Patients' impatience is an independent determinant of poor diabetes control

Diabetes Metab. 2011 Dec;37(6):497-504. doi: 10.1016/j.diabet.2011.03.004. Epub 2011 May 7.

Abstract

Aims: Some individuals have a preference for the present rather than for the future. We investigated the impact of this impatient relationship to temporality on adherence to medication and HbA(1c) level in type 2 diabetic patients.

Methods: An observational, cross-sectional monocenter study in 90 patients consulting for a health check-up at a Center for Preventive Medicine. We used questionnaires assessing adherence to medication, impatience in a fictive monetary choice (preferring a smaller amount now to a higher amount later) and in daily life situations, foresight, locus of control, and social deprivation.

Results: Impatience in the monetary choice was associated with non-adherence to medication (P=0.005). In a multivariate logistic regression model, the risk of observing HbA(1c)≥7% was associated with a long duration of diabetes (OR 5.2, CI 1.7-15.7, P=0.003), monetary impatience (OR=5.1, CI 1.7-15.4, P=0.004), a high "chance and other people" score of the locus of control (OR=5.1, CI 1.7-15.7, P=0.004), a suboptimal foresight (OR 3.9, CI 1.2-12.0, P=0.02). A decision-tree analysis (CHAID algorithm) showed that in this cohort of 90 patients, the 11 people who were adherent to medication, patient in the monetary scenario, had optimal foresight, and gave importance neither to chance nor to other people, had all HbA(1c) below 7%.

Conclusion: An impatient relationship to temporality was found associated with non-adherence to medication and uncontrolled HbA(1c) in type 2 diabetic patients. Treatment strategies for chronic diseases should be tailored according to this novel dimension of psychology.

MeSH terms

  • Choice Behavior
  • Cross-Sectional Studies
  • Decision Trees
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • France / epidemiology
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Logistic Models
  • Male
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Self Care / psychology*
  • Self Care / statistics & numerical data
  • Socioeconomic Factors
  • Surveys and Questionnaires

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents