Worse Medication Adherence Research Articles

Factors Influencing Antihypertensive Medication Adherence Among Historically Underrepresented Adults: A Meta-analysis.

Addressing disparities in blood pressure control must include supporting antihypertensive medication adherence (MA). Developing effective MA interventions requires identifying the most important factors influencing MA. In this review, the authors aimed to meta-analyze the results of research testing associations between factors potentially influencing antihypertensive MA and assessed antihypertensive MA in historically underrepresented populations. Additional exploratory analyses focused on system-level factors, which have been understudied and may particularly impact disparities in MA. A health sciences librarian assisted with searching across 10 databases. Inclusion criteria included (1) published in English, (2) sample of adults with hypertension, (3) ≥50% of participants having self-identified as a race/ethnicity underrepresented in the country where the study was conducted, and (4) reporting sufficient data to calculate effect size(s). Fifty-eight studies were eligible for inclusion. Nine factors met criteria for planned analyses. Older age ( r = 0.08, P < .01; k = 26 studies) and higher income ( r = 0.11, P = .01; k = 15) were significantly correlated with better MA. Having depressive symptoms was significantly correlated with worse MA ( r = -0.18, P < .01; k = 11). Effect sizes for sex, education level, marital status, number of medications, comorbidities, and perceived social support were not significant. System-level factors examined included insurance coverage, access to healthcare, perceived barriers, having a primary care provider, perceptions of their healthcare provider, and experiences of discrimination in healthcare. Understanding the impact of factors associated with antihypertensive MA in historically underrepresented adults can support development of targeted, culturally relevant MA interventions. Future research should examine the impact of system-level factors on antihypertensive MA among historically underrepresented populations.

Antihypertensive and Lipid-Lowering Medication Adherence in Young Adults With Youth-Onset Type 2 Diabetes

Youth-onset type 2 diabetes is associated with early development of chronic complications. Treatment of elevated blood pressure (BP), nephropathy, and dyslipidemia are critical to reduce morbidity. Data are needed on adherence to BP- and lipid-lowering medications in young adults with youth-onset diabetes. To assess adherence and factors associated with adherence to BP- and lipid-lowering medications in young adults with youth-onset type 2 diabetes and diagnoses of hypertension, nephropathy, or dyslipidemia. This cohort study measured medication adherence with 3 monthly unannounced pill counts at 2 time points 1 year apart during iCount, conducted during the last years (2017-2019) of the observational phase of the Treatment Options for Type 2 Diabetes in Adolescents and Youth study. Psychosocial factors associated with medication adherence were examined. Participants included individuals with youth-onset type 2 diabetes with hypertension, nephropathy, or dyslipidemia receiving diabetes care in their communities. Data were analyzed from September 2022 to September 2023. The main outcome was BP- and lipid-lowering medication adherence, with low adherence defined as using less than 80% of pills and high adherence, at least 80% of pills. Psychosocial factors were measured using the Beliefs about Medicines Questionnaire and Material Needs Insecurities Survey. Of 381 participants in iCount, 243 participants (mean [SD] age, 26.12 [2.51] years; 159 [65.43%] women) with hypertension, nephropathy, or dyslipidemia were included in analysis. Among 196 participants with hypertension or nephropathy, 157 (80.1%) had low adherence. Participants with low adherence, compared with those with high adherence, were younger (mean [SD] age, 25.99 [2.41] vs 27.26 [2.41] years; P = .005), had higher glycated hemoglobin A1c (mean [SD], 10.33% [2.66 percentage points] vs 8.85% [2.39 percentage points]; P = .001), shorter diabetes duration (mean [SD], 12.32 [1.49] vs 12.90 [1.46] years; P = .03), and less education (eg, 17 participants [10.83%] vs 0 participants with no high school diploma; P = .004). Of 146 participants with dyslipidemia, 137 (93.8%) had low adherence and only 9 participants (6.2%) had high adherence. Of 103 participants with low adherence to BP-lowering medications and using oral hypoglycemic agents, 83 (80.58%) had low adherence to oral hypoglycemic agents. Beliefs that medications are necessary were higher for participants with high adherence to BP-lowering medications than those with low adherence in unadjusted analyses (mean [SD] necessity score, 16.87 [6.78] vs 13.89 [9.15]; P = .03). In adjusted multivariable analyses of participants with hypertension or nephropathy, having at least 1 unmet social need (odds ratio [OR], 0.20; 95% CI, 0.05-0.65; P = .04) and medication concerns (OR, 0.63; 95% CI, 0.40-0.96; P = .01) were associated with worse medication adherence 1 year follow-up. Diabetes distress, self-efficacy, depressive and anxiety symptoms, and self-management support were not associated with 1-year medication adherence. These findings suggest that adherence to BP- and lipid-lowering medications was very poor in this cohort. To improve medication adherence and prevent early vascular events, approaches that identify and address medication concerns and unmet social needs are needed.

