Adherence in Patients with Type 2 Diabetes and Depression and the Role of Physician-Patient Relationship: A Cross-Sectional Study

Abstract

Background: Diabetes mellitus (DM) challenges health and quality of life of patients, families, and communities. Patients with comorbid depression are more likely to develop macrovascular and microvascular complications. The aim was to assess glycemic control and adherence in diabetic patients with comorbid depression. Further, the study evaluated the relationship between adherence and the physician-patient relationship. Methods: The study was conducted at Al-Agouza Family Medicine Center (AFMC) between February 2018 and March 2020. The included patients were between 35 - 80 years of age; had type 2 diabetes with hemoglobin A1c (HbA1c) ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dl, and scored between 11 - 30 on the Beck Depression Inventory (BDI). Logistic regression, chi-square, and analysis of variance (ANOVA) were used to assess the relationship between depression, adherence, physician-patient relationship, and other variables. Results: The study included 100 eligible patients with a median BDI score of 20 (10 - 30). The median diabetic panel for patients was FBS 188 (126 - 348) mg/dl, PPS 282.50 (162 - 448) mg/dl, and HbA1c 9.5 (6.6 - 14.0)%. Depression and regular follow-up visits were statistically associated with improvement of diabetes symptoms (p = 0.019). There was a significant relationship (p < 0.001) between adherence, regular follow-up visits, and knowledge of DM. Further, there was a significant relationship between the physician-patient relationship and DM improvement (p = 0.047). Conclusion: Physician-patient relationship was paramount to improving adherence and positive diabetes care. Our findings suggest a shift to a physician-patient relationship model with mutual agreement on medical decisions is highly recommended.