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Mediators of medication adherence and glycaemic control and their implications for direct outpatient medical costs: a cross‐sectional study
Author(s) -
Lum Z. K.,
Tsou K. Y. K.,
Lee J. Y.C.
Publication year - 2018
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13619
Subject(s) - medicine , diabetes mellitus , distress , mediation , cross sectional study , medication adherence , outpatient clinic , clinical psychology , endocrinology , pathology , political science , law
Aims To investigate the effects of diabetes‐related distress and perception of hyperglycaemia on self‐reported medication adherence and glycaemic control, as measured by HbA 1c , and to compare the cost outcomes in patients with sub‐optimally vs uncontrolled Type 2 diabetes mellitus. Methods We conducted a retrospective cross‐sectional study that involved the review of a chronic disease database in Singapore. Data on clinical characteristics, diabetes‐related distress, perception of hyperglycaemia, self‐reported medication adherence and costs were obtained from the database. Mediation analyses were conducted using a linear regression‐based approach. A final path model was built to illustrate the sequential mediating effects of diabetes‐related distress and perception on the association of medication adherence and HbA 1c concentration. Results Diabetes‐related distress and perception of hyperglycaemia were significantly associated with medication adherence and HbA 1c concentration. Mediation analyses showed a significant indirect effect of diabetes‐related distress and perception of hyperglycaemia on medication adherence and HbA 1c concentration. People with uncontrolled diabetes were found to incur significantly higher total direct medical costs than those with sub‐optimally controlled diabetes ( P = 0.034), with medication cost as the main cost driver (66.6%). Conclusions Identifying the influence of the sequential mediating effects of distress and perception was important in understanding the pathway between medication adherence and glycaemic control. This suggests the importance of a team‐based approach to address these mediators and thus improve glycaemic control. Poor glycaemic control was also found to be associated with higher direct medical costs.