Non-adherence to glucocorticoid replacement therapy was common in patients with Addison's disease (46%) and was associated with more frequent adrenal crisis, poorer quality of life, and poorer disease knowledge.
Key Findings
Results
Nearly half of patients with Addison's disease were non-adherent to glucocorticoid replacement therapy.
Cross-sectional study of 58 patients with Addison's disease (39 women and 19 men), mean age 48.4±13.3 years.
27 patients (46%) were classified as non-adherent based on the Girerd questionnaire.
Non-adherence was defined as three or fewer negative answers to the Girerd questionnaire (score ≤3/6).
Results
Multiple clinical and demographic factors were independently associated with non-adherence to glucocorticoid replacement therapy.
Age below 48 years was associated with non-adherence (ORa=4.8, 95% CI: 2.8–10.7).
Poor adherence to comorbidity treatments was associated with non-adherence (ORa=5.0, 95% CI: 3.0–12.2).
History of adrenal crisis was associated with non-adherence (ORa=4.1, 95% CI: 2.0–8.3).
Baseline cortisolemia at diagnosis >5 µg/dl was associated with non-adherence (ORa=2.3, 95% CI: 1.2–6.2).
Low systolic blood pressure was also independently associated with non-adherence (ORa=4.8, 95% CI: 2.6–8.2).
Results
Anthropometric and metabolic factors including lower BMI, smaller waist circumference, lower fasting blood glucose, and lower triglycerides were independently associated with non-adherence.
BMI <26.7 kg/m² was associated with non-adherence (ORa=3.9, 95% CI: 1.1–6.9).
Waist circumference <90 cm was associated with non-adherence (ORa=1.8, 95% CI: 1.1–2.9).
Fasting blood glucose <0.9 g/l was associated with non-adherence (ORa=2.5, 95% CI: 1.1–5.3).
Triglyceride <1 g/l was associated with non-adherence (ORa=2.2, 95% CI: 1.1–5.1).
Results
Disease knowledge was positively correlated with adherence to glucocorticoid replacement therapy.
There was a statistically significant positive correlation between the disease knowledge questionnaire score and the Girerd adherence score (p=0.02, r=0.31).
Poor knowledge about the disease was independently associated with non-adherence (ORa=3.9, 95% CI: 1.2–7.2).
A questionnaire was specially designed to assess patients' disease knowledge.
Results
Quality of life was positively correlated with adherence to glucocorticoid replacement therapy.
There was a statistically significant positive correlation between the AddiQoL score and the Girerd adherence score (p=0.01, r=0.32).
The AddiQol questionnaire, specific to Addison's disease, was used to assess patients' quality of life.
Non-adherence to glucocorticoid replacement therapy was associated with poorer quality of life.
Yazidi M, Salem M, Oueslati I, Khessairi N, Chaker F, Chihaoui M. (2024). Adherence to glucocorticoid replacement therapy in Addison's disease: Association with patients' disease knowledge and quality of life.. Endocrinologia, diabetes y nutricion. https://doi.org/10.1016/j.endien.2023.10.004