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Hoogendoorn, Claire J.; Krause-Steinrauf, Heidi; Uschner, Diane; Wen, Hui; Presley, Caroline A.; Legowski, Elizabeth A.; Naik, Aanand D.; Golden, Sherita Hill; Arends, Valerie L.; Brown-Friday, Janet; Krakoff, Jonathan A.; Suratt, Colleen E.; Waltje, Andrea H.; Cherrington, Andrea L.; Gonzalez, Jeffrey S.; Crandall, J.P.; McKee, M.D.; Behringer-Massera, S.; Brown-Friday, J.; Xhori, E.; Ballentine-Cargill, K.; Duran, S.; Estrella, H.; Gonzalez de la torre, S.; [...]

Emotional Distress Predicts Reduced Type 2 Diabetes Treatment Adherence in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

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  • Media type: E-Article
  • Title: Emotional Distress Predicts Reduced Type 2 Diabetes Treatment Adherence in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)
  • Contributor: Hoogendoorn, Claire J.; Krause-Steinrauf, Heidi; Uschner, Diane; Wen, Hui; Presley, Caroline A.; Legowski, Elizabeth A.; Naik, Aanand D.; Golden, Sherita Hill; Arends, Valerie L.; Brown-Friday, Janet; Krakoff, Jonathan A.; Suratt, Colleen E.; Waltje, Andrea H.; Cherrington, Andrea L.; Gonzalez, Jeffrey S.; Crandall, J.P.; McKee, M.D.; Behringer-Massera, S.; Brown-Friday, J.; Xhori, E.; Ballentine-Cargill, K.; Duran, S.; Estrella, H.; Gonzalez de la torre, S.; [...]
  • imprint: American Diabetes Association, 2024
  • Published in: Diabetes Care
  • Language: English
  • DOI: 10.2337/dc23-1401
  • ISSN: 0149-5992; 1935-5548
  • Origination:
  • Footnote:
  • Description: <jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>We examined longitudinal associations between emotional distress (specifically, depressive symptoms and diabetes distress) and medication adherence in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing four glucose-lowering medications added to metformin in adults with relatively recent-onset type 2 diabetes mellitus (T2DM).</jats:p> </jats:sec> <jats:sec> <jats:title>RESEARCH DESIGN AND METHODS</jats:title> <jats:p>The Emotional Distress Substudy assessed medication adherence, depressive symptoms, and diabetes distress in 1,739 GRADE participants via self-completed questionnaires administered biannually up to 3 years. We examined baseline depressive symptoms and diabetes distress as predictors of medication adherence over 36 months. Bidirectional visit-to-visit relationships were also examined. Treatment satisfaction, beliefs about medication, diabetes care self-efficacy, and perceived control over diabetes were evaluated as mediators of longitudinal associations.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>At baseline, mean ± SD age of participants (56% of whom were White, 17% Hispanic/Latino, 18% Black, and 66% male) was 58.0 ± 10.2 years, diabetes duration 4.2 ± 2.8 years, HbA1c 7.5% ± 0.5%, and medication adherence 89.9% ± 11.1%. Higher baseline depressive symptoms and diabetes distress were independently associated with lower adherence over 36 months (P &amp;lt; 0.001). Higher depressive symptoms and diabetes distress at one visit predicted lower adherence at the subsequent 6-month visit (P &amp;lt; 0.0001) but not vice versa. Treatment assignment did not moderate relationships. Patient-reported concerns about diabetes medications mediated the largest percentage (11.9%–15.5%) of the longitudinal link between emotional distress and adherence.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Depressive symptoms and diabetes distress both predict lower adherence to glucose-lowering medications over time among adults with T2DM. Addressing emotional distress and concerns about anticipated negative effects of taking these treatments may be important to support diabetes treatment adherence.</jats:p> </jats:sec>