Adherence to insulin therapy is important for glycaemic control in persons with Type 1 diabetes mellitus (T1DM), but is difficult to quantify. We developed, applied and assessed the utility of a self-administered questionnaire to document adherence to basal-bolus and continuous subcutaneous insulin infusion (CSII) regimens in young adults with T1DM.
Participants and methods
Young adults with T1DM attending a multidisciplinary diabetes clinic were invited to complete the Fremantle Diabetes Care Record (FDCR), a performance-based measure designed to capture frequencies of key T1DM self-care behaviours over a 14-day period. Recent HbA1c results were collected separately.
137 young adults (age 18-27 years) with T1DM participated, representing 80% of invited clinic attendees. A measure of insulin administration adherence indicated 44% of the cohort had days on which one or more prescribed insulin doses were missed and 8 participants reported not administering insulin/wearing an insulin pump on one or more days over the 14-day period. On average, one or more injections/bolus doses were missed on 3.9 days in the fortnight. Of those on basal-bolus regimens (n=100), 91.5% indicated daily long-acting insulin administration however, 39.5% reported days on which one or more short-acting insulin doses were missed over a 14 day period. Well over a third of participants reported not testing their blood glucose levels (34.5%) and did not carry food as precaution for hypoglycaemia (35.5%) on one or more days over the 14-day period. 78 participants (56.9%) had HbA1c results with mean (±SD) 9.1±1.7%. Of these, 66.7% had HbA1c ≥8.5 and 19.2% ≤7.5%. Poorer adherence with insulin administration and blood glucose testing as recorded by the FDCR were associated with higher HbA1c values.
The FDCR was easy to administer and acceptable to young adults with T1DM. Insulin non-adherence was common and associated with poorer glycaemic control. Documenting insulin non-adherence may assist behavioural interventions aimed at improving diabetes self-care.