Aim
To identify psychosocial predictors of medication adherence in young adults with youth‐onset type 2 diabetes in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort.
...Methods
Participants (mean age: 26 years) completed validated psychosocial measures. Unannounced telephone pill counts were completed at T1 (baseline) and T2 (follow‐up, approximately 1 year later) to assess adherence to oral hypoglycaemia agents (OHAs). Adherence to insulin was assessed by self‐report. Logistic and linear regressions identified factors that predicted ‘low adherence’ (<80% of pills/insulin) and per cent adherence, adjusted for potential confounders.
Results
Of 171 participants with OHA adherence scores at T1 and T2 (65% women, 43% Hispanic and 35% non‐Hispanic Black), 65.4% were low adherent. After adjustment (including T1 adherence), concerns about diabetes medicines (adverse effects, dependence) at T1 predicted higher odds of being low adherent (categorical) at T2 (p = 0.019). Housing insecurity (p = 0.045) and reporting ≥2 need insecurities (p = 0.027) at T1 predicted lower per cent adherence (continuous) at T2. Of 157 participants with insulin adherence scores at T1 and T2 (69% women, 38% Hispanic and 38% non‐Hispanic Black), 36.3% were low adherent. After adjustment (including T1 adherence), beliefs that medicines are overused predicted higher odds of insulin low adherence at T2 (p = 0.013), and beliefs that medicines are harmful (p = 0.004) and overused (p = 0.010) predicted lower per cent insulin adherence at T2.
Conclusions
Suboptimal medication adherence, common in young adults with youth‐onset type 2 diabetes, is predicted by interfering beliefs about medicines and social factors. We must address these beliefs and unmet needs to develop tailored interventions for this vulnerable group.
Background
Established diabetes care ("diabetes home") and regular healthcare visits are important to achieve optimal health. Nothing is known about psychosocial factors that predict healthcare usage ...(HCU) in young adults with youth-onset type 2 diabetes, at risk for early complications.
Objective
To identify psychosocial predictors of HCU in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort.
Design
Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for potential confounders, identified predictors of sub-optimal HCU (defined as no diabetes home, 0 visits for routine care, or ≥ 1 urgent care visit in prior 6 months).
Participants
N
= 366 TODAY2 participants with T1 and T2 data (381 consented). Mean age = 26.0 years, 67.8% female, 37.7% non-Hispanic Black, 35.8% Hispanic, 20.2% non-Hispanic white, 6.3% "other," mean HbA1c = 9.4%.
Main Measures
HCU survey; reliable and valid measures of diabetes self-efficacy, depressive symptoms, anxiety symptoms, diabetes distress, beliefs about medicines, diabetes attitudes, material need insecurities, self-management support.
Key Results
25.4% had no diabetes home, 23.7% had 0 routine care visits, 46% had ≥ 1 urgent care visit (prior 6 months). Beliefs in the necessity of (adjusted odds ratio OR = 1.28; 95% confidence interval CI = 1.12, 1.46,
p
< 0.001), and concerns about (OR = 1.29;CI = 1.08,1.54,
p
= 0.004), diabetes medicines, and its negative psychosocial impacts (OR = 1.57;CI = 1.04, 2.38,
p
= 0.03), predicted higher odds of having a diabetes home at T2. Beliefs that medicines are harmful predicted lower odds of a diabetes home (OR = 0.56;CI = 0.37,0.85,
p
= 0.006). Necessity beliefs (OR = 1.2;CI = 1.06,1.36,
p
= 0.004), and self-management support (OR = 1.5;CI = 1.08,2.07,
p
= 0.01) predicted higher odds of having ≥ 1 diabetes care visit, harm beliefs predicted lower odds (OR = 0.6;CI = 0.41,0.88,
p
= 0.01).
Conclusions
Sub-optimal healthcare usage, common in young adults with youth-onset type 2 diabetes, is predicted by beliefs about medicines, diabetes impact, and self-management support. We must address these factors to help this vulnerable group establish stable diabetes care.
Background: Established diabetes care (“diabetes home”) and regular healthcare visits are important to achieve good outcomes. Nothing is known about psychosocial factors that predict healthcare usage ...(HCU) in young adults with youth-onset type 2 diabetes.
Objective: To identify psychosocial predictors of HCU in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort.
Design: Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for covariates, were used to identify predictors of sub-optimal HCU (defined as no diabetes home, 0 routine care visits, ≥1 urgent care visit in prior 6 months).
