Endocrine Abstracts

Objective: To determine the cumulative incidence of nonadherent patients with type-2-diabetes from an outpatient clinic, and to examine determinants and consequences of premature discharge.

Research design and methods: A cohort comprising patients with type-2-diabetes referred to a Diabetes Clinic from 2009-2012 was assessed. Patients were categorized as nonadherent if discharged within two years of referral due to nonattendance and/or nonadherence to medication and control. Medication and biochemical values at baseline and two years later were assessed. Data regarding co-morbidity, mortality and socioeconomics were extracted from national registers, and determinants and consequences of nonadherence were assessed.

Results: 1072 patients were identified, and of these 1008 met the inclusion criteria. The cumulated incidence of patients classified as nonadherent was 20.3 %. Nonadherent patients were younger at time of type-2-diabetes diagnosis and had poorer glycaemic control at referral and two years later. Both non-western ethnicity and low education were determinants of nonadherence, but the effect of ethnicity became insignificant when adjusting for education, whereas the effect of education was less influenced by ethnicity. Cohabitation had no influence on adherence. Nonadherence was significantly associated with increased mortality also after adjusting for ethnicity and education, whereas the significance disappeared when adjusting for cohabitation.

Conclusions: Significant differences in glycaemic control, socioeconomics, and mortality were found between an adherent and a nonadherent group of type-2-diabetes patients. Low education seemed to be the principal determinant of nonadherence, while living alone was a mediator of increased mortality. To reach nonadherent patients and to reduce their risk of complications and reduced life expectancy, differentiated efforts should be considered.