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HSR&D 2004 National Meeting Abstracts

1067. The Burden of Diabetes Therapy: Effect on Adherence and Treatment Design
Sandeep Vijan, MD, MS, HSR&D, Ann Arbor Healthcare System, RA Hayward, HSR&D, Ann Arbor Healthcare System, DL Ronis, HSR&D, Ann Arbor Healthcare System, TP Hofe, HSR&D, Ann Arbor Healthcare System

Objectives: Management of blood glucose levels in diabetes can be complex and burdensome. However, few studies have evaluated patientsí views of the burdens of these therapies, or how views of burden relate to adherence.

Methods: 1653 veterans with type 2 diabetes rated their views of the burden of various diabetes treatments and their treatment adherence (response rate = 67%). Independent predictors of burden and adherence were examined using multivariate regression.

Results: Ratings of burdens of diabetes therapies were highly skewed. On a 0 to 6 scale, patients rated pills (median = 1) as the least burdensome and insulin and home glucose monitoring as the most burdensome (median for each = 5; in combination, median = 6). Prior experience with therapy was strongly associated with lower burden, particularly for insulin (p<0.001), although this difference was attenuated with increasing injection frequency. The main predictor of treatment adherence was ratings of burden; for example, after adjustment for covariates, patients who rated insulin as very burdensome were highly adherent 71.3% of the time, while those who rated the burden as minimal were highly adherent 84.0% of the time.

Conclusions: Patients view insulin-based treatment regimens and home glucose monitoring as highly burdensome, although experience with treatment attenuates burden. Adherence to treatment is strongly correlated with treatment burden. These burdens may be a source of less than ideal glucose control seen in many settings. Clinicians and those who design diabetes intervention programs should focus on minimizing patient burden to optimize adherence, possibly by using a shared decision-making approach to selecting therapy.