Cross-sectional analysis of factors associated with medication adherence in western Kenya

ObjectivesPoor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western...

Relationships between neuropsychological performance, insight, medication adherence, and social metacognition in schizophrenia

BackgroundSocial metacognition is still poorly understood in schizophrenia, particularly its neuropsychological basis and its impact on insight and medication adherence. We therefore quantified social metacognition as the agreement between objective and subjective mentalization and assessed its correlates in a sample of individuals with schizophrenia spectrum disorders. MethodsParticipants consisted of 143 patients with schizophrenia or schizoaffective disorders who underwent a metacognitive version of a mentalization task, an extensive neuropsychological battery, and a clinical evaluation to assess their insight into illness and medication adherence. We studied potential interactions between confidence judgments and several neuropsychological and clinical variables on mentalization accuracy with mixed-effects multiple logistic regressions. ResultsConfidence judgments were closely associated with mentalization accuracy, indicative of good social metacognition in this task. Working memory, visual memory, and reasoning and problem-solving were the three neuropsychological dimensions positively associated with metacognition. By contrast, the two measures of medication adherence were associated with poorer metacognition, whereas no association was found between metacognition and clinical insight. The multiple regression model showed a significant positive impact of better working memory, older age at onset, longer duration of hospitalization, and worse medication adherence on social metacognition. ConclusionsWe discuss possible mechanisms underlying the apparent association between social metacognition and working memory. Adherence should be monitored when remediating social metacognition, and psychoeducation should be given to patients with a high level of awareness of their capacity to mentalize.

Working memory deterioration as an early warning sign for relapse in remitted psychosis: A one-year naturalistic follow-up study

BackgroundRelapse prevention is an important goal in the clinical management of psychosis. Cognitive deficits/deterioration can provide useful insights for monitoring relapse in psychosis patients. MethodsThis was a prospective, naturalistic 1-year follow-up study involving 110 psychosis patients with full clinical remission. Relapse, defined as the recurrence of psychotic symptoms, was monitored monthly along with digital tracking of verbal and visual working memory using a mobile app developed for this study. Cognitive deterioration was defined as worsening performance over 2 months prior to relapse or study termination, whichever was earlier. Other clinical, cognitive, functioning, and psychosocial variables were also collected. ResultsAt 1 year, 18 (16.36%) patients relapsed, of which 6 (33.33%) required hospitalization. Relapse was predicted by verbal working memory deterioration 2 months prior to relapse (p = 0.029), worse medication adherence (p = 0.018), and less resilience (p = 0.014). ConclusionsVerbal working memory deterioration is a novel early sign of relapse. It is a clearly defined, objectively measurable, and reproducible marker that can help clinicians and healthcare workers identify patients at risk of relapse and make decisions about maintenance therapy. Moreover, digital monitoring is a viable tool in the management of relapse.

Stigma in bipolar disorder: A current review of the literature.

Stigma has been found to have an impact on those living with bipolar disorder, with many experiencing negative consequences of stereotypes, prejudice and discrimination as a result of their condition. The aim of this review was to assess the current literature in bipolar disorder to determine the impact of stigma on people living with this condition and caregivers. Public stigma was associated with greater functional impairment, anxiety and poorer work-related outcomes, while self-stigma was also found to be associated with lower levels of functioning across a range of domains and greater depressive and anxiety symptoms. For those with bipolar disorder, public stigma was reported at similar rates to those with schizophrenia and depression in some studies, with other studies noting mixed results. Qualitative studies noted that public stigma and discrimination were experienced from family, friends and healthcare providers. Self-stigma was found to be higher for those who were younger in several studies and associated with worse medication adherence. It was generally found to be higher in bipolar disorder participants than in those with anxiety disorders and lower than those with personality disorders. Limitations of the current research include the following: few studies have used a longitudinal design, few have assessed the impact of stigma on medication adherence and few have explored these issues in younger populations. More research is needed to explore the experiences of self-stigma for those in the younger age group specifically, given the relationship between younger age and greater self-stigma noted in several studies and the relationship between this and lower treatment adherence.

