RESUMO
BACKGROUND: Adherence to treatment has been defined as the degree to which a patient's behavior corresponds to medical or health advice; however, the most appropriate method to evaluate adherence to diabetes care has yet to be identified. We conducted analyses to compare adherence assessments and blood glucose monitoring measures with regard to their ability to predict glycemic control in adults with type 1 diabetes. METHODS: We analyzed four instruments to evaluate adherence: Self-Care Inventory-Revised, a self-administered survey; Diabetes Self-Monitoring Profile (DSMP), administered by trained researchers; a categorical (yes/no/sometimes) adherence self-evaluation; and a continuous (0-100) adherence self-evaluation. Blood glucose monitoring frequency was evaluated by self-report, diary, and meter download. RESULTS: Participants (n = 82) were aged 39.0 ± 13.1 years with a mean diabetes duration of 21.2 ± 11.1 years; 27 % monitored blood glucose >4 times/day. The DSMP score was the strongest predictor of glycemic control (r = -0.32, P = 0.004) among adherence assessments, while blood glucose monitoring frequency assessed by meter download was the strongest predictor among blood glucose monitoring measures (r = -40, P < 0.001). All the self-report assessments had a significant but weak correlation with glycemic control (r ≤ 0.28, P ≤ 0.02). The final adjusted model identified the assessment of blood glucose monitoring frequency by meter download as the most robust predictor of HbA1c (estimate effect size = -0.58, P = 0.003). CONCLUSIONS: In efforts to evaluate adherence, blood glucose monitoring frequency assessed by meter download has the strongest relationship with glycemic control in adults with type 1 diabetes.
RESUMO
BACKGROUND: The purpose of this study was to carry out a cross-cultural adaptation to Brazilian Portuguese, validation, and comparison of two questionnaires to measure adherence in patients with type 1 diabetes. There are no validated instruments to measure treatment adherence in Brazilian patients with type 1 diabetes. METHODS: Type 1 diabetes outpatients of a tertiary hospital in Southern Brazil were recruited to examine psychometric properties of the Diabetes Self-Management Profile (DSMP) and Self-Care Inventory-revised (SCI-R) adapted to Brazilian Portuguese. Analyses assessed the reliability and validity according to its associations with glycated hemoglobin (A1C). Seventy-five patients [age: 34.9 ± 13.7 years; A1C: 9.2 ± 2% (75 mmol/mol); diabetes duration: 18.1 ± 11.8 years] were evaluated. RESULTS: The translated versions of the instruments showed adequate internal consistency (DSMP Cronbach's α =0.76; SCI-R Cronbach's α =0.71). A positive correlation was found between all the items and total scores, except for item 12 in DSMP and item 13 in SCI-R, and for this reason, these items were excluded from the translated versions. In predictive validity analysis, A1C correlated significantly with the DSMP total (r = -0.46) and with the SCI-R total (r = -0.44). CONCLUSIONS: The Brazilian Portuguese versions of DSMP and SCI-R yielded a reliable and valid tool to measure adherence treatment for patients with type 1 diabetes, with a significant correlation between total scores and A1C.