A randomized controlled trial to provide adherence information and motivational interviewing to improve diabetes and lipid control

Abstract

Purpose: The purpose of this study was to assess whether providing medication adherence information with or without motivational interviewing improves diabetes and lipid control.

Methods: Study participants were adult members of a health system in southeast Michigan, were using both oral diabetes and lipid-lowering medications, and had glycated hemoglobin (A1C) or low-density lipoprotein cholesterol (LDL-C) levels not at goal. Participants were randomly assigned to receive usual care (UC), n = 567; have medication adherence information (AI) provided to their physician, n = 569; or have AI and receive motivational interviewing (MI) though trained staff (AI + MI), n = 556. Primary outcomes were A1C and LDL-C levels at 18 months post randomization.

Results: Primary outcomes were not significantly different between patients in the AI or AI + MI study arms when compared with UC. Similarly, neither oral diabetes nor lipid-lowering medication adherence was significantly different between groups. Patient participation in the AI + MI arm was low and limit the interpretation of the study results, but post hoc analysis of the AI + MI study arm showed that the number of MI sessions received was positively associated with only oral diabetes medication adherence.

Conclusion: Neither AI nor MI significantly improved diabetes and lipid control when compared with UC. Moreover, patient participation appeared to be a particular barrier for MI.

Figure 1

Flow diagram detaining patient recruitment, exclusion, enrollment, and study arm randomization for the multi-arm adherence intervention trial. Also shown are the individuals lost to follow-up due to death or health plan disenrollment after randomization. The post hoc per protocol analysis consisted of individuals who remained after removing those lost to follow-up.