Food insecurity and mental health during the COVID-19 pandemic in cystic fibrosis households.

The COVID-19 pandemic impacted many households due to shelter-in-place orders and economic hardship. People with cystic fibrosis (CF) experienced increased food insecurity compared to the general population before the pandemic, even though adequate food access is needed to maintain nutrition goals associated with improved health-related outcomes. Little is known about the impact the pandemic had on the food insecurity of people with CF and their families. To investigate how the COVID-19 pandemic impacted food insecurity, mental health, and self-care in people with CF. Adults with CF and parents/guardians of children with CF were recruited via social media to complete online questionnaires from May 2020 to February 2021. Questionnaires in English and Spanish included USDA 2-question food insecurity screening, Patient Health Questionnaire-4 for mental health screening, and directed questions on the impact of the pandemic. Of 372 respondents, 21.8% of the households experienced food insecurity during the pandemic compared to 18.8% prepandemic (p < .001). More food insecure patients with CF reported weight loss (32.1% vs. 13.1%, p < .001), worse airway clearance adherence (13.6% vs. 5.8%, p < .01), and worse medication adherence (12.4% vs. 1.7%, p < .01) compared to food secure patients. Food insecure subjects were more likely to have an abnormal mental health screen compared to food secure subjects (53.1% vs. 16.2%, p < .001). Food insecurity increased in the CF population during the COVID-19 pandemic. Food insecure subjects reported worse mental health and self-care during the pandemic compared to food secure subjects.

The Relationship Between COVID-19 Related Stress and Medication Adherence Among High-Risk Adults During the Acceleration Phase of the US Outbreak.

PurposeTo assess the relationship between stress regarding COVID-19 and medication adherence.Patients and MethodsOlder adults with ≥1 chronic condition(s) were recruited from 4 active, federally funded studies in Chicago to participate in a longitudinal telephone survey. Participants self-reported stress regarding COVID-19 in the last week. Adherence was measured via the ASK-12 survey.ResultsMost participants reported feeling stressed “some of the time” (54.0%), while 18.2% felt stressed “most” or “all of the time” and 27.8% “never” felt stressed. In bivariate analyses, participants who reported being stressed “most” or “all of the time” had worse medication adherence than participants who reported being stressed “some of the time” or “never” (p < 0.001). In multivariable analyses, participants who reported feeling stressed “most” or “all of the time” had worse adherence than those who “never” felt stressed (Adjusted Least Square Mean (Standard Error): 21.3 (0.6) vs 19.7 (0.6), p=0.01).ConclusionStress due to COVID-19 has significantly impacted medication adherence, which has negative implications for the course of both COVID-19 and comorbid conditions. Healthcare providers should be aware of the potential impact of COVID-19 on patients’ mental and physical well-being and consider ways to routinely assess patient experiences.

When Stakes Are High and Stress Soars: Addressing Health Literacy in the Critical Care Environment.

When Stakes Are High and Stress Soars: Addressing Health Literacy in the Critical Care Environment.

782-P: Diabetes Stigma and Associations with Medication Adherence and Glycemic Control

Diabetes stigma is an emerging determinant of behaviors and outcomes. The theoretically-informed validated Comprehensive Diabetes Stigma Scale (CDSS), evaluates diabetes stigma and includes four subscales measuring enacted, perceived and self-stigma and concealment. This study tested associations between CDSS scores, medication adherence and HbA1c in a prospective cohort. We hypothesized that greater diabetes stigma would be associated with worse diabetes medication adherence and HbA1c. Pearson’s correlations and multivariable linear regression models adjusting for age, sex, race, education, insurance, partner status, diabetes duration and insulin use quantified the association of baseline CDSS scores and with ARMS-D scores and HbA1c assessed 3-6 months after enrollment. Participants (n=254) were 60 (SD 11) years old, 53% female, 80% White, 61% used insulin, mean HbA1c 7.7% (SD 1.6), and were living with diabetes for 14 (SD 9) years. CDSS scores and bivariate correlations shown in the Table. In adjusted models, CDSS overall score was associated with worse medication adherence (β 95%CI: 0.70, 0.01 - 1.39; p=0.05), but not with HbA1c (0.21, -0.05- 0.47; p=0.45). Only concealment was associated with worse HbA1c (0.48, 0.18-0.78; p=0.01). Prospective adjusted associations underline the importance of addressing concealment as a behavioral response to stigma leading to worse clinical outcomes in diabetes. Disclosure K. Cavanaugh: None. L.B. Beach: None. A.J. Hackstadt: None. K. Wallston: None. T. Elasy: None. L.S. Mayberry: None. Funding National Institutes of Health (P30DK92986-09, P30DK020593, UL1TR002243, K12HL143959)

Neurocognitive intra-individual variability within HIV+ adults with and without current substance use.

