3,637 persons with type 2 diabetes.Principal FindingsThirty nine percent of patients reported good medication adherence, 49% medium adherence and 12% poor adherence. The factors significantly associated with poor adherence in multivariate analysis were socio-demographic factors: age <45 years, non-European geographical origin, financial difficulties and being professionally active; disease and therapy-related factors: HbA1c>8% and existing diabetes complications; and health care-related factors: difficulties for taking medication alone, decision making by the patient only, poor acceptability of medical recommendations, lack of family or social support, need for information on treatment, reporting no confidence in the future, need for medical support and follow-up by a specialist physician.ConclusionsIn a country with a high level of access to healthcare, our study demonstrated a substantial low level of medication adherence in type 2 diabetic patients. Better identification of those with poor adherence and individualised suitable recommendations remain essential for better healthcare management.

Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes

Most of interventions that have attempted to improve medication adherence in type 2 diabetes have been educational; on the assumption that knowledge regarding diabetes might affect patients' adherence to their treatment regimen. The purpose of the study was to investigate any association of knowledge and medication adherence with glycemic control in patients with type 2 diabetes mellitus. Setting The study was conducted at the Diabetes Outpatients Clinic, Hospital Pulau Penang. A cross-sectional study was conducted with a convenience sample of 540 adult patients with type 2 diabetes attending the clinic. A questionnaire including previously validated Michigan Diabetes Knowledge Test and Morisky Medication Adherence Scale was used and the patients' medical records were reviewed for haemoglobin A1C (HbA1C) levels and other disease-related information. A total of 35 (6.48%) patients were excluded after data collection due to lack of HbA1C results. Five hundred and five patients were included in the final analysis, with a mean age of 58.15 years (SD = 9.16), 50.7% males and median HbA1C of 7.6 (IQR was 6.7-8.9). The median total knowledge score was 7.0 (IQR was 5.0-10.0) while the median adherence score was 6.5 (IQR was 4.75-7.75). Significant correlations were found between the three variables (HbA1C, knowledge and adherence). A significantly higher score for knowledge and adherence (P < 0.05) was found in those patients with lower HbA1C. Higher diabetes knowledge, higher medication adherence and using mono-therapy were significant predictors of good glycemic control in the multivariate analysis. Patients' knowledge about diabetes is associated with better medication adherence and better glycemic control. In addition to other factors affecting medication adherence and glycemic control, healthcare providers should pay attention to knowledge about diabetes that the patients carry towards medication adherence.

Medication Adherence, Comorbidities, and Health Risk Impacts on Workforce Absence and Job Performance

To understand impacts of medication adherence, comorbidities, and health risks on workforce absence and job performance. Retrospective observational study using employees' medical/pharmacy claims and self-reported health risk appraisals. Statin medication adherence in individuals with Coronary Artery Disease was significant predictor (P < 0.05) of decreasing absenteeism. Insulin, oral hypoglycemic, or metformin medication adherence in type 2 diabetics was significant (P < 0.05) predictor of decreasing job performance. Number of comorbidities was found as significant (P < 0.5) predictor of absenteeism in five of nine subsamples. Significant links (P < 0.05) between high health risks and lower job performance were found across all nine subsamples. Results suggest integrated health and productivity management strategies should include an emphasis on primary and secondary prevention to reduce health risks in addition to tertiary prevention efforts of disease management and medication management.

Memory, Health Locus of Control and Adherence in Type II Diabetic Patients in Iran - Tabriz

This study aimed to find out the relationship between memory, health locus of control, and adherence. One hundred twenty patients with type II diabetes were selected. The findings showed that there was a significant negative relation between memory slips with adherence, also there was a significant positive correlation between internal, external health locus of control (other-powerful), with adherence. The result showed that the type II Diabetic patients who did have less memory slips, and know powerful individuals like physician responsible for their health and then they believe in own roles to control their health, display more adherence.

Does intervention by an allied health professional discussing adherence to medicines improve this adherence in Type 2 diabetes?

