Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus

A.D. Morris (Lead / Corresponding author), D.I.R. Boyle, A.D. McMahon, S.A. Greene, T.M. MacDonald, R.W. Newton

Research output: Contribution to journalArticle

398 Citations (Scopus)

Abstract

Background. Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database. Methods. We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA(1c)) 8.4 (1.9)%, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA(1c)), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled. Findings. Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day. 25 (28%) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 [68; range 9-246] insulin days/annum). There was a significant association between HbA(1c) and the adherence index (R2 = 0.39; p < 0.001). In the top quartile (HbA(1c) > 10%), 14 (64%) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and all hospital admissions related to acute diabetes complications (p = 0.008). The deterioration in glycaemic control observed in patients aged 10-20 years was associated with a significant reduction (p = 0.01) in the adherence index. Interpretation. We found direct evidence of poor compliance with insulin therapy in young patients with IDDM. We suggest that poor adherence to insulin treatment is the major factor that contributes to long-term poor glycaemic control and diabetic ketoacidosis in this age group.
Original languageEnglish
Pages (from-to)1505-1510
Number of pages6
JournalLancet
Volume350
Issue number9090
DOIs
Publication statusPublished - 22 Nov 1997

Fingerprint

Ketosis
Type 1 Diabetes Mellitus
Insulin
Diabetic Ketoacidosis
Therapeutics
Pharmacies
Diabetes Complications
Young Adult
Glycosylated Hemoglobin A
Scotland
Teaching Hospitals
Prescriptions

Cite this

Morris, A.D. ; Boyle, D.I.R. ; McMahon, A.D. ; Greene, S.A. ; MacDonald, T.M. ; Newton, R.W. / Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. In: Lancet. 1997 ; Vol. 350, No. 9090. pp. 1505-1510.
@article{0b8e6e74dc6e4dc6a15659c68a8df1d4,
title = "Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus",
abstract = "Background. Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database. Methods. We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA(1c)) 8.4 (1.9){\%}, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA(1c)), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled. Findings. Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day. 25 (28{\%}) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 [68; range 9-246] insulin days/annum). There was a significant association between HbA(1c) and the adherence index (R2 = 0.39; p < 0.001). In the top quartile (HbA(1c) > 10{\%}), 14 (64{\%}) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and all hospital admissions related to acute diabetes complications (p = 0.008). The deterioration in glycaemic control observed in patients aged 10-20 years was associated with a significant reduction (p = 0.01) in the adherence index. Interpretation. We found direct evidence of poor compliance with insulin therapy in young patients with IDDM. We suggest that poor adherence to insulin treatment is the major factor that contributes to long-term poor glycaemic control and diabetic ketoacidosis in this age group.",
author = "A.D. Morris and D.I.R. Boyle and A.D. McMahon and S.A. Greene and T.M. MacDonald and R.W. Newton",
note = "cited By 376",
year = "1997",
month = "11",
day = "22",
doi = "10.1016/S0140-6736(97)06234-X",
language = "English",
volume = "350",
pages = "1505--1510",
journal = "Lancet",
issn = "0140-6736",
number = "9090",

}

Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. / Morris, A.D. (Lead / Corresponding author); Boyle, D.I.R.; McMahon, A.D.; Greene, S.A.; MacDonald, T.M.; Newton, R.W.

In: Lancet, Vol. 350, No. 9090, 22.11.1997, p. 1505-1510.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus

AU - Morris, A.D.

AU - Boyle, D.I.R.

AU - McMahon, A.D.

AU - Greene, S.A.

AU - MacDonald, T.M.

AU - Newton, R.W.

N1 - cited By 376

PY - 1997/11/22

Y1 - 1997/11/22

N2 - Background. Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database. Methods. We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA(1c)) 8.4 (1.9)%, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA(1c)), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled. Findings. Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day. 25 (28%) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 [68; range 9-246] insulin days/annum). There was a significant association between HbA(1c) and the adherence index (R2 = 0.39; p < 0.001). In the top quartile (HbA(1c) > 10%), 14 (64%) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and all hospital admissions related to acute diabetes complications (p = 0.008). The deterioration in glycaemic control observed in patients aged 10-20 years was associated with a significant reduction (p = 0.01) in the adherence index. Interpretation. We found direct evidence of poor compliance with insulin therapy in young patients with IDDM. We suggest that poor adherence to insulin treatment is the major factor that contributes to long-term poor glycaemic control and diabetic ketoacidosis in this age group.

AB - Background. Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database. Methods. We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA(1c)) 8.4 (1.9)%, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA(1c)), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled. Findings. Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day. 25 (28%) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 [68; range 9-246] insulin days/annum). There was a significant association between HbA(1c) and the adherence index (R2 = 0.39; p < 0.001). In the top quartile (HbA(1c) > 10%), 14 (64%) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and all hospital admissions related to acute diabetes complications (p = 0.008). The deterioration in glycaemic control observed in patients aged 10-20 years was associated with a significant reduction (p = 0.01) in the adherence index. Interpretation. We found direct evidence of poor compliance with insulin therapy in young patients with IDDM. We suggest that poor adherence to insulin treatment is the major factor that contributes to long-term poor glycaemic control and diabetic ketoacidosis in this age group.

U2 - 10.1016/S0140-6736(97)06234-X

DO - 10.1016/S0140-6736(97)06234-X

M3 - Article

VL - 350

SP - 1505

EP - 1510

JO - Lancet

JF - Lancet

SN - 0140-6736

IS - 9090

ER -