HIV infection and current substance use (SU) are linked to cognitive and functional deficits, yet findings on their combined effects are mixed. Neurocognitive intraindividual variability, measured as dispersion of scores across a neuropsychological battery, is associated with worse cognitive outcomes and functional deficits among HIV+ adults but has not been studied in the context of HIV+ adults with current SU. We hypothesized that, among HIV+ adults, current SU would be associated with greater dispersion, that greater dispersion would be associated with worse medication adherence, and that this relationship would be worse among substance users. Forty HIV+ adults completed neuropsychological, psychiatric, SU, and medical evaluations and an electronic medication adherence measure. General linear models evaluated the main effect of SU status on neurocognitive dispersion, and models stratified by SU status evaluated the effect of dispersion on medication adherence, adjusting for relevant covariates. The SU+ group showed greater dispersion than did the SU- group, t(38) = 2.74, p = .049, d = 0.81, but this association did not survive multiple comparisons. Stratified analyses indicated a negative relationship between dispersion and medication adherence among the SU+ group but not in the SU- group; however, this effect was reduced after accounting for depressive symptoms. We found preliminary evidence that current SU is associated with greater neurocognitive dispersion among HIV+ adults. SU and neurocognitive dispersion may have a synergistic effect on medication adherence; however, this effect is largely accounted for by depressive symptoms. Future research should examine progression of dispersion in HIV and consequent neurocognitive and functional deficits in those with current SU. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Patterns of Healthcare Use and Medication Adherence among Youth with Systemic Lupus Erythematosus during Transfer from Pediatric to Adult Care.

Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes. We describe patterns of rheumatology/nephrology care and changes in healthcare use and medication adherence during transfer. We identified youth ages 15-25 with SLE using US private insurance claims from Optum's deidentified Clinformatics Data Mart. Rheumatology/nephrology visit patterns were categorized as (1) unilateral transfers to adult care within 12 months, (2) overlapping pediatric and adult visits, (3) lost to followup, or (4) continuing pediatric care. We used negative binomial regression and paired t tests to estimate changes in healthcare use and medication possession ratios (MPR) after the last pediatric (index) visit. We compared MPR between youth who transferred and age-matched peers continuing pediatric care. Of the 184 youth transferred out of pediatric care, 41.8% transferred unilaterally, 31.5% had overlapping visits over a median of 12 months before final transfer, and 26.6% were lost to followup. We matched 107 youth continuing pediatric care. Overall, ambulatory care use decreased among those lost to followup. Acute care use decreased across all groups. MPR after the index date were lower in youth lost to followup (mean 0.24) compared to peers in pediatric care (mean 0.57, p < 0.001). Youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months and have worse medication adherence, placing them at higher risk for adverse outcomes.

The Association between Medication Adherence and Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study

To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). The CIGTS was a randomized, multicenter clinical trial comparing initial treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed glaucoma. Three hundred seven participants randomized to the medication arm of the CIGTS. Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, "Did you happen to miss any dose of your medication yesterday?" The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported. Mean deviation over time. Three hundred seven subjects (306 with adherence data) were randomized to treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P= 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17-1.06; P= 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86-1.98; P < 0.0001); and subjects who reported missing medication doses at two thirds of visits showed a loss of 2.23 dB (95% CI, 1.19-3.26; P < 0.0001). This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and glaucomatous vision loss.

The implementation and sustainment facilitation strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized, type 2 hybrid trial.

