***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to determine the adherence to oral hypoglycemic medications and associated factors in type 2 Diabetes Mellitus patients who were referred to the Isfahan Endocrinology and Metabolism Research Centre ( IEMRC ) . Convenience sampling was used to enroll 248 patients with type 2 diabetes in a prospect i ve study at IEMRC from January 2007 to January 2008 . Patients had to be on a stable dose of oral hypoglycemic medications ( glyburide and metformin ) or for 3 months prior to the study and willing to participate in consultation sessions with a pharmacist . Pill count and self report methods were used to measure the adherence .  Mean ( SD ) of patients studied was 56.6 ( 8.9 ) years and 62 % were females . The mean ( SD ) duration of diabetes in the study patients was 10.8 ( 6.1 ) years and 81.9 % of them were literate with basic education . Non-adherence rates to metformin and glyburide were recorded in 39.7 % and 35.3 % of the study population respectively . Lower HbA1C levels and higher education were associated with higher adherence rates . Forgetfulness , confusion , fasting , adverse effects , complexity of medication regimen and disruption of routines were most commonly reported causes of non adherence . Prevalence of adherence to these two medications did not differ significantly between pill count ( 62.3 % ) and self report ( 62.8 % ) , ( p > 0.05 ) . Adherence rates did not vary by pill count and self report significantly . It was concluded that good adherence to medications was associated with a lower HbA1C profile ; so it seems that pill count is a useful method in the clinical practice to identify non-adherent patients . Further studies are needed to find out efficient interventions to improve the patient ’s adherence Background : There have been a number of studies relating medication adherence to patient characteristics . There is less research on influence of health care providers on patients ’ medication-taking behavior . Objectives : To evaluate the pharmacy-level effect on medication adherence for patients receiving antidiabetic medications . Research Design : This was a hypothesis-driven retrospective study using cross-sectional design and insurance cl aims data . The main analytical interest was the pharmacy-level effect on proportion of days covered as the measure of medication adherence . Multilevel r and om and mixed-effect models were used to tease out the pharmacy-level effect on patient outcomes . Subjects : The study population consisted individuals aged 18–64 years , insured under employer-sponsored private health plans . Results : We estimated models with and without covariates . In both models , pharmacy cluster effect was statistically significant ( P<0.001 ) . In the model without covariates , pharmacy cluster effect accounted for 12.8 % ( 95 % confidence interval , 12.4%–13.1 % ) of total variance in adherence , whereas in the model with covariates pharmacies accounted for 12.1 % ( 95 % confidence interval , 11.6%–12.4 % ) of total variance . Covariates associated significantly with adherence were age , sex , mail order pharmacy , and prescription drug copay . Conclusions : The results suggest significant variation in medication adherence attributable to pharmacy factor , independent of other effects . The underlying reason could be varying level of influence from pharmacies ’ efforts to inform or influence patients to take medications in prescribed manners . More research is necessary to better underst and the effect of specific pharmacy characteristics and practice styles differences OBJECTIVE To evaluate the psychosocial barriers to insulin use in low-income , type 2 diabetic patients ; the clinical characteristics of these patients ; and the possible causes of nonadherence to insulin regimens months after prescription . METHODS We studied a prospect i ve cohort of low-income patients with type 2 diabetes mellitus , aged 45 to 75 years , attending a tertiary health care center in Mexico City , Mexico . Patients were eligible if their diabetes was not controlled with oral agents , and they were excluded if they had type 1 diabetes mellitus , a secondary cause of diabetes , had been admitted to the hospital within the month before study commencement , had been previously treated with insulin , had severe diabetic complications , or had a chronic or disabling medical illness . All patients were prescribed 6 to 10 units of neutral protamine Hagedorn insulin before bedtime and received a referral to visit with a diabetes nurse educator . The main outcome was adherence or nonadherence to insulin therapy  , and it was correlated with several variables including attitudes toward insulin , diabetes self-management , diabetes-related knowledge , depression , and diabetes-related distress . Brief medical history , complete battery of question naires , and laboratory workup were obtained at baseline and 1 to 3 months after insulin prescription . RESULTS Twenty-nine consecutive patients were included . Mean age ( + /- st and ard deviation ) was 59 + /- 8 years , 18 ( 62 % ) were women , mean diabetes duration was 14 + /- 9 years , and mean hemoglobin A1c level was 10.8 + /- 1.4 % .  Negative attitudes toward insulin  were very common , particularly in patients with less education and poorer diabetes-related knowledge ( odds ratio , 6.2 ; 95 % confidence interval , 1.04 - 47.3 ; P = .02 ) . Even when they received precise recommendations , 12 patients ( 41 % ) did not adhere to insulin treatment . Patients who did not adhere to therapy were most commonly women and were depressed ( P = .05 ) . Improved adherence was significantly associated with the additional support of a diabetes nurse educator ( odds ratio , 6.6 ; 95 % confidence interval , 1.0 - 55.7 ; P = .02 ) . CONCLUSIONS Improving patient perception and acceptance of insulin with the help of diabetes educators can facilitate earlier and more aggressive intervention and thus optimize glycemic control Purpose The purpose of this study is to assess factors related to diabetes medication nonadherence in a sample of predominantly Spanish-speaking Mexican-origin adults residing along the US-Mexico border . Methods As part of a r and omized controlled trial , 302 patients r and omly sample d from a clinic roster completed a baseline interview .  Medication nonadherence was assessed with the  Morisky Medication Adherence Scale .  