In the Journals

Medication adherence lapses with depressive symptoms in adolescents with type 2 diabetes

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June 29, 2016

Type 2 diabetes medication adherence does not appear to be affected by sex, age, family income, parental education or treatment group, but lower medication adherence was found among youths with type 2 diabetes and depressive symptoms, according to researchers.

Lorraine Levitt Katz, MD, an attending physician at The Children’s Hospital of Philadelphia, and colleagues evaluated data from the TODAY trial on 699 children aged 10 to 17 years with recent-onset type 2 diabetes assigned to one of three treatment groups: metformin alone, metformin plus rosiglitazone or metformin plus an intensive lifestyle program.

Lorraine Katz

Lorraine Levitt Katz

Participants were recruited between July 2004 and February 2009. Researchers sought to identify factors that predict medication adherence and examine relationships among adherence, glycemic control and indices of insulin action. Participants were assigned to two pills per day, and adherence was calculated by pill count when packs were returned at visits. Researchers defined high adherence as taking at least 80% of medication and low adherence as taking less than 80% of medication.

Over time, adherence declined with 72% of participants exhibiting high adherence at 2 months to 56% at 48 months (P < .0001). Participants with clinically significant depressive symptoms at baseline were more likely to have low adherence (18%) compared with those without depressive symptoms (12%; P = .0415). Adherence did not differ with sex, age, family income, parental education or treatment group.

Higher insulin sensitivity (P = .0012) and higher oral disposition index (P = .0248) were linked to high medication adherence.

 “Youth with type 2 diabetes have a progressive decline in beta cell function (insulin secretion) over time,” Katz told Endocrine Today. “However, glycemic control may decline despite excellent adherence, and intensification of therapy may be indicated. As depressive symptoms may be related to medication adherence, screening and treatment for depression are important factors in management type 2 diabetes. Glucose control may deteriorate in youth despite good adherence, and clinicians need to be prepared to institute additional therapies.” by Amber Cox

Disclosure:Katz reports no relevant financial disclosures. One researcher reports being a consultant to Takeda Pharmaceuticals.

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itj+ Perspective

Eliot LeBow

Eliot LeBow

Psychological issues, such as depression, attention-deficit disorder and various other emotional disorders, affect a patient's ability to manage their diabetes. According to the American Association of Diabetes Educators as well as the American Diabetes Association, depression is two to three times more prevalent among people with diabetes than among the general public. This study quantifies the reality that can be seen every day in clinical practice.  
The fact that medication adherence is not affected by sex, age, income, education or treatment group, is not surprising. Depression affects all demographics equally, and it debilitates an individual's ability to function and complete everyday tasks.   

Depression affects various abilities necessary to manage diabetes, such as diminished ability to think, concentrate, make decisions or remember. Depression also negatively affects patient’s motivation toward self-preservation, self-care and desire to complete even the smallest task. 

It's my professional opinion that it is important for medical professionals to evaluate their patients for depression and refer them to a psychotherapist for further evaluation and possible psychological and psychiatric interventions. Referral to a mental health professional can make all the difference when it comes to reducing the impact of depression on diabetes management and increasing patient compliance.

Eliot LeBow, LCSW, CDE

New York, NY
Founder of DiabeticTalks and Diabetes-Focused Psychotherapy

Disclosure: LeBow reports no relevant financial disclosures.