Background:Substance use disorders (SUDs) among people with HIV are both prevalent and problematic. The Substance Abuse Treatment to HIV care project was funded to test the Implementation and Sustainment Facilitation (ISF) strategy as an adjunct to the Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-based brief intervention (MIBI) for SUDs within HIV community-based organizations.Methods:Using a cluster-randomized, type 2 hybrid trial design, 39 HIV organizations were randomized to either (1) ATTC (n = 19) or (2) ATTC + ISF (n = 20). Each HIV organization identified two staff members to be prepared to implement the MIBI (N = 78). Subsequently, during the implementation phase, HIV organizations in each condition randomized client participants (N = 824) to one of the two intervention conditions: usual care (UC; n = 415) or UC + MIBI (n = 409). Both staff-level outcomes and client-level outcomes were examined.Results:The ISF strategy had a significant impact on the implementation effectiveness (i.e., the consistency and the quality of implementation; β = .65, p = .01) but not on time-to-proficiency (β = −.02) or level-of-sustainment (β = .09). In addition, the ISF strategy was found to have a significant impact on the intervention effectiveness (the effectiveness of the MIBI), at least in terms of significantly decreasing the odds (odds ratio = 0.11, p = .02) of clients using their primary substance daily during follow-up.Conclusion:The ISF strategy was found to be an effective adjunct to the ATTC strategy in terms of implementation effectiveness and intervention effectiveness. It is recommended that future efforts to integrate the project’s MIBI for SUD within HIV organizations use the ATTC + ISF strategy. However, given the ISF strategy did not have a significant impact on level-of-sustainment, implementation research testing the extent to which the ATTC + ISF strategy can be significantly enhanced through effective sustainment strategies is warranted.Plain language abstractSubstance use among people living with HIV is associated with increased mental health problems, worse medication adherence, and worse HIV viral suppression. Increasing substance use-related services in HIV community-based organizations is an important public health need. The Substance Abuse Treatment to HIV care project tested two strategies for helping HIV organizations implement a brief intervention (BI) designed to motivate clients to decrease their substance use. The project also tested if receiving a BI improved clients’ outcome. Two staff from each of the 39 participating organizations were taught how to deliver the BI using the Addiction Technology Transfer Center (ATTC) training strategy (online and in-person training, monthly feedback, and coaching). Half of the organizations also received the Implementation and Sustainment Facilitation (ISF) strategy, which included monthly meetings with an ISF coach for the two BI staff and one or more leadership staff from the organization. Organizations that received both the ATTC and ISF strategies delivered more BIs and higher quality BIs than organizations that only received the ATTC strategy. In addition, clients receiving BIs at organizations that received both strategies were more likely to decrease their substance use. However, receiving both strategies did not improve how quickly staff learned to deliver the BI or improve the number of BIs delivered during the project’s 6-month sustainment phase. Future research focused on implementing BIs within HIV organizations should consider using the ATTC and ISF strategies while also seeking to enhance the strategies to improve sustainment.

Psychosocial factors and medication adherence among recipients of vascularized composite allografts.

Objectives:Psychosocial factors are important predictors of medication adherence, and subsequently graft survival, in solid organ transplantation. Early experiences suggest this may also be the case in vascularized composite allotransplantation.Methods:Using validated tools, we surveyed upper extremity transplant recipients at two centers to assess depression (Patient Health Questionnaire-9), personality (Ten-Item Personality Inventory), anxiety (Generalized Anxiety Disorder 7-Item Scale), post-traumatic stress disorder (Primary Care Post-Traumatic Stress Disorder Screen for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), and social support (Multidimensional Scale of Perceived Social Support). Medication adherence among vascularized composite allotransplantation recipients at two centers was assessed by a member of the clinical research team using the recipients’ medical records.Results:Medication adherence was reported for 12 vascularized composite allotransplantation recipients, and 9 vascularized composite allotransplantation recipients completed psychosocial assessments. Most recipients were believed to be adherent to their immunosuppression, however, three recipients were believed to be non-adherent and a member of the clinical team had discussed non-adherence at least once with five recipients. Results from the psychosocial assessment (n = 9) indicated that eight participants had high levels of social support, and eight demonstrated high levels of conscientiousness which have been associated with better medication adherence in solid organ transplantation. However, three participants demonstrated mild anxiety, two demonstrated minimal symptoms of depression, and one demonstrated post-traumatic stress disorder which have been associated with worse medication adherence in solid organ transplantation.Conclusion:These findings lay the groundwork for future assessments of the role psychosocial factors play in facilitating medication adherence and broader transplant outcomes.

