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Patient Adherence Improves Glycemic Control
Mary K. Rhee, MD,
Wrenn Slocum, RN, MPH,
David C. Ziemer, MD,
Steven D. Culler, PhD,
Curtiss B. Cook, MD,
Imad M. El-Kebbi, MD,
Daniel L. Gallina, MD,
Catherine Barnes, RN, PhD and
Lawrence S. Phillips, MD
From the Division of Endocrinology and Metabolism, Department of
Medicine, Emory University School of Medicine, Atlanta, Georgia (Drs Rhee,
Ziemer, Cook, El-Kebbi, Gallina, Barnes, Phillips); the Strategic National
Stockpile Program, Program Preparedness Branch, the Centers for Chronic
Disease Control and Health Prevention, Atlanta, Georgia (Mr Slocum); and the
Department of Health Policy and Management, Rollins School of Public Health,
Emory University, Atlanta, Georgia (Dr Culler).
Correspondence to Mary K. Rhee, MD, Emory University School of Medicine,
Faculty Office Building, Room 435, 49 Jesse Hill Jr Drive, SE, Atlanta, GA
30303
(mrhee{at}emory.edu)
Purpose
The purpose of this study was to assess the influence of appointment
keeping and medication adherence on HbA1c.
Methods
A retrospective evaluation was performed in 1560 patients with type 2
diabetes who presented for a new visit to the Grady Diabetes Clinic between
1991 and 2001 and returned for a follow-up visit and HbA1c after 1 year of
care. Appointment keeping was assessed by the number of scheduled intervening
visits that were kept, and medication adherence was assessed by the percentage
of visits in which self-reported diabetes medication use was as recommended at
the preceding visit.
Results
The patients had an average age of 55 years, body mass index (BMI) of 32
kg/m2, diabetes duration of 4.6 years, and baseline HbA1c of 9.1%.
Ninety percent were African American, and 63% were female. Those who kept more
intervening appointments had lower HbA1c levels after 12 months of care (7.6%
with 6-7 intervening visits vs 9.7% with 0 intervening visits). Better
medication adherence was also associated with lower HbA1c levels after 12
months of care (7.8% with 76%-100% adherence). After adjusting for age,
gender, race, BMI, diabetes duration, and diabetes therapy in multivariate
linear regression analysis, the benefits of appointment keeping and medication
adherence remained significant and contributed independently; the HbA1c was
0.12% lower for every additional intervening appointment that was kept
(P = .0001) and 0.34% lower for each quartile of better medication
adherence (P = .0009).
Conclusion
Keeping more appointments and taking diabetes medications as directed were
associated with substantial improvements in HbA1c. Efforts to enhance glycemic
outcomes should include emphasis on these simple but critically important
aspects of patient adherence.
The Diabetes Educator, Vol. 31, No. 2,
240-250 (2005)
DOI: 10.1177/0145721705274927
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