Determinants of adherence to hypoglycemic agents and medical visits in patients with type 2 diabetes mellitus.

Aim: To assess glycemic control in diabetic patients, to measure the impact on such control of adherence to hypoglycemic agents and to medical visits, and to explore factors that allow for predicting adherence.

Methods: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target HbA levels was estimated. Adherence was assessed using the Haynes-Sackett test. Change in HbA from the first to the last visit, adherence, and attendance to visits were analyzed according to comorbidities, cardiovascular risk factors, and treatments used.

Results: The study simple consisted of 639 patients (mean follow-up time, 11.1±11.2 months), of whom 66.6% achieved target HbA levels. Change in HbA from the first to the last visit was explained in 54.2% of patients by baseline HbA (P<0.001), in 13% by treatment adherence (P<0.001), and in 9.6% by visit adherence (P<0.001). Non-insulinization (P=0.011) and smoking cessation (P=0.032) predisposed to greater adherence. Insulinization (P=0.019) and lack of diabetes education (P=0.033) predisposed to visit non-compliance.

Conclusions: Improvement in HbA is determined by baseline HbA, treatment adherence, and attendance to visits. Patients on insulin have poorer adherence and are more likely to miss the appointments, those who stop smoking adhere more to hypoglycemic agents, and those given therapeutic education are more likely to keep the appointments.