The impact of mental ill health on medication adherence level in patients diagnosed with type 2 diabetes
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AbstractBackground: In the UK, 4.9 million people have type 2 Diabetes Mellitus (T2DM), costing the NHS £10 billion annually. One in six-people (17.0%) in England has experienced depression or anxiety in the past 12 months. T2DM is managed by pharmacological therapy and lifestyle adjustment. The aim of this study was to explore if there is a relationship between depression, anxiety and poor medication adherence in patients diagnosed with T2DM. Method: A pilot, single-site, observational study of patients with T2DM (n=64) randomly assigned into group A (3-consultations) or group B (2-consultations). All initial consultations were in-person, while follow-ups were by telephone. Participants were screened; for medication adherence using MMAS-8©; for depression using CUDOS© and anxiety with CUXOS©, and the findings were managed appropriately. The measurable outcomes were changes in HbA1c, BP, medication-adherence, depression, anxiety and self-reported wellbeing. Thematic and comparative analysis was conducted by groups and demographic variables using paired sample t-test and statistical regression. Results: Adherence to diabetes medications improved for both groups (intentional: p = 0.15 and unintentional, p =0.01). Similarly, adherence to all other chronic diseases medications means were improved for both groups (intentional, p = 0.32 and unintentional, p = 0.02). The depression, anxiety and well-being means were also improved (p = 0.01 and p = 0.04 p = <0.01 respectively). HbA1c results did not show statistical significance (p = 0.77). BP readings were unchanged but remained in the recommended range for both groups, under 130/82 mmHg. Based on the manual thematic coding, there were three possible phenomenon (high self-care efficacy and favourable disease prognosis [F= 7 & M=4], high self-care efficacy and poor disease prognosis [F= 15 & M=11] and poor self-care efficacy and poor disease prognosis[F= 12 & M=11]) and one phenomenon was not proven due to the small sample size and possible patients self-reporting bias (poor self-care efficacy and favourable disease prognosis [F= 1 & M=3]). Conclusions: A significant inter-relationship was found between depression and/or anxiety, adherence to therapy and T2DM prognosis. More frequent interventions were advantageous. Two prototype T2DM management algorithms; generic and tailored to patients from Pakistani and Bangladeshi backgrounds were created. These were adopted in the study site and were provided to the HRA in the final ethics report for NHS use in the wider primary care. Other ethnicities and chronic conditions could be similarly investigated.
PublisherUniversity of Wolverhampton
TypeThesis or dissertation
DescriptionA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.
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