SLR - October 2009 - Nelida Dumitrache
Reference:
Aikens J. E., Pietter J. D. (2009) Diabetic patients’ medications underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments, Diabetes Care, 32(1), 19-34.
Scientific Literature Review
Reviewed by: Nelida Dumitrache, DPM, PGY1
Residency Program: Southern Arizona VA Health Care Systems
Podiatric Relevance: This study attempts to determine the cause of diabetes medication underuse in economically stressed populations.
Methods:
The researchers recruited 806 patients from an economically stressed city and evaluated their beliefs about antihyperglycemic and antihypertensive medication. Specifically, their perception with respect to the necessity of the medication and the perception of possible harmfulness from these medications was assessed. These beliefs were then compared to patients’ demographical characteristics, functional health literacy, out-of-pocket prescription cost, number of medical conditions, number of prescribed medications, prescribed insulin, satisfaction with medical information, HA1C and blood pressure.
Results:
The investigators found that 46% of the patients in this study underused antihyperglycemics, and that a third of these were due to cost. Belief that antihyperglycemics were harmful was significantly correlated with younger age, African American descent, greater number of medical conditions, greater number of prescribed medications, use of insulin and low functional literacy. Perceived need for antihyperglycemics was significantly higher in patients who were younger, had greater number of medical conditions and prescribed medications, and were prescribed insulin. Neither was correlated with HA1C. Concern about the harmfulness of hyperglycemics and antihypertensives was significantly higher among patients who underused them, and especially higher in patients with cost-related underuse.
Conclusions:
To enhance adherence to antihyperglycemic medications, physicians should address multiple factors, including perceived harm, cost, and health literacy. Physicians should also consider racial history, specifically the perceived mistrust of the medical establishment among African-American communities.