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Aim Despite the widespread assumption that adherence drives glycaemic control, there is little published support for this in Type 2 diabetes. The study objective was to determine whether self-reported medication adherence predicts future glycaemic control in Type 2 diabetes, after accounting for baseline control. Methods Medication adherence (4-item Morisky scale), glycaemic control (HbA1c%), and other variables were assessed in 287 adult primary care patients prescribed oral medication (40% also on insulin) for Type 2 diabetes. Glycaemic control was reassessed 6 months later. Regression analyses examined concurrent and future glycaemic control as a function of baseline medication adherence after adjustment for baseline glycaemia and other potential confounders. Results Only half of patients reported high adherence. Cross-sectional adjusted analysis replicated prior reports of an adherence-HbA1c association ( P = 0.011). Even after adjusting for baseline HbA1c, each one-point increase in baseline Morisky total score was associated with a 1.8 mmol/mol (or 0.16%) increase in HbA1c measured 6 months later. Additionally, baseline endorsement of forgetting to take medication was associated with a 4.7 mmol/mol (or 0.43%) increase in 6-month HbA1c ( P = 0.005). This effect persisted after adjusting for psychological distress and did not vary by key demographic and medical features. Conclusions Even after stringent adjustment for baseline glycaemic control, self-reported adherence to diabetes medication predicts long-term glycaemic control. The Morisky scale is an easy-to-use clinical tool to identify patients whose glycaemic control will subsequently worsen, regardless of age, gender and psychological distress. [ABSTRACT FROM AUTHOR]

Aims Although depression has weak associations with several Type 2 diabetes mellitus (DM) outcomes, it is possible that these associations are concentrated within certain patient subgroups that are more vulnerable to their effects. This study tested the hypothesis that depression is related to glycaemic control and diabetes-related quality of life (DQOL) in patients who are prescribed injected insulin, but not those on oral glucose-lowering agents alone. Methods Participants (103 on insulin, 155 on oral glucose-lowering agents alone) with Type 2 DM were recruited from a large US healthcare system and underwent assessment of glycaemic control (glycated haemoglobin; HbA1c), medication adherence and diabetes self-care behaviours, DQOL and depression (none, mild, moderate/severe). Results There was a significant regimen × depression interaction on HbA1c ( P = 0.002), such that depression was associated with HbA1c in patients using insulin (β = 0.35, P < 0.001) but not in patients using oral agents alone (β = –0.08, P = NS). There was a similar interaction when quality of life was analysed as an outcome ( P = 0.002). Neither effect was mediated by regimen adherence. Conclusions The generally weak association between depression and glycaemic control is concentrated among patients who are prescribed insulin. Similarly, the association between depression and illness quality of life is strongest in patients prescribed insulin. Because this is not attributable to depression-related adherence problems, psychophysiological mechanisms unique to this group ought to be carefully investigated. Clinicians might be especially vigilant for depression in Type 2 DM patients who use insulin and consider its potential impact upon their illness course. [ABSTRACT FROM AUTHOR]