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Barriers and strategies for oral medication adherence among children and adolescents with Type 2 diabetes.




Diabetes research and clinical practice Feb ; ()


Venditti EM1; Tan K2; Chang N3; Laffel L4; McGinley G5; Miranda N6; Tryggestad JB7; Walders-Abramson N8; Yasuda P9; Delahanty L10; TODAY Study Group11;

Author Information
  • 1Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA.
  • 2George Washington University Biostatistics Center, Rockville, MD. Electronic address: elghorml@bsc.gwu.edu.
  • 3Children's Hospital Los Angeles, Los Angeles, CA.
  • 4Joslin Diabetes Center, Boston, MA.
  • 5Children's Hospital of Philadelphia, Philadelphia, PA.
  • 6Baylor College of Medicine, Houston, TX.
  • 7University of Oklahoma Health Sciences Center, Oklahoma City, OK.
  • 8Department of Pediatrics, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO.
  • 9Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA.
  • 10Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA.


AIMS: Examine barriers for taking glucose-lowering oral medications, associated baseline characteristics, strategies used, and the adherence impact in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.

METHODS: We studied youth prescribed oral diabetes medications over two years (N = 611, 583, and 525 at 6, 12, and 24 months). Clinicians documented barriers (e.g. forgetting, routines, other concerns) in the subsample that reported missed doses (N=423 [69.2%], 422 [72.4%], and 414 [78.9%] at 6, 12, and 24 months, respectively). Adherence strategies were also assessed (e.g. family, schedule, reminder device) using standard questions. Logistic regression was used to analyze associations with medication adherence.

RESULTS: Those missing doses were not different from the total sample (61.5% female, 13.9 ± 2.0 years, >80% racial/ethnic minorities). No baseline demographic or clinical predictors of barriers to medication adherence were identified. Among those for whom barriers were assessed, "forgetting" with no reason named (39.3%) and disruptions to mealtime, sleep, and schedule (21.9%) accounted for the largest proportion of responses. Family support was the primary adherence strategy identified by most youth (≥ 50%), followed by pairing the medication regimen with daily routines (> 40%); the latter strategy was associated with significantly higher adherence rates (p=0.009).

CONCLUSIONS: Family supported medication adherence was common in this mid-adolescent cohort, but self-management strategies were also in evidence. Findings are similar to those reported among youth with other serious chronic diseases. Prospective studies of multi-component family support and self-management interventions for improving medication adherence are warranted.

TRIAL REGISTRATION: ClinicalTrials.gov NCT00081328 Funding Support and Conflict of Interest Disclosures: Reported following Conclusion.

Copyright © 2018 Elsevier B.V. All rights reserved.




Publication Type: Journal Article

This article is licensed under the the National Library of Medicine License. It uses material from the PubMed National Library of Medicine Data.

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