Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit | JoVE Visualize

Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit

A D Morris¹, D I Boyle, A D McMahon

¹Department of Medicine, University of Dundee Ninewells Hospital and Medical School, Scotland, UK.

Lancet (London, England)|December 6, 1997

View abstract on PubMed

Summary

Poor adherence to insulin therapy in young patients with insulin-dependent diabetes mellitus (IDDM) is linked to worse glycaemic control and increased diabetic ketoacidosis. Improving compliance is crucial for better long-term health outcomes in this population.

Area of Science:

Endocrinology
Metabolic Disorders
Public Health

Background:

Intensive insulin therapy is key for managing microvascular complications in insulin-dependent diabetes mellitus (IDDM).
Variable adherence to insulin treatment is a significant concern, potentially leading to poor glycaemic control and diabetic ketoacidosis in adolescents and young adults.
The Diabetes Audit and Research in Tayside Scotland (DARTS) database was utilized to investigate insulin prescription and dispensing patterns.

Purpose of the Study:

To assess the association between prescribed insulin doses and dispensed amounts in young IDDM patients.
To determine the relationship between insulin adherence and glycaemic control (HbA1c), diabetic ketoacidosis, and hospital admissions for acute complications.

Main Methods:

A cohort of 89 patients (mean age 16 years) with IDDM was studied.
The adherence index was calculated based on prescribed insulin doses and dispensed volumes from community pharmacies.
Statistical models were used to analyze associations between the adherence index, HbA1c, diabetic ketoacidosis, and hospital admissions.

Main Results:

A significant inverse association was found between HbA1c and the adherence index (R2 = 0.39; p < 0.001).
Patients with higher HbA1c levels (>10%) frequently showed reduced insulin collection, indicating missed doses.
The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and other acute diabetes complications (p = 0.008).

Conclusions:

Direct evidence of poor insulin therapy compliance was observed in young IDDM patients.
Poor adherence to insulin treatment is identified as a major contributor to long-term poor glycaemic control and diabetic ketoacidosis in this demographic.
Interventions to improve insulin adherence are recommended for better management of diabetes in adolescents and young adults.