==== Front J Family Med Prim CareJ Family Med Prim CareJFMPCJournal of Family Medicine and Primary Care2249-48632278-7135Medknow Publications & Media Pvt Ltd India JFMPC-7-64510.4103/jfmpc.jfmpc_345_17Letter to EditorAppropriately reporting results using the medication subscale of the summary of diabetes self-care activities measure: A comment on Dasappa et al. (2017) Basu Saurav 11 Department of Community Medicine, Maulana Azad Medical College, New Delhi, IndiaAddress for correspondence: Dr. Saurav Basu, Maulana Azad Medical College, New Delhi, India. E-mail: saurav.basu1983@gmail.comMay-Jun 2018 7 3 645 646 Copyright: © 2018 Journal of Family Medicine and Primary Care2018This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. ==== Body Dear Editor, It is well established that poor adherence to antidiabetic medications in diabetics causes deterioration of glycemic control and accelerates the onset and progression of microvascular and macrovascular complications of diabetes.[1] The study by Dasappa et al. further corroborates that diabetics in socioeconomically disadvantaged communities are at the risk of medication nonadherence.[2] The researchers utilized the medication subscale of the Summary of Diabetes self-care activities measure (SDSCA-MS) developed by Toobert et al. for assessing medication adherence.[3] The scale includes 2 items which query patients regarding their medication intake behavior during the previous 7 days from the day of assessment. The first item of the SDSCA-MS assesses the number of days on which the patient took his prescribed (antidiabetic) medication or insulin, and the second item assesses the number of days on which the patient took the correct number of pills. The response in both the items will yield a number ranging from 0 to 7. The SDSCA-MS score in the study sample should subsequently be reported as mean and standard deviation in the following manner: The SDSCA-MS score can be reported only for the first item (1 item SDSCA-MS) but preferably by averaging responses to both the items (2 item SDSCA-MS)[3] An alternative validated method recommended by Mayberry et al. is to calculate the 1 and 2 item SDSCA-MS scores by averaging responses to the first item and both items, respectively, for each of the antidiabetic medications in the prescribed regimen[4] Observations from literature show that SDSCA-MS scores have been dichotomized into categorical outcomes with a score of <7 defined as nondaily medication adherence while a score of ≤5 signifying <80% adherence defined as nonadherence.[5] In the present study, Dasappa et al. have not reported SDSCA-MS scores in terms of continuous outcomes and arbitrarily defined a diabetic patient who misses even a single dose of his antidiabetic during the previous 7 days as not having good adherence. They further hypothesize that the subjects may be nonadherent due to their inability to afford the medication which cannot be inferred from their observations. This is because patients with SDSCA-MS score of 6 are more likely to be missing medications due to forgetfulness or carelessness compared to those reporting a score of 0 which rather reflects lack of medication possession due to possible inability to afford medications. However, the dichotomous outcome reported in this study classifies a patient reporting an SDSCA-MS score of 0 and another of 6 in the same category. In conclusion, reporting SDSCA-MS scores as continuous outcomes (mean and standard deviation) allow a more accurate estimation of the prevailing level of medication adherence in the study population. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. ==== Refs 1 Rhee MK Slocum W Ziemer DC Culler SD Cook CB El-Kebbi IM Patient adherence improves glycemic control Diabetes Educ 2005 31 240 50 15797853 2 Dasappa H Prasad S Sirisha M Ratna Prasanna SV Naik S Prevalence of self-care practices and assessment of their sociodemographic risk factors among diabetes in the urban slums of Bengaluru J Fam Med Prim Care 2017 6 218 21 3 Toobert DJ Hampson SE Glasgow RE The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale Diabetes Care 2000 23 943 50 10895844 4 Mayberry LS Gonzalez JS Wallston KA Kripalani S Osborn CY The ARMS-D out performs the SDSCA, but both are reliable, valid, and predict glycemic control Diabetes Res Clin Pract 2013 102 96 104 24209600 5 Rajasekharan D Kulkarni V Unnikrishnan B Kumar N Holla R Thapar R Self-care activities among patients with diabetes attending a tertiary care hospital in Mangalore Karnataka, India Ann Med Health Sci Res 2015 5 59 64 25745579