The self-management of type 2 diabetes mellitus (T2DM), which involves adherence to medical instructions on diet and nutritional advice, physical activity, medication regimen, and weight and stress management, is necessary for the treatment of T2DM. In this study, we investigated the relationship between patients’ perceptions of their disease and their adherence to their medications. And we attempted to determine whether distinct subphenotypes of behavioral change of medication adherence can be discerned based on a patients’ perceptions. A cross-sectional study using a questionnaire was conducted among 157 patients with T2DM from October 2015 to September 2017. Questionnaires were administered to assess the participants’ demographic and clinical characteristics, medication adherence, diabetes knowledge, and perception of being diabetic. Principal component analysis (PCA) and cluster analyses were performed to classify medication adherence patterns in the total cohort. Multiple regression analyses were performed to identify the determinant factors of medication adherence. PCA showed the interpretable medication adherence of patients with diabetes by using component 1 (“accessibility to medical treatment”) and component 2 (“status of taking medicines”). We identified four groups that show significantly different medication adherence by using cluster analysis on the basis of the two components. Multiple regression analysis showed that body mass index (BMI), family history of diabetes, one factor of patient’s perception (living an orderly life), and diabetes knowledge were found to be significant predictors of medication adherence in patients with T2DM. In patients with T2DM, the patient’s diabetes perception of “living an orderly life” is associated with medication adherence. A poor adherence group may be able to change their adherence to diabetes treatment by developing the perception of “living an orderly life.”

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The relationship between patients' perception of type 2 diabetes and medication adherence: a cross-sectional study in Japan.

Aims This systematic review sought to synthesize the evidence regarding the effectiveness of illness perception interventions compared with control conditions at changing illness perceptions and improving glycaemic control in individuals with type 2 diabetes. Methods Seven electronic databases were searched between October 2018 and May 2020. Randomized controlled trials that tested interventions informed by the Common-Sense Model in adults with type 2 diabetes, and measured illness perceptions and glycaemic control at pre- and post-intervention were included. The Cochrane risk of bias tool was used to assess risk of bias. Results A total of 4095 articles were identified, of which nine randomized control trials (2561 participants) across 12 publications were included in this review. Findings showed that all the illness perception domains were modified in at least one trial, with the exception of cyclical timeline perceptions. Coherence, personal control, treatment control and chronic timeline perceptions were the most frequently modified perceptions. Glycaemic control demonstrated an improvement in the intervention group compared to the control group at 3 and 6 months post-intervention in two trials. Risk of bias assessment showed high risk of bias especially for the blinding of participants and the personnel domain. Conclusions There is limited evidence that interventions informed by the Common-Sense Model can improve glycaemic control in individuals with type 2 diabetes through changing inaccurate illness perceptions. Recommendations for future research are to tailor intervention content based on baseline perceptions, measure the emotional and causal domains, and involve family members in the intervention. (PROSPERO registration: CRD42019114532).

A systematic review of illness perception interventions in type 2 diabetes: Effects on glycaemic control and illness perceptions.

Aims To develop an intervention and evaluate its effectiveness in pharmacotherapeutic empowerment of patients with type 2 diabetes mellitus (T2DM). Method This is an intervention study with before and after evaluation. The intervention was conducted between 2015 and 2016 with users of the Unified Health System (SUS) in Brazil. The study was divided into six stages: initial evaluation, three individual patient-pharmacist meetings every 15 days over 6 weeks, clinical discussion between pharmacists, and final evaluation. At each meeting with the patient, specific themes for empowerment were addressed using educational booklets and pharmaceutical care. Clinical and laboratory evaluations and questionnaires on self-efficacy (IMDSES), self-care (QAD) and distress (PAID-5) were conducted before and three months after the intervention. Results 47 patients completed the intervention. Glycated hemoglobin of patients had a median reduced from 7.0% to 6.6% after the intervention (p = 0.02). There was a significant difference (p  Conclusion The results of the study suggest that the strategy developed is effective in promoting the empowerment of T2DM patients, improved glycemic control and self-care.

Pharmacotherapeutic empowerment and its effectiveness in glycemic control in patients with Diabetes Mellitus.

