Yaşlı Diyabetik Hastalarda Kırılganlık Durumuna Göre İlaç Uyumunun Değerlendirilmesi

Öz

AMAÇ: Bu çalışma, yaşlı diyabet hastalarında kırılganlık ile ilaç uyumu arasındaki ilişkiyi araştırmayı amaçladı. GEREÇ ve YÖNTEM: Kesitsel nitelikteki bu çalışma, Mart-Kasım 2021 tarihleri arasında Konya Şehir Hastanesi’nde gerçekleştirildi ve 60 yaş ve üzerindeki 194 diyabet hastası dahil edildi. Kırılganlık durumu FRAIL ölçeği ile, ilaç uyumu ise 8 maddelik morisky ilaç uyumu ölçeği ile değerlendirildi. Komorbidite yükü, Modifiye Charlson Komorbidite indeksi kullanılarak ölçüldü. İstatistiksel analizlerde ki-kare testi, Mann- Whitney U testi, Kruskal-Wallis testi ve lojistik regresyon modelleri kullanıldı. BULGULAR: Katılımcıların medyan yaşı 67 idi (ÇEY: 64-71) ve %69,6’sı kadındı. Kırılganlık prevalansı %50 olarak saptandı ve kırılganlık ile ilaç uyumu arasında anlamlı bir ilişki bulunmadı (p=0,318). Ancak, düşük uyumun bağımsız belirleyicileri arasında daha kısa diyabet süresi (p=0,049), diyabet eğitimi almamış olmak (p=0,020) ve yüksek HbA1c düzeyleri (p=0,010) yer aldı. Düşük ilaç uyumu gösteren hastaların kan şekeri takibini daha az sıklıkla yaptığı (p=0,008) ve hastaneye yatış risklerinin daha yüksek olduğu görüldü. SONUÇ: Yaşlı diyabet hastalarında kırılganlık ile ilaç uyumu arasında anlamlı bir ilişki saptanmadı. Bunun yerine, diyabet eğitimi, glisemik kontrol ve öz izlem uygulamaları ilaç uyumunda daha belirleyici faktörler olarak öne çıktı. Bu bulgular, yapılandırılmış eğitim programlarının ve bireyselleştirilmiş müdahalelerin ilaç uyumunu artırmadaki önemini vurgulamaktadır. Kırılganlık ve uyum arasındaki karmaşık ilişkinin daha iyi anlaşılabilmesi için daha geniş örneklemli ve uzunlamasına takipli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Diabetes mellitus
• kırılganlık
• ilaç uyumu
• yaşlı

Evaluation of Medication Adherence According to Frailty Status in Older Diabetic Patients

Öz

OBJECTIVE: This study aimed to investigate the relationship between frailty and medication adherence in elderly patients with diabetes mellitus. MATERIALS and METHODS: A cross-sectional study was conducted at Konya City Hospital between May and November 2021, including 194 diabetic patients aged 60 years and older. Frailty status was assessed using the FRAIL scale, and medication adherence was evaluated with the 8-item morisky medication adherence scale The Modified Charlson Comorbidity index was used to quantify comorbidity burden. Statistical analyses included the chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and logistic regression models. RESULTS: The median age of the participants was 67 years (IQR: 64-71), and 69.6% were female. The prevalence of frailty was 50%, and no significant association was found between frailty and medication adherence (p=0.318). However, variables independently associated with low adherence included shorter diabetes duration (p=0.049), lack of diabetes education (p=0.020), and higher HbA1c levels (p=0.010). Patients with low adherence monitored their blood glucose significantly less frequently (p=0.008) and had a higher risk of hospitalization. CONCLUSION: Frailty was not significantly associated with medication adherence in elderly diabetic patients. Instead, diabetes education, glycemic control, and self-monitoring practices played a more significant role. These findings highlight the importance of structured education programs and individualized interventions to improve adherence. Future studies with larger sample sizes and longitudinal follow-up are needed to better understand the complex interplay between frailty and adherence.

Anahtar Kelimeler

• Diabetes mellitus
• frailty
• medication adherence
• elderly

Kaynakça

1. 1. Murad K, Kitzman DW. Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Fail Rev. 2012; 17: 581-588.
2. 2. Uchmanowicz I, Chudiak A, Jankowska-Polańska B, Gobbens R. Hypertension and Frailty Syndrome in Old Age: Current Perspectives. Card Fail Rev. 2017; 3: 102-107.
3. 3. Jankowska-Polańska B, Dudek K, Szymanska-Chabowska A, Uchmanowicz I. The influence of frailty syndrome on medication adherence among elderly patients with hypertension. Clin Interv Aging. 2016; 11: 1781-1790.
4. 4. Cadarette SM, Solomon DH, Katz JN, Patrick AR, Brookhart MA. Adherence to osteoporosis drugs and fracture prevention: no evidence of healthy adherer bias in a frail cohort of seniors. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2011; 22: 943-954.
5. 5. Qiao X, Tian X, Liu N, et al. The association between frailty and medication adherence among community-dwelling older adults with chronic diseases: Medication beliefs acting as mediators. Patient Educ Couns. 2020; S0738- 3991(20)30279-2.
6. 6. Živanović D, Javorac J, Stojkov S, Szabo N čamprag. Public Health Issues of Global Population Ageing. Black Sea J Health Sci. 2020; 3: 88-93.
7. 7. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012; 16: 601-608.
8. 8. Sayiner ZA, Savaş E, Kul S, Morisky DE. Validity and Reliability of the Turkish Version of the 8-Item Morisky Medication Adherence Scale in Patients With Type 2 Diabetes. Eur J Ther. 2020; 26: 47-52.