Increasing adherence to medicines should improve glycaemic control and be cost effective in patients with Type 2 diabetes. It is assumed that the intervention of an allied health professional will improve adherence to medicines, but this has not been well documented. The aim of this review was to determine whether an intervention by an allied health professional, including a discussion of adherence to medicines, improved adherence to medicines in these subjects. A comprehensive review of the literature was undertaken to determine this. All available studies were included and critically reviewed. When adherence to medicines was high in the treatment of Type 2 diabetes, an intervention by an allied health professional did not improve adherence. In studies in which the adherence could be improved the results were varied, with some studies showing improvement and some not. This variation existed whether the allied health professional was a nurse, a pharmacist or a diabetes educator, and whether the intervention was by phone or by counselling in person. In conclusion, prior to undertaking an intervention to improve adherence to medicines in Type 2 diabetes, it is necessary to know the baseline level of adherence, and if adherence is already high there is no point in undertaking an intervention. When adherence to medicines is low, it is not clear which interventions will improve adherence, and further studies are needed to clarify this.

Modeling the economic impact of medication adherence in type 2 diabetes: a theoretical approach

While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis. We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM) and oral (OAD) medications. Two analyses were performed, one which ignored adherence (analysis 1) and one which incorporated it (analysis 2). Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios. In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY) gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY). This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM. Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be considered in health care decision-making. Future work on the impact of adherence on health economic outcomes, and validation of different approaches to modeling adherence, is warranted.

Eficacia del modelo PRECEDE, de educación para la salud, en el control metabólico y de los factores de riesgo cardiovascular en pacientes con diabetes mellitus tipo 2

ObjectiveTo evaluate the effectiveness of PRECEDE model for health education, in the metabolic control and the reduction of cardiovascular risk factors, in type 2 diabetic patients followed for over two years in primary health care services. Materials and methodsPRECEDE model for health education was used in 318 patients with type 2 diabetes, from five primary health care centres. The study was conducted during two years of monitoring. ResultsAfter two years of follow-up was observed decrease in diastolic and systolic pressures (p < 0.05), as well as in levels of total cholesterol and LDL-cholesterol (p < 0.05). Patients with good metabolic control (glycated hemoglobin A1c < 7% and LDL cholesterol < 100 mg/dl), increased from 9.9% to 16.8% (p < 0,05). On the other hand, 27% of patients improved their level of therapeutic adherence, and there was a decreased in the number of patients with microalbuminuria from 8.4% to 6.3% (p = 0.05). Finally, we found no differences in levels of glycated hemoglobin A1c, BMI and cardiovascular risk. Mortality after two years was 0.7%. DiscussionPRECEDE model for health education is a useful method in the management of type 2 diabetes, that reduce the levels of blood pressure both systolic and diastolic, decrease the lipid levels, and improve the level of therapeutic adherence in type 2 diabetic patients, followed for two years.

Patient versus general practitioner perception of problems with treatment adherence in type 2 diabetes: From adherence to concordance

Objectives: To determine the prevalence of problems with treatment adherence among type-2 diabetic patients with regards to medication, dietary advice, and physical activity; to identify the associated clinical and psychosocial factors; and to investigate the degree of agreement between patient-perceived and GP-perceived adherence. Methods: Consecutive patients were solicited during visits to 39 GPs. In total, 521 patients self-reported on treatment adherence, anxiety and depression, and disease perception. The GPs reported clinical and laboratory data and patients' adherence. A multivariate analysis identified the factors associated with adherence problems. Results: Problems of adherence to medication, dietary advice, and physical activity recommendations were reported by 17%, 62%, and 47% of the patients, respectively. Six independent factors were found associated with adherence problems: young age, body-mass index (BMI) > 30 kg/m2, glycosylated haemoglobin (HbA1c) > 8%, single life, depression, and perception of medication as a constraint. Agreement between patients’ and GPs’ assessments of treatment problems reached 70%. Conclusion: In type 2 diabetes, problems with dietary advice or physical activity are far more frequent than problems with medication, and not all physicians are fully aware of patients’ problems. More active listening and shared decision-making should enhance adherence and improve outcomes.

Insulin delivery with FlexPen®: dose accuracy, patient preference and adherence

The introduction of insulin pens has helped improve adherence in Type 1 or 2 diabetes, and reduce inaccurate dosing, fear of injection, and social embarrassment associated with vial and syringe. This report presents the published evidence base for the accuracy, patient preference and economic evaluation of one prefilled pen, FlexPen® (Novo Nordisk A/S, Bagsværd, Denmark) and discusses recent changes to the design of this pen. Primary research publications that included the study of FlexPen were identified from various sources. Several studies have shown that FlexPen delivers high, medium and low doses of insulin significantly more accurately than vial and syringe, SoloStar® (sanofi-aventis, Paris, France) or OptiClik® (sanofi-aventis, Paris, France). Patients have also found FlexPen easier to use than vial and syringe. A Next Generation FlexPen® has been developed, which maintains the demonstrated accuracy of FlexPen and is accompanied by a reduced injection force for simpler and more comfortable use, and clear colour scheme for insulin type to avoid medication errors.

