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Measuring Concurrent Oral Hypoglycemic and Antidepressant Adherence and Clinical Outcomes
Hillary R. Bogner, MD, MSCE; Heather F. de Vries, MSPH; Alison J. O'Donnell, BA; and Knashawn H. Morales, ScD
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Measuring Concurrent Oral Hypoglycemic and Antidepressant Adherence and Clinical Outcomes

Hillary R. Bogner, MD, MSCE; Heather F. de Vries, MSPH; Alison J. O'Donnell, BA; and Knashawn H. Morales, ScD
Self-reported adherence tended to overestimate medication adherence compared with electronic monitoring. Electronic monitoring of oral hypoglycemic agents but not self-reported adherence predicted glycemic control.
Poor adherence is a major obstacle to the benefit of medication regimens in the treatment of comorbid T2DM and depression. Regular monitoring and discussion of adherence is an important aspect of clinical encounters. Given a lack of identification of clear risk profiles for nonadherence, physicians may only be able to suspect nonadherence during the course of treatment for depression and diabetes. Our data demonstrated that over time self-reported adherence more closely approximated electronic monitoring. However, heavy reliance on self-reported adherence in practice could affect the quality of clinical care. If nonadherence is suspected, reasons for nonadherence should be examined and addressed to mitigate poor health prognoses and adverse clinical outcomes. Improved management of both T2DM and depression through improved adherence could have an important public health impact on patient functional status and mortality.55

Author Affiliations: From Department of Family Medicine and Community Health (HRB, HFD, AJO), Center for Clinical Epidemiology and Biostatistics (HRB, HFD, AJO, KHM), University of Pennsylvania, Philadelphia, PA.

Funding Source: This work was supported by American Diabetes Association Clinical Research Award 1-09-CR-07. Dr Bogner was supported by NIMH grant MH082799 and MH047447. Dr Morales was supported by an NIMH-mentored Career Development Award (MH073903).

Author Disclosures: The authors (HRB, HFD, AJO, KHM) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (HRB, KHM); acquisition of data (HRB, HFD, AJO); analysis and interpretation of data (HRB, KHM, HFD, AJO); drafting of the manuscript (HRB, KHM, HFD, AJO); critical revision of the manuscript for important intellectual content (HRB, KHM, HFD, AJO); statistical analysis (KHM); provision of study materials or patients (HRB); obtaining funding (HRB); administrative, technical, or logistic support (HFD, AJO); and supervision (HRB).

Address correspondence to: Hillary R. Bogner, MD, MSCE, Assistant Professor, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, 9 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104. E-mail:
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