9. 9. Moon SJ, Lee WY, Hwang JS, Hong YP, Morisky DE. Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8. PLOS ONE. 2017; 12: e0187139.
10. 10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40: 373-383.
11. 11. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med. 2000; 108: 609-613.
12. 12. Cacciatore F, Testa G, Galizia G, et al. Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta Diabetol. 2013; 50: 251–260.
13. 13. Nguyen TN, Harris K, Woodward M, et al. The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure-Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial. Diabetes Care. 2021; 44: 1622-1629.
14. 14. Leung V, Wroblewski K, Schumm LP, Huisingh-Scheetz M, Huang ES. Reexamining the Classification of Older Adults With Diabetes by Comorbidities and Exploring Relationships With Frailty, Disability, and 5-year Mortality. J Gerontol A Biol Sci Med Sci. 2021; 76: 2071-2079.
15. 15. Abdelhafiz AH, Koay L, Sinclair AJ. The effect of frailty should be considered in the management plan of older people with Type 2 diabetes. Future Sci OA. 2016; 2: FSO102.
16. 16. Xiu S, Mu Z, Zhao L, Sun L. Low free triiodothyronine levels are associated with risk of frailty in older adults with type 2 diabetes mellitus. Exp Gerontol. 2020; 138: 111013.
17. 17. Thein FS, Li Y, Nyunt MSZ, et al. Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality. Postgrad Med. 2018; 130: 561-567.
18. 18. Umegaki H. Sarcopenia and frailty in older patients with diabetes mellitus. Geriatr Gerontol Int. 2016; 16: 293-299.
19. 19. Karahan YA, Başaran A, Ordahan B, et al. Polypharmacy in Osteoporosis Patients. Turk J Osteoporos. [Internet]. Available from: https://turkosteoporozdergisi.org/articles/ polypharmacy-in-osteoporosis-patients/tod.96720
20. 20. Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care. 2002; 25: 1015- 1021.
21. 21. Ersoy C, Tuncel E, Özdemir B, Ertürk E, İmamoğlu Ş. Diabetes Education and Metabolic Control in Patients With Type 2 Diabetes Mellitus Under Insulin Treatment. J Uludağ Univ Med Fac. 2006; 32: 43-47.
22. 22. Shauyet I, Basat S, Yünoğlu GG, et al. The Relationship Between Frailty and Treatment Compliance in Diabetic and Geriatric Patients Using Insulin. Namık Kemal Med J. [Internet]. 2021; Available from: https://namikkemalmedj. com/articles/the-relationship-between-frailty-andtreatment- compliance-in-diabetic-and-geriatric-patientsusing- insulin/nkmj.galenos.2021.39974
23. 23. Egede LE, Gebregziabher M, Echols C, Lynch CP. Longitudinal effects of medication nonadherence on glycemic control. Ann Pharmacother. 2014; 48: 562-570.
24. 24. Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004; 27: 2149-2153.
25. 25. Evans M, Engberg S, Faurby M, et al. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review. Diabetes Obes Metab. 2022; 24: 377-390.
26. 26. Asche C, LaFleur J, Conner C. A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clin Ther. 2011; 33: 74-109.
27. 27. Sharma T, Kalra J, Dhasmana D, Basera H. Poor adherence to treatment: A major challenge in diabetes. J Indian Acad Clin Med. 2014; 15.
28. 28. van Bruggen R, Gorter K, Stolk RP, et al. Refill adherence and polypharmacy among patients with type 2 diabetes in general practice. Pharmacoepidemiol Drug Saf. 2009; 18: 983-991.
29. 29. Shams N, Amjad S, Kumar N, Ahmed W, Saleem F. Drug Non-Adherence In Type 2 Diabetes Mellitus; Predictors And Associations. J Ayub Med Coll Abbottabad JAMC. 2016; 28: 302-307.
30. 30. Murray MD, Kroenke K. Polypharmacy and medication adherence: small steps on a long road. J Gen Intern Med. 2001; 16: 137-139.
31. 31. Williams GC, Patrick H, Niemiec CP, et al. Reducing the health risks of diabetes: how self-determination theory may help improve medication adherence and quality of life. Diabetes Educ. 2009; 35: 484-492.
32. 32. Mone P, Gambardella J, Lombardi A, et al. Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults. Cardiovasc Diabetol. 2022; 21: 10.
33. 33. Bonikowska I, Szwamel K, Uchmanowicz I. Adherence to Medication in Older Adults with Type 2 Diabetes Living in Lubuskie Voivodeship in Poland: Association with Frailty Syndrome. J Clin Med. 2022; 11: 1707.