Background Illness perceptions (IP) involve coping strategies and behavioural responses that can influence glycaemic control. Despite the importance of good glycaemic control, the majority of patients in Asia are not achieving glycaemic targets. An evaluation of IP in association with glycaemic control, medication adherence and chronic kidney disease (CKD) in Type 2 diabetes mellitus patients (T2DM) was carried out in an outpatient setting in Malaysia Method A cross-sectional study was conducted using the Revised Illness Perception Questionnaire in a purposive sample of 384 T2DM patients. Results There were 55.7% females, median age was 58.2 years and median duration of diabetes was 13 years. The majority (79.4%) of patients had poor diabetes control (HbA1c ≥ 7.0%) and 39.6% of patients had low medication adherence. Patients with good glycaemic control had a higher Timeline Acute/Chronic and Emotional Representations score, hence they held the correct belief that diabetes is chronic and experienced negative emotions. Highly adherent patients had a higher Illness Coherence (χ2 = 21.385, p  Conclusion Dimensions of IP have been shown to be significantly associated with the assessed variables, therefore intervention studies with education, support and counselling should be conducted in Asia with the ultimate aim of empowering patients through IP-targeted management.

Evaluation of illness perceptions and their associations with glycaemic control, medication adherence and chronic kidney disease in type 2 diabetes mellitus patients in Malaysia.

Illness perception of patients with pemphigus vulgaris.

OBJECTIVES Despite the availability of a wide selection of anti-diabetic treatments, many type 2 DM (T2DM) patients still do not have controlled glucose levels. In addition to pharmacological intervention, patients' own implicit beliefs about their illness should be targeted for health intervention. Thus, we conducted a quantitative study to evaluate the associations between illness perception (IP) domains and metabolic control (HbA1c) of T2DM patients in Selama Hospital and to identify patients' perceptions of the causal T2DM factors. METHOD A cross-sectional study was conducted in the outpatient department of Selama Hospital from October to December 2015. A total of 200 T2DM patients were recruited using systematic random sampling. A self-administered validated questionnaire consisting of three sections was used, and the data were analysed using SPSS version 18. The associations between eight IP domains and HbA1c were evaluated via multiple linear regression. P values <0.05 were considered significant. KEY FINDINGS The analysis included data from 200 respondents with a mean age of 57.7 years (SE = 9.8). The majority were women (64.5%) and Malays (86%) with a primary school education (43.5%) and a family history of diabetes (53.5%). The median duration of illness was 5 years (IQR = 7), and the median HbA1c level was 8.15% (IQR = 3.1). The mean score for the eight IP domains was 33.7 (SE = 8.43) out of a total score of 80. Using multiple linear regression, HbA1c was found to be significantly associated with IP domains of identity symptoms at 0.221 (95% CI 0.083-0.358). Moreover, 79.4% of patients ranked diet and eating behaviour as the main factor for T2DM. CONCLUSION The IP domain of identity symptoms was significantly correlated with T2DM metabolic control. By understanding patients' IP, healthcare providers can focus on behavioural approaches to managing T2DM patients. Steps must be taken to educate patients about the importance of diet control in managing T2DM.

The associations of illness perception with metabolic control (HbA1c) among type 2 diabetes mellitus patients in a district hospital.

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The influence of beliefs about medicines on medication nonadherence among hemodialysis patients: a multicenter study from Malaysia

This study aimed to assess the association between Malaysian hemodialysis patients’ Necessity-Concerns Framework and medication adherence. This was a cross-sectional multicenter study conducted in Penang, Malaysia, by purposive sampling. Data were collected using a 5-item Medication Adherence Report Scale (MARS-5) and the Beliefs about Medicine Questionnaire (BMQ). Multiple linear regression was used to assess the association between patients’ medication beliefs and adherence. A total of 325 hemodialysis patients were recruited from 8 hemodialysis centers. The mean age of patients was 60.18 ± 21.54 years, and they were prescribed a median of 9 (95% CI: 8.0–11.0) medications daily. The mean score of medication adherence was 23.41 ± 1.81 based on the MARS-5 score. In the BMQ analysis, 88.0% of the patients believed that their medications prevent them from becoming worse, while 36.3% expressed worry about the side effects. The Necessity-Concerns differential score was 5.26 ± 3.91, with 67.1% of the patients having an accepting attitude. The belief of getting very sick without medications was a significant predictor of medication adherence. Meanwhile, the worry about becoming heavily dependent on medications has a significant negative association with medication adherence. In conclusion, counseling should be customized for patients with negative beliefs about medications and potential nonadherence.

Association of Necessity-Concerns Framework with medication adherence among Malaysian hemodialysis patients: A multicenter cross-sectional study

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The associations of illness perception with metabolic control (HbA1c) among type 2 diabetes mellitus patients in a district hospital.

The influence of beliefs about medicines on medication nonadherence among hemodialysis patients: a multicenter study from Malaysia

Association of Necessity-Concerns Framework with medication adherence among Malaysian hemodialysis patients: A multicenter cross-sectional study