Participants: N= 366 TODAY2 participants. Mean age=26.0 years, 67.8% female, 37.7% non-Hispanic Black, 35.8% Hispanic, 20.2% non-Hispanic white, mean HbA1c=9.4%.
Main measures: HCU survey; reliable, valid measures of diabetes self-efficacy, depressive symptoms, anxiety symptoms, diabetes distress, beliefs about medicines, diabetes attitudes, material need insecurities and self-management support.
Key Results: 25.4% had no diabetes home, 23.7% had 0 routine care visits, 46% had ≥1 urgent care visit in prior 6 months. Beliefs in the necessity of (p<0.001), and concerns about (p=0.004), diabetes medicines, and diabetes having negative psychosocial impacts (p=0.034), predicted higher odds of having a diabetes home at T2. Beliefs that medicines are harmful predicted lower odds of having a diabetes home (p=0.006). Necessity beliefs (p=0.002), concerns (p=0.025), and self-management support (p=0.014) predicted higher odds of having ≥ 1 diabetes care visit in prior 6 months, harm beliefs predicted lower odds (p=0.005).
Conclusions: Sub-optimal healthcare usage is common in young adults with youth-onset type 2 diabetes and is predicted by beliefs about medicines and self-management support. We must address these factors to help this vulnerable group establish a stable foundation for diabetes care.
Disclosure
P.M.Trief: None. D.Uschner: None. B.Anderson: None. H.Wen: None. J.D.Bulger: None. R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)
•Almost 70% of young adults with youth-onset type 2 diabetes were low-adherent to oral medications.•Approximately one-third of young adults were low-adherent to insulin.•Non-Hispanic Blacks, women ...and those without healthcare coverage were at greatest risk for poor adherence.•Given poor outcomes, medication adherence interventions that work for this group are needed.
To assess prevalence of, and factors associated with, medication adherence of young adults with youth-onset type 2 diabetes.
Oral hypoglycaemia agent (OHA) adherence was measured with unannounced telephone pill counts, insulin adherence was self-reported. Those taking ≥ 80% of pills/insulin were classified “high-adherent,” <80% of pills/insulin “low-adherent.” Analyses included unadjusted, and adjusted linear and logistic regressions assessing associations of participant factors with adherence.
For people taking OHAs (N = 212, mean age 26 yrs, 67% women, 18% non-Hispanic White, 35% non-Hispanic Black, 41% Hispanic), 69.8% were low-adherent. HbA1c was lower in the high-adherent group (9.2%/77 mmol/mol vs. 10.0%/86 mmol/mol, p < 0.04). More non-Hispanic Blacks were low-adherent (85.7%) than Hispanics (60.2%) and non-Hispanic whites (55.3%, p < 0.002); 91.4% of participants without healthcare coverage were low-adherent vs. 65.5% of those with coverage (p < 0.004). After adjustment, gender (p = 0.024), race/ethnicity (p < 0.001) and healthcare coverage (p = 0.001) remained related to OHA adherence. For insulin (N = 192), 37% were low-adherent. HbA1c was associated with insulin adherence (low = 11.2%/99 mmol/mol vs. high = 10.0%/86 mmol/mol, p < 0.001) with and without adjustment.
Young adults with youth-onset type 2 diabetes, especially females, non-Hispanic Blacks and those without healthcare coverage, commonly had low-OHA adherence. Glycaemic control was also poor. Interventions to improve medication adherence are needed for this vulnerable group.
Youth-onset type 2 diabetes (T2D) is associated with early development of vascular complications. Treatment of hypertension and dyslipidemia are critical to reduce morbidity. iCount examined ...adherence to blood pressure (BP) and lipid-lowering medications in young adults with youth-onset T2D (mean age 26 y, duration of T2D 12 y, BMI 37 kg/m2) and hypertension/nephropathy (n=196) or dyslipidemia (n=146) during the observational phase of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY)2 study (2017-2019). They were receiving diabetes care in their communities. Adherence was assessed with 3 monthly unannounced phone pill counts at 2 times 1 year apart. Percent low adherent (<80% pill-taking) and high-adherent (≥80% pill-taking) did not change over time. Of participants with hypertension and/or nephropathy, 80.1% were low adherent, 19.9% were high adherent. Those who were low adherent had fewer years of education (p=0.004), higher HbA1c (p=0.001) and shorter diabetes duration (p=0.031). Of those with dyslipidemia, 93.8% were low adherent, 6.2% high adherent. Those low adherent to BP (p<0.001) and lipid-lowering (p≤0.008) medications were also low adherent to oral hypoglycemic medications or insulin. Beliefs that medications are necessary were lower for those low adherent to BP and lipid-lowering medications (unadjusted analyses); concerns about medications also were lower for those low adherent to lipid-lowering medications. In adjusted multivariable analyses of participants with hypertension or nephropathy, having ≥1 material need insecurity predicted medication adherence 1 year later (p=0.010). Belief about medicines, diabetes distress, self-efficacy, depressive and anxiety symptoms, and self-management support were not 1 yr predictors of medication adherence. To prevent early vascular events, approaches that further identify and address unmet needs should be studied.