Health profile and medication adherence of diabetic patients in the Portuguese population

AimsTo understand the psychological and behavioural impact of type 2 diabetes in the Portuguese Primary Care setting. MethodsObservational, cross-sectional study of a convenience sample of portuguese people diagnosed with type 2 diabetes mellitus. The Diabetes Health Profile (DHP-18) and the Four Item Morisky Medication Adherence Scale (MMAS-4) were applied, as well as socio-demographic and disease-related questions. ResultsIn a n=110 patient sample, lower education level showed a negative impact on the Psychological Distress dimension (p=0,013). In the Barriers to activity dimension, significant differences were found between different age groups (p=0,033) – a better health profile was observed in the 40–59 years group and also between gender (p=0,039) – greater impact in female subjects. Disinhibited Eating dimension wasn’t associated with any of the studied variables. However, all the groups showed worse results in this domain. No associations were found between DHP and medication adherence. Worse medication adherence is more common when there is a prevailing notion of lack of control of diabetes. Discussion and ConclusionUsing DHP, a larger negative impact related to type 2 diabetes mellitus is found in those with lower educational level, female and younger (20–39 years) or older (60–79 years) subjects. Broader information strategies aimed at improving the quality of life of diabetic patients is necessary, particularly those related to nutrition.

Abstract P208: Association of Baseline Medication Burden With Blood Pressure Control, Patient-Reported Outcomes, and Serious Adverse Events: Findings from the SPRINT Trial

Background: Achieving intensive systolic blood pressure (SBP) control (&lt;120 mmHg) requires more antihypertensive medications than standard control (&lt;140 mmHg). It is unclear how total medication burden impacts hypertension outcomes. Objective: To evaluate the association of total medication burden at baseline and SBP control, serious adverse events (SAEs), medication adherence, and treatment satisfaction in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: Baseline medication data were obtained by pill bottle review at randomization and categorized as high (≥ 5 prescription medications) vs low (&lt; 5 medications) medication burden. SBP control per randomization goal, eight item Morisky Medication Adherence Scale (MMAS 8), and Treatment Satisfaction Questionnaire were evaluated at 1-year. SAEs were collected over the trial. We calculated adjusted risk ratios (RR) and hazard ratios (HR) for each outcome associated with medication burden using multivariable regression models stratified by randomized group. Results: Among 8454 participants with available data at 1-year follow up, 4797 (57%) and 3657 (43%) had high and low medication burden, respectively (mean medications ± SD; 8 ± 3 vs 3 ± 1). High medication burden was associated with reduced SBP control in the intensive arm (RR, 95%CI; intensive 0.92, 0.87-0.98; standard 0.98, 0.94-1.03; interaction p 0.01) and increased SAEs in both arms (HR, 95%CI; intensive 1.57, 1.40-1.77; standard 1.59, 1.41-1.78; interaction p 0.54). High medication burden was associated with worse medication adherence in the intensive arm and improved adherence in the standard arm (RR for MMAS 8 ≥6, 95%CI; intensive 0.97, 0.94-1.00; standard 1.05, 1.02-1.09; interaction p &lt;0.01). High medication burden was not associated with hypertension treatment satisfaction (RR for satisfied/very satisfied, 95%CI; intensive 0.99, 0.98-1.00; standard 0.98, 0.97-1.00; interaction p 0.50). Conclusion: In SPRINT, high medication burden at baseline was associated with higher risk of SAEs. The association of high medication burden on the likelihood of achieving SBP goal and medication adherence at 1 year was different by treatment arm; medication burden was not associated with hypertension treatment satisfaction.

Comprehensive Diabetes Stigma Scale—Associations with Patient Characteristics and Outcomes

