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Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptoms

Authors Kokoszka A

Received 13 October 2016

Accepted for publication 27 December 2016

Published 17 March 2017 Volume 2017:11 Pages 587—595


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Andrzej Kokoszka1,2

1II Department of Psychiatry, Medical University of Warsaw, 2Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland

Background: Insulin analogs are regarded as more convenient to use than human insulin; however, they require a different administration scheme due to their unique pharmacokinetic and pharmacodynamic properties. This study aimed to assess difficulties with adherence to treatment with insulin analogs in patients with type 2 diabetes mellitus (T2DM), who had previously been treated with human insulin. The associations between difficulties with adherence and clinical, demographic, and psychological characteristics were also evaluated.
Patients and methods: The study was conducted on 3,467 consecutively enrolled patients with T2DM (54.4% women), mean age 63.9 years (SD =9.57), who had recently undergone a physician-directed change in treatment from human insulin to insulin analogs. The questionnaires addressed difficulties with switching the therapy, coping styles, well-being, and perception of self-influence on the disease.
Results: No adherence problems in switching therapy were reported in 56.6% of patients. Specific moderate difficulties were reported in 10.4%–22.1% of patients, major difficulties in 0.7%–6.9% of patients, and very significant difficulties in 0.03%–1.3% of patients. Overall, remembering to modify the insulin dose in the case of additional meals was the most frequently reported difficulty, and problems with identifying hypoglycemic symptoms were the least frequently reported. The increased risk of difficulties was moderately related to low perception of self-influence on diabetes and poor well-being. The intensity of problems was higher among those who were less-educated, lived in rural areas, had complications, and/or reported maladaptive coping styles.
Conclusion: Switching from human insulin to an insulin analog did not cause adherence problems in more than half of the patients. In the remaining patients, difficulties in adherence correlated with maladaptive coping styles, low perception of self-influence on disease course, and depressive symptoms.

Keywords: adherence, type 2 diabetes mellitus, insulin, insulin analogs, treatment adherence

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