Disclosure
P. M. Trief: None. R. S. Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. B. K. Burke: None. H. Wen: None. S. Kalichman: None. J. D. Bulger: None. B. J. Anderson-thomas: None.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)
Background: Medication adherence is poor in young adults (YAs) with youth-onset type 2 diabetes (T2D). Little is known about intrapersonal factors that may relate to adherence.
Aims: To assess ...associations of intrapersonal factors to medication adherence in Treatment Options for Adolescents and Youth (TODAY2) YAs.
Methods: Validated measures (attitudes, beliefs, self-efficacy, distress, depression, anxiety) and insulin use surveys, were completed at a TODAY2 visit. Adherence to oral hypoglycemia agents (OHAs) was assessed with 3 monthly unannounced phone pill counts. Those taking ≥ 80% of pills/insulin classified “high-adherent;” < 80% of pills/insulin, “low-adherent.” If taking none, reasons were queried and adjudicated (no need vs. low-adherent). Logistic regressions assessed factors associated with OHA/insulin adherence controlling for gender, race/ethnicity, education, duration, healthcare coverage, and HbA1c.
Results: Of 381 YAs in iCount (mean age 26 yrs, 68% female, 20% non-Hispanic white, 38% non-Hispanic Black, 36% Hispanic, 64.9% <$25k income, mean HbA1c 9.4%), 224 were taking OHAs. As 12 lacked adherence scores, 212 were in OHA analyses; 70.0% were low-adherent to OHAs. Negative beliefs about medicines were associated with low OHA adherence in univariate, but not multivariate analyses. No measured intrapersonal factor was associated with OHA adherence. Of 192 in insulin analyses, 37.0% were low-adherent to insulin. Low insulin adherence was associated with less belief in seriousness of T2D (p=0.036), more concern that medications are overused (p=0.005) and diabetes distress (p=0.020). Insulin adherence did not relate to other diabetes attitudes or beliefs, depressive symptoms or anxiety. Limitations: small N with high depressive/anxiety symptoms; self-reported insulin use.
Conclusion: Poor medication adherence is common in YAs with youth-onset T2D. More needs to be learned about factors associated with adherence to develop tailored, effective interventions.
Disclosure
P. M. Trief: None. D. Uschner: None. M. Tung: None. K. Drews: None. S. Kalichman: None. B. Anderson: None. J. D. Bulger: None. R. S. Weinstock: Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1RO1DK110456-01A1; U01DK61230)
Aim: To identify psychosocial factors in young adults (mean age 26 yrs) that predict medication adherence 1 year later in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) ...observational study.
Methods: Validated psychosocial measures (attitudes, beliefs, self-efficacy, distress, depression, anxiety, self-management support, needs insecurities) were completed at baseline (T1) . Medication adherence was assessed at T1 and 1 year later (T2) . Adherence to oral hypoglycemia agents (OHA) was assessed with 3 monthly unannounced phone pill counts. Insulin adherence was self-report. Adherence was defined categorically (≥ 80% pills/insulin=high adherent; < 80% = low adherent) and continuously (% adherence) . Logistic and linear regressions assessed psychosocial measures as predictors of adherence group (high vs. low) and % adherence, controlling for potential confounders.
Results: OHA adherence: Mean scores declined from T1 to T2 (57.9% vs. 51.4%, p=0.004; N=171) . In adjusted multivariable analyses, more concerns about diabetes medications (e.g. long-term effects) (p=0.035) and lack of healthcare coverage (p=0.043) predicted higher odds of being low adherent. Beliefs that medications are harmful (p=0.004) or overused (p=0.002) , lack of healthcare coverage (p<0.0001) , reporting ≥1 (p=0.004) and ≥2 (p=0.017) need insecurities predicted lower % adherence.Insulin adherence: Mean scores were stable from T1 to T2 (70.8% vs. 69.3%, p=0.622; N=157) . Beliefs that medications are harmful (p=0.022) or overused (p=0.002) and lower self-management support (p=0.006) predicted being low adherent and lower % adherence. High diabetes distress predicted lower % adherence (p=0.044) .
