Diabetes Care:有效的服药依从性自我报告利于2型糖尿病管理
2012-12-11 Diabetes Care Diabetes Care
来自美国的一项研究结果，支持易于管理的自我报告对改善糖尿病患者服药依从性的有效性。在1个月内，按百分比计算评级的服药依从性，与药物事件监视系统(MEMS)和糖化血红蛋白之(HbA1c)间显示最强的关联;而在那些需要报告错误剂量的受试者中，有较弱的关联。为期一周、要求受访者记录错误剂量数量的自我评价和测量，表现为易于受到抑郁症严重程度的影响而产生偏差。研究在2012年11月30日在线发表于《糖尿
来自美国的一项研究结果，支持易于管理的自我报告对改善糖尿病患者服药依从性的有效性。在1个月内，按百分比计算评级的服药依从性，与药物事件监视系统(MEMS)和糖化血红蛋白之(HbA1c)间显示最强的关联;而在那些需要报告错误剂量的受试者中，有较弱的关联。为期一周、要求受访者记录错误剂量数量的自我评价和测量，表现为易于受到抑郁症严重程度的影响而产生偏差。研究在2012年11月30日在线发表于《糖尿病护理》(Diabetes Care)杂志。
该研究旨在评估糖尿病患者自我报告以评价服药依从性的有效性，以及评估抑郁症对这些自我报告有效性的影响。
研究共纳入170例患有2型糖尿病、接受口服药物治疗的成年受试者，完成一组在变化反应尺度和时间框架条件下的服药依从性自我报告，接受抑郁症的结构化临床晤谈，并提供了血液样本以检测HbA1c，作为干预研究筛查的一个组成部分。其中对于患有临床显著抑郁症和HbA1c≥7.0%的一个受试者样本亚群，接受MEMS瓶盖以记录服药依从性。分析评估依从性测量和HbA1c、子样本中MEMS之间的关系。调节线性回归分析评估抑郁症的严重程度是否改变依从性与HbA1c的关系。
结果表明，受试者[N=170，57%为男性，81%是白人，平均糖化血红蛋白为8.3%(SD，1.7)]的自我报告依从性与较低的HbA1c显著相关(r=-0.18至-0.28，P<0.03)。在子样本中(N=88)，所有的自我报告均与MEMS测量的依从性相关(r=0.35至0.55，P≤0.001)。抑郁症显著减弱了3/6个自我报告和糖化血红蛋白之间的关系;在抑郁水平较高时，依从性与HbA1c的相关性变为不显著。
OBJECTIVE
To assess the validity of self-report measures of diabetes medication adherence and evaluate the effect of depression on the validity of these reports.
RESEARCH DESIGN AND METHODS
Adults with type 2 diabetes, treated with oral medications, completed a set of medication adherence self-reports that varied response scales and time frames, were administered structured clinical interviews for depression, and provided blood samples for HbA1c as part of a screening for an intervention study. A subsample of participants with HbA1c ≥7.0% and clinically significant depression received Medication Event Monitoring System (MEMS) bottle caps to record adherence. Analyses examined relationships between adherence measures and HbA1c and, in the subsample, MEMS. Moderated linear regression evaluated whether depression severity modified relationships with HbA1c.
RESULTS
Participants’ (n = 170, 57% men, 81% white, mean HbA1c = 8.3% [SD, 1.7]) adherence self-reports were significantly (r = −0.18 to −0.28; P < 0.03) associated with lower HbA1c. In the subsample (n = 88), all self-reports were significantly (r = 0.35 to 0.55; P ≤ 0.001) associated with MEMS-measured adherence. Depression significantly moderated the relationship between three of six self-reports and HbA1c; at high levels of depression, associations with HbA1c became nonsignificant.
CONCLUSIONS
Results support the validity of easily administered self-reports for diabetes medication adherence. One-month, percentage-based ratings of adherence had the strongest associations with MEMS and HbA1c; those requiring the report of missed doses had weaker associations. One-week self-ratings and measures that require respondents to record the number of missed doses appear to be vulnerable to bias from depression severity.
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