{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:11:35Z","timestamp":1788757895454,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"\n Background<\/jats:title>\n Therapeutic adherence is a key component of chronic disease management, particularly in high-risk patients. Type 2 diabetes (T2DM) is common in this population; however, real-world evidence on therapeutic adherence and the factors associated with it among high-risk patients with T2DM remains limited in Spain and other regions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate therapeutic adherence and identify factors associated with nonadherence among high-risk patients with T2DM using real-world primary care data.<\/jats:p>\n <\/jats:sec>\n \n Materials and methods<\/jats:title>\n A cross-sectional study was conducted among adults with T2DM classified as high-risk chronic patients using primary healthcare electronic health records from the Madrid Region as of 30 April 2021. Sociodemographic, functional, clinical, lifestyle, pharmacological, and primary healthcare utilization variables were analyzed according to therapeutic adherence status. Multivariable logistic regression was performed to identify factors independently associated with therapeutic nonadherence.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 67,746 high-risk patients with T2DM, adherence information was available for 65,856 patients, of whom 45,669 (69.3%) were classified as nonadherent. Nonadherent patients had a higher prevalence of polypharmacy (62.1% vs. 58.7%) and greater healthcare utilization, with a higher mean number of primary care contacts during the first year (25.3 vs. 24.4). In the multivariable analysis, the independent factors associated with higher odds of nonadherence were older age (odds ratio (OR\u00a0=\u00a01.008), male sex (OR\u00a0=\u00a01.073), foreign status (OR\u00a0=\u00a01.157), Individual Health Card category 3 (annual income up to \u20ac18,000) (OR\u00a0=\u00a01.245), ischaemic heart disease (OR\u00a0=\u00a01.137), heart failure (OR\u00a0=\u00a01.072), COPD (OR\u00a0=\u00a01.571), asthma (OR\u00a0=\u00a01.622), depression (OR\u00a0=\u00a01.054), palliative care (OR\u00a0=\u00a01.352), smoking status (OR\u00a0=\u00a01.102), polypharmacy (OR\u00a0=\u00a01.345), and \u226520 primary care contacts (OR\u00a0=\u00a01.066).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Therapeutic nonadherence is highly prevalent among high-risk patients with T2DM managed in routine primary care. Nonadherence was independently associated with treatment burden, specific patterns of clinical complexity, behavioral factors, and healthcare needs, with some associations showing modest effect sizes, highlighting the multifactorial nature of therapeutic adherence in this population. These findings support the integration of routine adherence assessment and individualized medication management strategies into primary care for patients with complex chronic conditions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fendo.2026.1947294","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:23:45Z","timestamp":1788755025000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic adherence and associated factors among high-risk patients with type 2 diabetes in primary healthcare: a cross-sectional study using real-world data from the Madrid Region"],"prefix":"10.3389","volume":"17","author":[{"given":"Mar\u00eda de la Concepci\u00f3n","family":"Mart\u00edn Trujillo","sequence":"first","affiliation":[{"name":"Doctoral Program in Health Sciences, Faculty HM of Health Sciences, University Camilo Jos\u00e9 Cela (UCJC)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Villimar Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Primary Care Pharmacy, Care Management of the Central Territorial Area, Madrid Health Service","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s Gaspar","family":"Castillo Sanz","sequence":"additional","affiliation":[{"name":"Foundation for Biomedical Research of Hospital Ni\u00f1o Jes\u00fas (FIBHUNJ)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Barrio-Cortes","sequence":"additional","affiliation":[{"name":"Doctoral Program in Health Sciences, Faculty HM of Health Sciences, University Camilo Jos\u00e9 Cela (UCJC)","place":["Madrid, Spain"]},{"name":"HM Hospitales Research Institute","place":["Madrid, Spain"]},{"name":"Foundation for Biosanitary Research and Innovation in Primary Health Care (FIIBAP)","place":["Madrid, Spain"]},{"name":"Research Network on Chronicity, Primary Health Care and Prevention and Health Promotion (RICAPPS), Carlos III Health Institute","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","unstructured":"Geneva\n World Health Organization\n Adherence to Long-Term Therapies: Evidence for Action\n \n 2003"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aprim.2016.06.003","article-title":"Adjusted morbidity groups: A new multiple morbidity measurement of use in primary care","volume":"48","author":"Monterde","year":"2016","journal-title":"Aten Primaria"},{"key":"B3","unstructured":"Madrid\n Ministerio de Sanidad, Consumo y Bienestar Social\n Informe Del Proyecto De Estratificaci\u00f3n De La Poblaci\u00f3n Por Grupos De Morbilidad Ajustados (GMA) En El Sistema Nacional De Salud (2014\u20132016) [Report on the Population Stratification Project by Adjusted Morbidity Groups (GMA) in the National Health System (2014\u20132016)]\n \n 2018"},{"key":"B4","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1186\/s12875-024-02586-z","article-title":"Treatment burden in multimorbidity: an integrative review","volume":"25","author":"Lee","year":"2024","journal-title":"BMC Prim Care"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2023-003873","article-title":"Real-world study of the multimorbidity and health service utilisation among individuals with non-diabetic hyperglycemia and type 2 diabetes mellitus in North West London","volume":"12","author":"Dattani","year":"2024","journal-title":"BMJ Open Diabetes Res Care"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2337\/dc25-S004","article-title":"4. 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