Conclusions: Negative beliefs about medicines and unmet material needs predicted poorer OHA adherence. Negative beliefs, low support and distress predicted lower insulin adherence. These factors may be targets for future interventions.
Disclosure
P.M.Trief: None. S.Kalichman: None. D.Uschner: None. L.M.Fette: None. H.Wen: None. K.Drews: None. B.Anderson: None. J.D.Bulger: None. R.S.Weinstock: Research Support; Boehringer Ingelheim International GmbH, Dexcom, Inc., Diasome, Eli Lilly and Company, Insulet Corporation, Kowa Pharmaceuticals America, Inc., Medtronic, Novo Nordisk, Tandem Diabetes Care, Inc., Tolerion, Inc.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (RO1DK110456, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254)
Individuals with type 1 diabetes (T1D) have increased risk for cognitive dysfunction and high rates of sleep disturbance. Despite associations between glycemia and cognitive performance using ...cross-sectional and experimental methods few studies have evaluated this relationship in a naturalistic setting, or the impact of nocturnal versus daytime hypoglycemia. Ecological Momentary Assessment (EMA) may provide insight into the dynamic associations between cognition, affective, and physiological states. The current study couples EMA data with continuous glucose monitoring (CGM) to examine the within-person impact of nocturnal glycemia on next day cognitive performance in adults with T1D. Due to high rates of sleep disturbance and emotional distress in people with T1D, the potential impacts of sleep characteristics and negative affect were also evaluated.
This pilot study utilized EMA in 18 adults with T1D to examine the impact of glycemic excursions, measured using CGM, on cognitive performance, measured
mobile cognitive assessment using the TestMyBrain platform. Multilevel modeling was used to test the within-person effects of nocturnal hypoglycemia and hyperglycemia on next day cognition.
Results indicated that increases in nocturnal hypoglycemia were associated with slower next day processing speed. This association was not significantly attenuated by negative affect, sleepiness, or sleep quality.
These results, while preliminary due to small sample size, showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive fluctuation in real world settings, an approach that may be utilized in other populations. Findings suggest reducing nocturnal hypoglycemia may improve cognition in adults with T1D.
Aims
To assess associations of psychosocial factors with medication adherence in young adults with youth‐onset type 2 diabetes in the Treatment Options for type 2 Diabetes in Adolescents and Youth ...(TODAY2) cohort.
Methods
Participants (mean age 26 years) completed validated psychosocial measures. Adherence to oral hypoglycemia agents (OHAs) was assessed with 3‐monthly unannounced phone pill counts; insulin adherence by self‐report. Logistic and linear regressions identified factors associated with “low‐adherence” (<80% of pills/insulin) controlling for confounders.
Results
Of 212 participants taking OHAs (67% female, 39% Hispanic, 36% non‐Hispanic Black), 69.8% were low‐adherent. After adjustment, beliefs that medicines are necessary was associated with lower odds of low‐adherence (p = 0.040, dichotomous). Less self‐management support (p = 0.008), no healthcare coverage (p = 0.001), ≥1 (p = 0.008)/≥2 (p = 0.045) need insecurities were associated with higher odds of low‐adherence. Factors associated with lower % adherence (continuous) were beliefs that medicines are harmful (p < 0.001)/overused (p = 0.007)/less necessary (p = 0.022), low self‐management support (p = 0.003), food insecurity (p = 0.036), no healthcare coverage (p < 0.001), ≥1 (p = 0.003)/≥2 (p = 0.018) need insecurities. Of 192 taking insulin (69% female, 36% Hispanic, 41% non‐Hispanic Black, 16% non‐Hispanic white), 37.0% were low‐adherent. Beliefs that medicines are overused (p = 0.009), that diabetes is not serious (p = 0.010), low diabetes self‐efficacy (p = 0.035), high distress (p = 0.027), low self‐management support (p = 0.001), food insecurity (p = 0.020), ≥1 (p = 0.011)/≥2 (p = 0.015) insecurities increased odds of insulin low‐adherence.
Conclusions
Poor medication adherence, common in young adults with youth‐onset type 2 diabetes, is associated with interfering beliefs, diabetes distress and social factors. We must address these factors to develop tailored interventions for this vulnerable group.