Consistent with the framework proposed by Venturini et al , four factors were examined : patient-related attributes , drug regimen characteristics and complexity , health status , and patient-provider interaction characteristics . Results Sixty percent of the patients were classified as nonadherent . Men , those who engaged in diabetes control behaviors less frequently , and individuals with depression were more likely to be classified as nonadherent . Among those who were Spanish-dominant , education and self-rated health also were significantly and negatively related to medication adherence ; patients with a high school education or greater and those who more positively rated their health were more likely to be classified as nonadherent compared to those with less than a high school education and those who rated their health as poor . Conclusions Results reflect potentially higher medication nonadherence rates for Latinos with type 2 diabetes living in rural communities along the US-Mexico border . Additionally , this study supports the need to address strategies to support medication adherence , including addressing depression , for diabetes control . Strategies to promote adherence among Latino men are sorely needed , as are strategies to address forgetfulness and carelessness regarding diabetes medicine taking Purpose The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence , glycemic control , and depression outcomes . Methods Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were r and omly assigned to an integrated care intervention or usual care .  Adherence was assessed at baseline , 2 , 4 , and 6 weeks using the  Medication Event Monitoring System to assess adherence . Outcomes assessed at baseline and 12 weeks included st and ard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression . Results In all , 58 participants aged 50 to 80 years participated . The proportion of participants who had 80 % or greater adherence to an oral hypoglycemic ( intervention 62.1 % vs usual care 24.1 % ) and an antidepressant ( intervention 62.1 % vs usual care 10.3 % ) was greater in the intervention group in comparison with the usual care group at 6 weeks . Participants in the integrated care intervention had lower levels of glycosylated hemoglobin ( intervention 6.7 % vs usual care 7.9 % ) and fewer depressive symptoms ( CES-D mean scores : intervention 9.6 vs usual care 16.6 ) compared with participants in the usual care group at 12 weeks . Conclusion A pilot r and omized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans . Integrated interventions may be more feasible and effective in real-world practice s with competing dem and s for limited re sources Purpose The purpose of this study was to evaluate the effectiveness of integrative health ( IH ) coaching on psychosocial factors , behavior change , and glycemic control in patients with type 2 diabetes . Methods Fifty-six patients with type 2 diabetes were r and omized to either 6 months of IH coaching or usual care ( control group ) . Coaching was conducted by telephone for fourteen 30-minute sessions . Patients were guided in creating an individualized vision of health , and goals were self-chosen to align with personal values . The coaching agenda , discussion topics , and goals were those of the patient , not the provider . Preintervention and postintervention assessment s measured medication adherence , exercise frequency , patient engagement , psychosocial variables , and A1C . Results Perceived barriers to medication adherence decreased , while patient activation , perceived social support , and benefit finding all increased in the IH coaching group compared with those in the control group . Improvements in the coaching group alone were also observed for self-reported adherence , exercise frequency , stress , and perceived health status . Coaching participants with elevated baseline A1C ( ≥7 % ) significantly reduced their A1C . Conclusions A coaching intervention focused on patients ’ values and sense of purpose may provide added benefit to traditional diabetes education programs . Fundamentals of IH coaching may be applied by diabetes educators to improve patient self-efficacy , accountability , and clinical outcomes PURPOSE The purpose of this study is to characterize the adherence and medication management barriers for adults with poorly controlled type 2 diabetes mellitus ( DM ) ( those with A1c 9 % or above ) and to identify specific adherence characteristics associated with poor diabetes control . METHODS This was a cross-sectional analysis of baseline data from a r and omized , controlled diabetes intervention conducted in University of Washington ( UW ) Medicine Clinics in the greater Seattle , Washington , area . The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months . Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Question naire . Specific adherence characteristics associated with poor diabetes control ( A1c > 9 % ) were identified using multivariate regression analysis . RESULTS Seventy-seven subjects ( mean A1c , 10.4 % ; mean duration of DM , 7 years ) were studied . The most common adherence challenges included paying for medications ( 34 % ) , remembering doses ( 31 % ) , reading prescription labels ( 21 % ) , and obtaining refills ( 21 % ) . Taking more than 2 doses of DM medication daily ( beta = .78 , SE = 0.32 , P = .02 ) and difficulty reading the DM medication prescription label ( beta = .76 , SE = 0.37 , P = .04 ) were significantly associated with higher hemoglobin A1c . Self-reported adherence was not related to A1c control . CONCLUSIONS In this study , we identified 2 factors that were associated with poorer A1c control . These findings highlight the importance of identifying potential challenges to medication adherence for those with DM and providing support to minimize or resolve these barriers to control Background Adherence to prescribed medications is a key dimension of healthcare quality . The aim of this large population -based study was to evaluate self-reported medication adherence and to identify factors linked with poor adherence in patients with type 2 diabetes in France . Methodology The ENTRED study 2007 , a French national survey of people treated for diabetes , was based on a representative sample of patients who cl aim ed reimbursement for oral hypoglycaemic agents and /or insulin at least three times between August 2006 and July 2007 , and who were r and omly selected from the data base of the two main National Health Insurance Systems . Medication adherence was determined using a six-item self-administered question naire . A multinomial polychotomous logistic regression model was used to identify factors associated with medication adherence in the 3,637 persons with type 2 diabetes . Principal Findings Thirty nine percent of patients reported good medication adherence , 49 % medium adherence and 12 % poor adherence . The factors significantly associated with poor adherence in multivariate analysis were socio-dem 
    Output:
    
Factors including age , race , health beliefs , medication cost , co-pays , Medicare Part D coverage gap , insulin use , health literacy , primary nonadherence , and early nonpersistence significantly affect adherence .
Higher adherence was associated with improved glycemic control , fewer emergency department visits , decreased hospitalizations , and lower medical costs .
Adherence was lower when medications were not tolerated or were taken more than twice daily , with concomitant depression , and with skepticism about the importance of medication .
Intervention trials show the use of phone interventions , integrative health coaching , case managers , pharmacists , education , and point-of-care testing improve adherence .