ADHERENCE TO INSULIN TREATMENT IN CHILDREN WITH TYPE I DIABETES MELLITUS AT A HOSPITAL IN MALAYSIA
Keywords:Adherence, Children, Malaysia, Type I diabetes mellitus
Objective: This study aimed to evaluate adherence to insulin treatment and identify factors that influence adherence in children with T1DM at a tertiary care hospital in Malaysia.
Methods: Patients were identified from the pharmacy computer system based on the prescribed insulin therapy from 2010 to 2014. Medical records of screened patients were then retrieved from the medical record department. Adherence was assessed via the medication possession ratio (MPR) and glycated hemoglobin A1c value. Patients were classified as adherent or non-adherent if the MPR calculated for the prescribed insulin regimen was â‰¥80% or <80%, respectively. Patients with A1c values <7.5% based on medical records were also classified as adherent.
Results: A total of 57 patients were included in this study, with a 57.9% male predominance and a mean age of 14.39 Â± 3.41 years. Thirty-nine (68.4%) and three patients (5.3%) were classified as adherent to insulin treatment according to MPR and A1c values, respectively. Poor agreement between the MPR and A1c value in determining adherence was found based on kappa analysis (kappa = âˆ’0.108, p=0.009). There was no association between age, sex, race, presence of comorbidities, or duration of T1DM diagnosed and adherence based on the A1c value (p>0.05). These predictors were also found to be insignificant based on multiple logistic regression analysis (p>0.05).
Conclusion: Adherence to insulin treatment based on the A1c measurement was generally poor among children with T1DM. Further prospective research should be performed in this area to identify reasons for the non-adherence to insulin treatment so that appropriate interventions can be instituted to improve adherence and ultimately prevent complications from the disease.Â
International Diabetes Federation. IDF Diabetes. 2nd ed. Brussels, Belgium: International Diabetes Federation; 2015. Available from: http://www.diabetesatlas.org.
Craig ME, Jones TW, Silink M, Ping YJ. Diabetes care, glycemic control, and complications in children with Type 1 diabetes from Asia and the Western pacific region. J Diabetes Complications 2007;21(5):280-7.
Walker T. For children, skipped medications often lead to emergency department visits. Formulary 2013;48:313.
Schwartz DD, Cline VD, Hansen JA, Axelrad ME, Anderson BJ. Early risk factors for non-adherence in paediatric Type 1 diabetes: A review of the recent literature. Curr Diabetes Rev 2010;6(3):167-83.
Chang CW, Yeh CH, Lo FS, Shih YL. Adherence behaviours in Taiwanese children and adolescents with Type 1 diabetes mellitus. J Clin Nurs 2007;16(7B):207-14.
Chisholm V, Atkinson L, Donaldson C, Noyes K, Payne A, Kelnar C. Predictors of treatment adherence in young children with Type 1 diabetes. J Adv Nurs 2007;57(5):482-93.
Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86(4):304-14.
Tan SM, Shafiee Z, Wu LL, Rizal AM, Rey JM. Factors associated with control of Type 1 diabetes in Malaysian adolescents and young adults. Int J Psychiatry Med 2005;35(2):123-36.
Faiman K, Motheral B. Evaluating medication adherence: Which measure is right for your program? J Manag Care Pharm 2000;6(6):499-504.
Donnelly LA, Morris AD, Evans JM; DARTS/MEMO collaboration. Adherence to insulin and its association with glycaemic control in patients with Type 2 diabetes. QJM 2007;100(6):345-50.
Ismail HI, Ng HP, Thomas T. Paediatric Protocols for Malaysian Hospitals. 3rd ed. Malaysia: Ministry of Health; 2013. p. 245-53. Available from: http://www.mpaweb.org.my/file_dir/6549703650eae1487f6fb.pdf. [Last accessed on 2016 Aug 24].
American Diabetes Association; 2014. Diabetes association sets new A1c target for children with Type 1 diabetes. Available from: http://www.diabetes.org/newsroom/press-releases/2014/diabetes-association-sets-new-a1c-target-for-children-with-type1-diabetes.html. [Last accessed on 2014 Dec 01].
De las Cuevas C. Towards a clarification of terminology in medicine taking behaviour: Compliance, adherence and concordance are related although different terms with different uses. Curr Clin Pharmacol 2011;6(2):74-7.
Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycaemic control in paediatric Type 1 diabetes: A meta-analysis. Pediatrics 2009;124(6):e1171-9.
Hilliard ME, Wu YP, Rausch J, Dolan LM, Hood KK. Predictors of deteriorations in diabetes management and control in adolescents with Type 1 diabetes. J Adolesc Health 2013;52(1):28-34.
Laxmisan A, Vaughan-Sarrazin M, Cram P. Repeated haemoglobin A1c ordering in the VA health system. Am J Med 2011;124(4):342-9.
Sacks DB, John WG. Interpretation of haemoglobin A1c values. JAMA 2014;311(22):2271-2. 18. Vink NM, Klungel OH, Stolk RP, Denig P. Comparison of various measures for assessing medication refill adherence using prescription data. Pharmacoepidemiol Drug Saf 2009;18(2):159-65.
Grey M, Davidson M, Boland EA, Tamborlane WV. Clinical and psychosocial factors associated with achievement of treatment goals in adolescents with diabetes mellitus. J Adolesc Health 2001;28(5):377-85.
Davis CL, Delamater AM, Shaw KH, La Greca AM, Eidson MS, Perez-Rodriguez JE, et al. Parenting styles, regimen adherence, and glycaemic control in 4-to 10-year-old children with diabetes. J Pediatr Psychol 2000;26(2):123-9.
Lim PK, Chia YY, Lek N, Haas L, Maryniuk M, Beck J, et al. Paediatric hospital readmissions with diabetes mellitus. Singapore Nurs J 2012;39(4):23-8.
Borus JS, Laffel L. Adherence challenges in the management of Type 1 diabetes in adolescents: Prevention and intervention. Curr Opin Paediatr 2010;22(4):405-11.
Krapek K, King K, Warren SS, George KG, Caputo DA, Mihelich K, et al. Medication adherence and association haemoglobin A1c in Type 2 diabetes. Ann Pharmacother 2004;38(9):1357-62.
Stewart C, Brown L, Poirier M. Guidelines for the management of paediatric diabetic ketoacidosis (DKA). Paediatr Emerg Med Pract 2006;3(3):1-16.
Karges B, Kapellen T, Neu A, Hofer SE, Rohrer T, Rosenbauer J, et al. Long-acting insulin analogs and the risk of diabetic ketoacidosis in children and adolescents with Type 1 diabetes: A prospective study of 10,682 patients from 271 institutions. Diabetes Care 2010;33(5):1031-3.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1997;33(1):159-74.
Asmini P. The influence of education of drug information by pharmacist on the improvement of knowledge and therapeutic target to Type 2 diabetes mellitus outpatients in hospital. Int J Pharm Pharm Sci 2017;9(3):199-204.
Balaiah S, Tirupa M, Narayana G, Mohanraj R, Reddy YP. Assessment of pharmaceutical care services on health related QOL in patients with Type 2 diabetes mellitus â€“ A prospective interventional study. Int J Pharm Pharm Sci 2014;6(7):456-61.
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