Introduction: Nonadherence to insulin therapy is a significant problem worldwide, which is associated with poor health outcomes among patients with type 1 diabetes (T1D). It is important to identify the risk factors related to nonadherence to target those at higher risk of diabetic complications. In Singapore, there is a knowledge gap in understanding the risk factors for insulin nonadherence in paediatric patients with T1D.
Objectives: To assess the prevalence of nonadherence to insulin therapy and its associated risk factors among paediatric patients with T1D in Singapore.
Methods: This was a retrospective, single-centre longitudinal study conducted in KK Womens and Childrens Hospital, which is the largest paediatric hospital in Singapore. Singaporean patients with T1D aged ≤18 years with ≥1 year of insulin collection from the hospital between 1st January 2012 to 31st December 2016 were included in the study. Those on insulin pumps were excluded. Patients were considered nonadherent when medication possession ratio (MPR) was less than 100%. Mann Whitney U test, t-test, and χ2 test were used to analyse medians, means, and proportions between the nonadherent and adherent groups, respectively. Regression analysis was used to identify risk factors for non-adherence. Sensitivity analyses was performed for varying definitions of nonadherence at MPR<95% and MPR<80%.
Results: A total of 210 patients were included in the study, where patients in the nonadherent group were older and had a longer duration of diabetes since diagnosis. Gender, race, financial class and number of concurrent medications were comparable between both groups. The prevalence of insulin nonadherence among paediatric patients with T1D in Singapore was 35.7% (95% CI=29.2%42.6%). This decreased to 26.2% (95% CI: 20.432.7%) at MPR<95% and 12.4% (95% CI: 8.317.6%) when nonadherence was defined at MPR<80%. An increase in age and diabetes duration were associated with 22.0% (P=0.002) and 12.6% (P=0.024) increased risk of nonadherence, respectively. Patients of Chinese descent were 56% (P=0.026) less likely to be nonadherent compared to other ethnicities. When nonadherence was defined at MPR<95% and MPR<80%, an increase in age and duration of diabetes were associated with 22.9% (P=0.001) and 27.3% (P=0.017) increase in risk of nonadherence, respectively.
Conclusion: More than one-third of the paediatric patients were nonadherent to insulin therapy, signifying a need to design targeted interventions based on the risk factors identified.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology