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Swastika Sekar Astri
Ratri Sonia Septiani

Klinik Pratama Firdaus

Impact of Family Support Improvement
Behaviors
on Anti Diabetic Medication Adherence
and Cognition in Type 2 Diabetic Patients

Hamidreza Khosravizade Tabasi, Farah Madarshahian,
Mohsen Khoshniat Nikoo, Mohsen Hassanabadi
and Gholamhossein Mahmoudirad

Khosravizade Tabasi et al. Journal of Diabetes & Metabolic Disorders 2014, 13:113
 Objective

to determine the impact of family support
improvement behavior on anti diabetic
medication adherence and cognition in type 2
diabetic patients.
 Time and Place

2013
Diabetes clinic
of the diabetes
Research center
affiliated to
Birjand Medical
University
Research Design

RandomisedTrial
Randomised Trial
Control
Control
 Participant

Inclussion :
Patients with Type 2 Diabetes more than one year
Three last HbA1c 7% in 12 months
No intention to change their lifestyle in the next 3
months
Taking oral hypoglycaemic agent, insulin, or both
More than 5 years schooling
Lived with their family in 2013
Age of over 30 years old
Attended the diabetes clinic of the diabetes research
center affiliated to Birjand Medical University

Exclussion :
Severe vision and hearing problems, stroke, any
endocrine disorder could interfere with cognition
and severe cardiovascular diseases that could
interfere with Number Connection Test (NCT)
performance or were known risk factors for
cognitive impairment

The intervention and control groups were
comprised of 45 and 46 patients with type 2
diabetes respectively, who had medium or low
adherence score according to Morisky Medication
Adherence Scale (MMAS), and had at least one
never answer in the Diabetes Social Support
Questionnaire (DSSQ) - family version.
 STUDY

TIME Control Groups Intervention Groups
DSSQ, RCT, DSSQ, RCT
Onset
MMAS MMAS
The key family members
instructed about the
importance of medication
Onset adherence & family
support in 45-60 session
by one of the researchers
3 DSSQ, RCT, DSSQ, RCT,
Months
later MMAS, HbA1c MMAS, HbA1c
 Outcomes

Mean of NCT score was significantly decreased after
intervention (P = 0.006)
a significant correlation was noted between DSSQ
scores and MMAS scores after intervention(r =0.67, P <
0.001).
 PICO
Problem
Family Support
The key family members were instructed about the
Intervent importance of medication adherence & family
ion support

Comparri No instruction for the key family members

son

Family support may improve medication adherence

through direct effect and cognitive status with indirect
Outcome
effect.
Results



 Conclusions

The results revealed that family support helps to improve
medication adherence and cognitive status in patients with
type 2 diabetes. Cognitive decline due to the presence of a
risk factor of type diabetes may occur as a result of
hyperglycaemia.

Family support may enhance medication adherence which

results in glycaemic control and cognitive improvement as
an indirect effect of family support. The results can help
health care provider while counseling family member of
people with type 2 diabetes. They can inform the family
members about their effective roles and also teach them
some techniques for improving their supportive behaviors.
 Recommendation

It is suggested to study a naturally occurring
social construct such as family support in
patients with higher medication adherence
and lower cognitive disorders to better
understanding these conditions and apply it in
artificially induced situations.
 Internal Validity
Does this

In a well conducted RCT study study do
it?
1.1 The study addresses an appropriate and clearly focused Yes
question
1.2 The assignment of subjects to treatment groups is Yes
randomised
1.3 An adequate concealment method is used No
1.4 The design keeps subjects and investigators blind about No
treatment allocation
1.5 The treatment and control groups are similar at the start of Yes
the trial
1.6 The only difference between groups is the treatment under Yes
investigation
1.7 All relevant outcomes are measured in a standard, valid and Yes
reliable way
1.8 What percentage of the individuals or clusters recruited into Intervention :
each treatment arm of the study dropped out before the 0%
study was completed? Control : 0%
1.9 All the subjects are analysed in the groups to which they Yes
were randomly allocated (often referred to as intention to

CAN I APPLY THESE VALID, IMPORTANT RESULTS TO MY
PATIENT?

Do these results apply to my patient?

Is my patient so different from those in the Yes
trial that the results dont apply?
Are my patients values and preferences
satisfied by the intervention offered?
Are they met by this regimen and its potential
consequences?
Yes
Overall Assessment of the Study
2.1 How well was the study done to minimize High quality (++)

bias?
2.2 Taking into account clinical considerations, Yes,
your evaluation of the methodology used, and Cognitive p<0,006
the statistical power of the study, are you Adherence p<0,001
certain that the overall effect is due to the
study intervention?
2.3 Are the results of this study directly applicable Yes
to the patient group targeted by this
guideline?
2.4 This study was a randomised control trial on 91 patients from an
outpatient diabetes clinic Birjand Medical University. They were
randomly divided to intervention (n = 45) and control (n = 46)
group. Data on the patients demographic information and their
family gathered using a questionnaire, For two groups Morisky
Medication Adherence Scale (MMAS), drug administration part of
Diabetes Social Support Questionnaire family version (DSSQ),
Number Connection Test (NCT) were applied and hemoglobin A1C
was measured two times in the onset of study and three months
later for control group and before and after intervention for
intervention group. The key family members of the intervention
group were taught according to their educational needs in small
groups. Result of this study are mean of NCT score was significantly
decreased after intervention, and there is p a significant correlation
was noted between DSSQ scores and MMAS scores after
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YOU