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