Depression, Self-Care, and Medication Adherence in Type 2 Diabetes

We examined the association between depression, measured as either a continuous symptom severity score or a clinical disorder variable, with self-care behaviors in type 2 diabetes. We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence. Of the patients, 19% met the criteria for probable major depression (HANDS score >or=9), and an additional 66.5% reported at least some depressive symptoms. After controlling for covariates, patients with probable major depression reported significantly fewer days' adherent to diet, exercise, and glucose self-monitoring regimens (P < 0.01) and 2.3-fold increased odds of missing medication doses in the previous week (95% CI 1.5-3.6, P < 0.001) compared with all other respondents. Continuous depressive symptom severity scores were better predictors of nonadherence to diet, exercise, and medications than categorically defined probable major depression. Major depression was a better predictor of glucose monitoring. Among the two-thirds of patients not meeting the criteria for major depression (HANDS score <9, n = 709), increasing HANDS scores were incrementally associated with poorer self-care behaviors (P < 0.01). These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care. Interventions aimed at alleviating depressive symptoms, which are quite common, could result in significant improvements in diabetes self-care.

Evaluation of treatment adherence in type 1 diabetes: a novel approach

Intensified insulin therapy requires outstanding compliance but no measure of therapy adherence has been agreed upon. The aim of the current study was to test the hypothesis that treatment adherence, as described by a novel multiple regression model, relates to glycosylated haemoglobin and hypoglycaemia frequency in type 1 diabetes. Furthermore, we sought to analyse the complex diurnal patterns of therapy adherence. Thirty type 1 diabetes patients (20 females and 10 males), treated with intensified insulin therapy, were studied in a retrospective manner. Patients were trained to follow treatment algorithms for adjusting regular insulin dosage which took into account the actual blood glucose, food intake and the time of the day. By means of multiple linear regression analysis, with regular insulin dosage as the dependent variable, blood glucose and food intake as the independent variables, the insulin treatment algorithms actually used by the individual patient were retrieved. The correlation between prescribed and implemented insulin therapy served as a measure of adherence. Metabolic control was assessed by glycosylated haemoglobin and hypoglycaemia frequency. Median glycosylated haemoglobin was 7.7% (range: 6.3-10.8); median monthly hypoglycaemia frequency was 3.8 (range: 0-9.8). Patients with good metabolic control (glycosylated haemoglobin < 7.7 and/or hypoglycaemia frequency < 3.8 per month) adhered to prescribed insulin dosing algorithms more frequently than those with poor metabolic control. In patients with type 1 diabetes on intensified therapy a positive relationship between adherence to the therapy prescribed and metabolic control exists.

Effect of Psychological Intervention on Exercise Adherence in Type 2 Diabetic Subjects

Previous research has pointed to the efficacy of physical activity in individuals suffering from type 2 diabetes mellitus (type 2 DM). However, as with other populations, adherence to exercise programs is often problematic. This study assessed the effectiveness of a combination of exercise and psychological interventions in type 2 diabetics in terms of disease management and exercise adherence. Forty newly diagnosed type 2 diabetic subjects (54 +/- 6.5 years) took part in the study. Subjects were allocated to an exercise-only intervention (EO) or a combined exercise and psychological adherence intervention (EP) group. Adherence to the program was also monitored at a 6-month follow-up. The results confirmed a significant improvement in physiological parameters (total mass, fat mass, grip strength, peak flow, flexibility, and VO2 max) after the 12-week program in both groups (P < 0.001). The EP group had significant changes in body fat, grip strength, and peak flow (P < 0.05) in comparison to the EO group. Components of the visual analog mood scale (VAMS) were positively influenced in both groups from the therapy program (P < 0.001). The directed psychological intervention had a significant influence on attendance to the 12-week program (P < 0.001). This also resulted in significantly better adherence 6 months later (P < 0.05). In conclusion, the results have demonstrated that psychological intervention is of paramount importance for ensuring high adherence rates during exercise therapy for type 2 diabetic subjects.