Patient‐reported outcomes and treatment adherence in type 2 diabetes using natural language processing: Wave 8 of the Observational International Diabetes Management Practices Study

• Published in: Journal of diabetes investigation Vol. 15; no. 9; pp. 1306 - 1316
• Main Authors: Chan, Juliana CN, Mbanya, Jean Claude, Chantelot, Jean‐Marc, Shestakova, Marina, Ramachandran, Ambady, Ilkova, Hasan, Deplante, Lucille, Rollot, Melissa, Melas‐Melt, Lydie, Gagliardino, Juan Jose, Aschner, Pablo
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01-09-2024; Wiley
• Subjects: Aged; Clincal; Clinical outcomes; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Female; Follow-Up Studies; Glycated Hemoglobin - analysis; Glycemic control; Hemoglobin; Humans; Hypoglycemic Agents - therapeutic use; Insulin; Male; Management; Middle Aged; Natural language processing; Patient education; Patient Reported Outcome Measures; Patient‐reported outcomes; Perceptions; Physicians; Questionnaires; Self-Management; Socioeconomic factors; Surveys and Questionnaires; Treatment - Education; Treatment Adherence and Compliance - psychology; Treatment Adherence and Compliance - statistics & numerical data; Type 2 diabetes; Variance analysis; Glycemic control; Type 2 diabetes; Clincal; Patient‐reported outcomes; Treatment - Education
• ISSN: 2040-1116; 2040-1124; 2040-1124
• DOI: 10.1111/jdi.14228

Aims/Introduction
We analyzed patient‐reported outcomes of people with type 2 diabetes to better understand perceptions and experiences contributing to treatment adherence.
Materials and Methods
In the ongoing International Diabetes Management Practices Study, we collected patient‐reported outcomes data from structured questionnaires (chronic treatment acceptance questionnaire and Diabetes Self‐Management Questionnaire) and free‐text answers to open‐ended questions to assess perceptions of treatment value and side‐effects, as well as barriers to, and enablers for, adherence and self‐management. Free‐text answers were analyzed by natural language processing.
Results
In 2018–2020, we recruited 2,475 patients with type 2 diabetes (43.3% insulin‐treated, glycated hemoglobin (HbA1c) 8.0 ± 1.8%; 30.9% with HbA1c <7%) from 13 countries across Africa, the Middle East, Europe, Latin America and Asia. Mean ± standard deviation scores of chronic treatment acceptance questionnaire (acceptance of medication, rated out of 100) and Diabetes Self‐Management Questionnaire (self‐management, rated out of 10) were 87.8 ± 24.5 and 3.3 ± 0.9, respectively. Based on free‐text analysis and coded responses, one in three patients reported treatment non‐adherence. Overall, although most patients accepted treatment values and side‐effects, self‐management was suboptimal. Treatment duration, regimen complexity and disruption of daily routines were major barriers to adherence, whereas habit formation was a key enabler. Treatment‐adherent patients were older (60 ± 11.6 vs 55 ± 11.7 years, P < 0.001), and more likely to have longer disease duration (12 ± 8.6 vs 10 ± 7.7 years, P < 0.001), exposure to diabetes education (73.1% vs 67.8%, P < 0.05), lower HbA1c (7.9 ± 1.8% vs 8.3 ± 1.9%, P < 0.001) and attainment of HbA1c <7% (29.7% vs 23.3%, P < 0.01).
Conclusions
Patient perceptions/experiences influence treatment adherence and self‐management. Patient‐centered education and support programs that consider patient‐reported outcomes aimed at promoting empowerment and developing new routines might improve glycemic control.
Reasons for (a) non‐adherence and (b) adherence in patients with type 2 diabetes.