BACKGROUND: Management of diabetes, and in particular blood glucose, can be complex and burdensome.
OBJECTIVE: To evaluate patient views of the burdens of therapy and its impact on self-management.
PATIENTS: Veteran patients with type 2 diabetes.
MEASUREMENTS: Patients described their views of the burden of diabetes treatments, adherence, and clinical and demographic status. Factors
associated with ratings of burden and adherence to therapy were examined using multivariate regression methods.
RESULTS: The response rate was 67% (n=1,653). Patients viewed pills as the least burdensome treatment and insulin as the most burdensome. Ratings of the burden
of insulin were lower if a patient had prior experience with therapy. Adherence to prescribed therapy varied substantially;
for example, patients followed medication recommendations more closely than other areas of self-management. Multivariate analyses
showed that the main predictor of adherence was patients’ ratings of the burden of therapy.
CONCLUSIONS: Injected insulin regimens are viewed as highly burdensome by patients, although this burden is attenuated by experience.
Adherence to self-management is strongly and independently correlated with views of treatment burden. The burden of diabetesrelated
treatments may be a source of suboptimal glucose control seen in many care settings. Providers should consider the burden
of treatment for a particular patient and its impact on adherence as part of a decision-making process to design effective
treatment regimens.
Key words diabetes - self-management - patient preferences
None of the authors has any financial or other conflicts of interests associated with this manuscript.
See editorial by Vinicor, p. 483.
Supported in part by Veterans Affairs Health Services Research Service grant IIR 970781, and by a Veterans Affairs Career
Development Award to Dr. Vijan.