Real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review

GAGLIARDINO JJ ET AL

DIABETIC MEDICINE

WILEY-BLACKWELL PUBLISHING, INC

Lugar: Londres; Año: 2013 vol. 30 p. 512 - 524

0742-3071

AimsTo identify real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus. MethodsA literature search was conductedin PubMed and EMBASE in November 2011to identify studiesreporting factors associated with adherence/non-adherence to insulin therapy in adults with Type 1 or Type 2 diabetes. ResultsSeventeen studies were identified;six used self-reported measures and 11 used calculated measures of adherence. Most (13/17) were conductedexclusively in the USA. Four categoriesof factors associated with non-adherence were identified: predictive factors for non-adherence, patient-perceived barriers to adherence, Type of delivery device and cost of medication. Forpredictive factors and patient-perceived barriers, only age, female sex and travelling were associated with non-adherence in more than one study. Fear of injections and embarrassment of injecting in public were also cited as reasons for non-adherence. Conversely, adherence wasimproved by initiating therapy with, or switching to, a pen device (in four studies), and by changing to an insurance scheme that lowered the financial burden on patients (in two studies). ConclusionsAdherence to insulin therapy is generally poor.Few factors or patient-perceived barriers were consistently identified as predictive for non-adherence, althoughfindings collectively suggest that a more flexible regimen may improve adherence. Switching to a pen device and reducing patient co-payments appear to improve adherence. Further real-world studies are warranted, especially in countries other than the USA, to identify factors associated with non-adherence andenable development of strategies to improve adherence to insulin therapy.