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Effect of Attitudes (ATT), Depression (DP) and Provider Relationship (PR) on Compliance with Self Monitoring of Blood Glucose (SMBG) and Glycemic Control (A1c) in Insulin-Treated Type 2 Diabetics

Shah JH, Wendel CS, Mohler MJ, Brown V, Plummer E, Duckworth WC, Murata GH. Effect of Attitudes (ATT), Depression (DP) and Provider Relationship (PR) on Compliance with Self Monitoring of Blood Glucose (SMBG) and Glycemic Control (A1c) in Insulin-Treated Type 2 Diabetics. Paper presented at: International Society of Endocrinology International Congress of Endocrinology; 2008 Nov 1; Rio de Janeiro, Brazil.


Objective: We conducted a multicenter observational study to evaluate the effect of patient ATT, DEP and PR on SMBG compliance and A1C. Materials and Methods: Self-report measures of ATT, DEP and PR were collected using a mailed survey in 1282 insulin-treated type 2 diabetics [73% non-Hispanic whites (NHW), 18 % Hispanics (H), 6% African Americans (AA), and 3% others] in southwestern USA. Multiple questions assessed ATT toward living with diabetes and its treatment. Clinical measures were derived from electronic medical records. All results were age adjusted. Compliance was calculated as reported number of SMBG performed per week divided by number of SMBG ordered by the providers. Results: Negative attitudes towards diabetes were associated with non-compliance with SMBG (p = 0.045 to 0.03 over multiple items). According to 10 item Center for Epidemiologic Study-Depression (CES-D 10) Scale, 36% of patient in the study experience depression (score range 0 to 30, higher score indicating worse depression). The DEP was significantly associated with SMBG non-compliance. A 10 point increase in CES-D 10 score was associated with a 22% increased risk of SMBG non-compliance (p < 0.02). The patient's perceived negative relationship with providers also significantly contributed to SMBG non-compliance (p < 0.01). A1C was positively correlated with CES-D 10 score. For a 10 unit increase in CES-D10 score, a 0.15% increase in A1C was observed (p < 0.03). Negative attitude towards diabetes had a significant impact on increasing A1C (p = 0.04 to 0.03 over multiple items). Also, perceived negative relationships with the providers were associated with significantly higher A1C (p < 0.001). The analysis showed that H and AA perceived that their providers understood how cultural values and needs can have effect on diabetes treatment. In contrast, NHW did not perceive importance of cultural understanding by providers for diabetes treatment. Conclusion: Among insulin-treated type 2 diabetic patients, attitudes towards diabetes and treatment, depression and poor perceived relationships with their providers decreased compliance with SMBG and had deleterious effects on glycemic control. Cultural sensitivity is important in the management of type 2 diabetes.

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