The ARMS-D out performs the SDSCA, but both are reliable, valid, and predict glycemic control

Diabetes Res Clin Pract. 2013 Nov;102(2):96-104. doi: 10.1016/j.diabres.2013.09.010. Epub 2013 Sep 26.


Aims: The Adherence to Refills and Medications Scale (ARMS) has been associated with objective measures of adherence and may address limitations of existing self-report measures of diabetes medication adherence. We modified the ARMS to specify adherence to diabetes medicines (ARMS-D), examined its psychometric properties, and compared its predictive validity with HbA1C against the most widely used self-report measure of diabetes medication adherence, the Summary of Diabetes Self-Care Activities medications subscale (SDSCA-MS). We also examined measurement differences by age (<65 vs. ≥65 years) and insulin status.

Methods: We administered self-report measures to 314 adult outpatients prescribed medications for type 2 diabetes and collected point-of-care HbA1C.

Results: One of the 12-item ARMS-D items was identified as less relevant to adherence to diabetes medications and removed. The 11-item ARMS-D had good internal consistency reliability (α=0.86), maintained its factor structure, and had convergent validity with the SDSCA-MS (rho=-0.52, p<0.001). Both the ARMS-D (β=0.16, p<0.01) and the SDSCA-MS (β=-0.12, p<0.05) independently predicted HbA1C after adjusting for covariates, but this association did not hold among participants ≥65 years in subgroup analyses. There were no differences in ARMS-D or SDSCA-MS scores by insulin status, but participants on insulin reported more problems with adherence on two ARMS-D items (i.e., feeling sick and medicine costs).

Conclusions: The ARMS-D is a reliable and valid measure of diabetes medication adherence, and is more predictive of HbA1C than the SDSCA-MS, but takes more time to administer. The ARMS-D also identifies barriers to adherence, which may be useful in research and clinical practice.

Keywords: Diabetes; Glycemic control; Insulin; Medication adherence; Validity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Blood Glucose
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / therapeutic use*
  • Insulin / therapeutic use
  • Male
  • Medication Adherence*
  • Middle Aged
  • Self Care
  • Self Report
  • Surveys and Questionnaires


  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin