TOOL DEVELOPMENT FOR EVALUATING ADHERENCE TO THE MANAGEMENT IN PATIENTS WITH TYPE 1 DIABETES MELLITUS (T1DM)
DOI:
https://doi.org/10.55519/JAMC-01-13878Keywords:
Type 1 Diabetes Mellitus, Medication Adherence, Blood Glucose Monitoring , Blood Glucose Monitoring Frequency, Diabetes management, Adherence assessment tool, Diabetes care evaluation.Abstract
Background: Type 1 Diabetes Mellitus (T1DM) is a chronic disease that needs strict adherence to maintain the glycaemic control and prevent complications. However, there is currently a lack of tools specifically designed for low- and middle-income country (LMIC) contexts to monitor adherence to T1DM management. The purpose of this study is to construct a self-administered tool to assess adherence to management protocols in T1DM patients. Methods: The adherence tool was developed in three phases: item pool construction, content validation, and pilot testing. The item pool construction phase consisted of a scoping review, focus group discussions (FGDs) and in-depth interviews (IDIs). In the second phase, expert validation and cognitive interviews were carried out to refine the questionnaire. Then, a pilot study on 25 T1DM patients was conducted to evaluate the tool’s internal consistency and reliability. Thematic and statistical analysis was employed to analyse qualitative and quantitative findings, respectively. Results: The developed tool consists of 43 questions, which covers different aspects of diabetes care including insulin dosage and administration 16 items), diet (12 items), and exercise (15 items). The tool was contextualised to cater for the needs of local patients and is delivered in the local language i.e. Urdu. The pilot study demonstrated good reliability (Cronbach alpha=0.78), test-retest reliability (Cronbach alpha=0.67) showing high internal consistency, and construct validity (Cronbach alpha=0.67) for the developed adherence assessment tool. Also, a strong correlation was found between adherence to overall T1DM management and HbA1C levels. Conclusion: The developed self-administered tool reliably assesses adherence to T1DM management in LMIC contexts. This tool offers a practical resource to monitor and improve glycaemic control in T1DM patients, tailored to local needs.
References
1. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect 2020;10(2):98–115.
2. Paschou SA, Papadopoulou-Marketou N, Chrousos GP, Kanaka-Gantenbein C. On type 1 diabetes mellitus pathogenesis. Endocr Connect 2018;7(1):R38–46.
3. Marks KP, Birkebæk NH, Pouwer F, Ibfelt EH, Thastum M, Jensen MB. Adherence in Diabetes Questionnaire (ADQ) score as a predictor of 11-year HbA(1c) trajectories in children and adolescents with type 1 diabetes: A population-based longitudinal study. Diabetes Res Clin Pract 2023;197:110558.
4. Ibrahim SA, El S, Owusu YB, Al-Khaja M, Khalifa A, Ahmed D, et al. Adherence as a Predictor of Glycemic Control Among Adolescents with Type 1 Diabetes: A Retrospective Study Using Real-world Evidence. Clin Ther 2022;44(10):1380–92.
5. Miller KM, Foster NC, Beck RW, Bergenstal RM, DuBose SN, DiMeglio LA, et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care 2015;38(6):971–8.
6. Rausch JR, Hood KK, Delamater A, Shroff Pendley J, Rohan JM, Reeves G, et al. Changes in treatment adherence and glycemic control during the transition to adolescence in type 1 diabetes. Diabetes Care 2012;35(6):1219–24.
7. Lv W, Luo J, Long Q, Yang J, Wang X, Guo J. Factors associated with adherence to self-monitoring of blood glucose among young people with type 1 diabetes in China: a cross-sectional study. Patient Prefer Adherence 2021;15:2809–19.
8. Małachowska M, Gosławska Z, Rusak E, Jarosz-Chobot P. The role and need for psychological support in the treatment of adolescents and young people suffering from type 1 diabetes. Front Psychol 2023;13:945042.
9. Nathan DM. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014;37(1):9–16.
10. Abiru N, Shimada A, Nishimura R, Matsuhisa M, Ozaki A, Ikegami H. Glycemic control status, diabetes management patterns, and clinical characteristics of adults with type 1 diabetes in Japan: Study of Adults’ Glycemia in T1DM subanalysis. Diabetol Int 2021;12(4):460–73.
11. McGee RG, Cowell CT, Arnolda G, Ting HP, Hibbert P, Dowton SB, et al. Assessing guideline adherence in the management of type 1 diabetes mellitus in Australian children: a population-based sample survey. BMJ Open Diabetes Res Care 2020;8(1):e001141.
12. Fayyaz F, Mardi P, Sobhani S, Sokoty L, Aghamahdi F, Qorbani M. Association of quality of life with medication adherence and glycemic control in patients with type 1 diabetes. J Diabetes Metabol Disord 2024;23(1):783–8.
13. Rochmah N, Soetjipto S, Faizi M, Hisbiyah Y, Perwitasari RK, Fedora K, et al. Frequent Self-Monitoring Blood Glucose Correlated to Better Medication Adherence and Glycemic Control in Children with Type 1 Diabetes Mellitus. Diabetes Metab Syndr Obes 2024;17:2203–9.
14. Erickson J, Crowley T, Sawin K. Self-Management in Children. In: Hinds P, Linder L, editors. Pediatric Oncology Nursing: Defining Care Through Science; 2020.
15. Zhu S, Liu F, Li J, Guan Y, Meng M, Li X, et al. Development and validation of a self-management scale of type 1 diabetes for Chinese adults. J Int Med Res 2020;48(8):0300060520947588.
16. Chan SL, Ho CZ, Khaing NE, Ho E, Pong C, Guan JS, et al. Frameworks for measuring population health: A scoping review. PLoS One 2024;19(2):e0278434.
17. Y Othman S, S Hasan S, A Garjees N. Effects of a Home-Based Nursing Intervention Program on Caregivers Care Adherence of Children Affected with Type I Diabetes Mellitus. J Med Chem Sci 2023;6(10):2319–26.
18. Gaćina S, Mlačak B, Bulum T, Filej B. Application of the Summary of Diabetes Self-Care Activities Questionnaire in Evaluating the Self-Care of People with Diabetes. Diabetology 2024;5(5):501–13.
19. Jiang T, Li A, Zhang M, Zhou Z, Wang L, Zhang X, et al. Zhang Y, Zhang Q. Measuring Self-Management Among People with Diabetes Mellitus: A Systematic Review of Patient-Reported Diabetes-Specific Instruments in English and Chinese. Adv Ther 2023;40(3):769–813.
20. Ardianti S, Agushybana F, Nugraga P. The influence of reminder sms intervention in improving drug compliance in the review of glycated Hemoglobin levels (Hba1c) and morisky medical capabilityscale (Mmas)-8 dm type 2 patients in community health centerssemarang city. Int J Health, Educ Soc 2020;3(1):1–2.
21. Moon SJ, Lee WY, Hwang JS, Hong YP, Morisky DE. Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8. PLoS One 2017;12(11):e0187139.
22. Modanloo M. Development and psychometric tools adherence of treatment in patients with chronic. Iran: Iran University; 2013.
23. Lam WY, Fresco P. Medication adherence measures: an overview. BioMed Res Int 2015;2015(1):217047.
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