Stigma related to health conditions has been linked to poor medication adherence and health outcomes. With input from patients living with diabetes, diabetes clinicians, and stigma researchers, we designed the Comprehensive Diabetes Stigma Scale (CDSS). We hypothesized that higher diabetes stigma would be associated with worse medication adherence, younger age, insulin use, and higher HbA1c values. We recruited adults with diabetes on ≥1 diabetes medication in person from one academic practice and online via ResearchMatch. Participants completed the 15-item CDSS and measures of perceived diabetes stigma from family members, psychological and behavioral consequences of diabetes stigma, and medication adherence. Participants self-reported the range of their most recent HbA1c lab value. Spearman correlations and multiple linear regression were used to assess associations between variables. Participants (n=311) were on average 61 ± 11 years; 56% female and 86% white. Most (69%) participants endorsed at least 1 CDSS-15 item, 34% reported HbA1c &amp;gt;7.0%, and 49% reported insulin use. CDSS-15 scores correlated with diabetes family perceived stigma (ρ=0.51, p&amp;lt;0.01) and consequences of diabetes stigma (ρ =0.63, p&amp;lt;0.01). Higher diabetes stigma correlated with worse medication adherence (ρ =0.40, p&amp;lt;0.01). This association remained significant after adjusting for age, sex, race, diabetes duration, insulin use, and marital, employment, and insurance status (β=0.17, p&amp;lt;0.01). By age, younger participants had higher CDSS-15 scores (ρ =-0.35, p&amp;lt;0.01). CDSS-15 scores did not differ by insulin use status (ρ =0.03, p=0.59). The mean CDSS-15 score of participants with HbA1c &amp;lt;6.4% (23; 95% CI 21-25) was lower than those with HbA1c &amp;gt;9.0% (30; 95% CI 19-41), but this difference was not significant (p=0.06). These findings reinforce that diabetes stigma is prevalent and show for the first time that diabetes stigma may be a unique factor contributing to suboptimal diabetes medication adherence. Disclosure L.B. Beach: None. S. Kankotia: None. C.U. Dinh: None. T. Elasy: None. L.S. Mayberry: None. K. Wallston: Advisory Panel; Self; EdLogics Inc.. G. Phillips: None. P. Janulis: None. K. Cavanaugh: None.

Relationship between healthy lifestyle behaviors and cardiovascular risk factors in Chinese patients with type 2 diabetes mellitus: a subanalysis of the CCMR-3B STUDY.

This subanalysis of a cross-sectional, nationwide study was undertaken to assess the relationship between healthy lifestyle behaviors and multiple cardiovascular risk factors among people with type 2 diabetes mellitus (T2DM). Data collected from 25,454 participants, including demographics, lifestyle behaviors and cardiovascular risk profiles, were analyzed. Blood pressure control as well as blood glucose and blood lipid (3Bs) levels were measured as multi-risk factors for cardiovascular disease. Healthy lifestyle behaviors included regular exercise, nonsmoking status and no alcohol consumption. The relationship between the healthy lifestyle behavior(s) and control of 3B(s) was calculated. Of the 25,454 eligible participants, 4171 (16.4%) were current smokers, 2011 (7.9%) currently consumed alcohol, and 11,174 (43.9%) did not exercise. In total, 654 (2.6%) reported all three unhealthy lifestyle behaviors. Most participants (71.1%) had received at least a high school education and were more likely to smoke and drink as compared to those with lower education. Unhealthy lifestyle behaviors were commonly found in participants with low atherosclerosis risk, such as non-elderly people and those with an above-college education level. Unhealthy lifestyle is associated with poor 3B control and worse medication adherence. Unhealthy lifestyles are common in Chinese people with T2DM, especially in people who are non-elderly and above-college educated. Interventions aimed at changing risky lifestyle behaviors are required for improved outcomes for Chinese patients with T2DM.

Effects of HIV and Methamphetamine on Brain and Behavior: Evidence from Human Studies and Animal Models.

Methamphetamine (Meth) use is frequent among HIV-infected persons. Combined HIV and Meth insults may exacerbate neural injury in vulnerable neuroanatomic structures or circuitries in the brain, leading to increased behavioral disturbance and cognitive impairment. While acute and chronic effects of Meth in humans and animal models have been studied for decades, the neurobehavioral effects of Meth in the context of HIV infection are much less explored. In-depth understanding of the scope of neurobehavioral phenotypes and mechanisms in HIV/Meth intersection is needed. The present report summarizes published research findings, as well as unpublished data, in humans and animal models with regard to neurobehavioral disturbance, neuroimaging, and neuropathology, and in vitro experimental systems, with an emphasis on findings emerging from the National Institute on Drug Abuse (NIDA) funded Translational Methamphetamine AIDS Research Center (TMARC). Results from human studies and animal (primarily HIV-1 gp120 transgenic mouse) models thus far suggest that combined HIV and Meth insults increase the likelihood of neural injury in the brain. The neurobehavioral effects include cognitive impairment and increased tendencies toward impaired behavioral inhibition and social cognition. These impairments are relevant to behaviors that affect personal and social risks, e.g. worse medication adherence, riskier behaviors, and greater likelihood of HIV transmission. The underlying mechanisms may include electrochemical changes in neuronal circuitries, injury to white matter microstructures, synaptodendritic damage, and selective neuronal loss. Utilization of research methodologies that are valid across species is instrumental in generating new knowledge with clinical translational value.