Abstract
Aim: To estimate the adherence to treatment among type 2 diabetic patients.
Background: Treatment adherence is a complex process that is controlled by multiple factors. Lack of treatment adherence is common with patients who suffer from type 2 diabetes and is becoming a very prevalent problem especially with the patients who suffer from non-communicable diseases (NCD) worldwide. Objective: To estimate the adherence to treatment among type 2 diabetic patients and the perception and practice of self-management among them. Methods: A cross-sectional study using a questionnaire was conducted amongst the patients of Kasturba Medical College, Mangalore, a coastal city of southern India. The questionnaire consisted of Medical Adherence Rating Scale (MARS) to assess how adherent the patient is to the treatment and the Diabetes Self-care Questionnaire (DSMQ) for assessing the various self-care practices employed by diabetic patients. The data obtained was entered and the analysis was done by using the Statistical Package for the Social Science (SPSS) version 25.0. Results: The study involved 95 patients and the mean age was found to be 50.71 ± 12.633 years. More than 60% of the study population were male and 78.9% were literate. Nearly half of the patients (49.5%) had been on treatment for a duration of >5 years. Eighty-two percent population (82.1%) were adherent to their medications. Adherence was found to be nearly eighty percent (79.5%) among the literates. Conclusion: Adherence was more among the males as compared to the females. Most patients in the study had been adherent to their medications prescribed to them. Most of them were on oral drugs only. The majority of the patients who had diabetes mellitus were found to have inadequate self-care management for diabetes mellitus.Keywords: Adherence, self-care management, medical adherence rating scale, treatment, diabetes, non-communicable diseases.
[2]
DiMatteo MR. Variations in patients' adherence to medical recommendations: A quantitative review of 50 years of research. Med Care 2004; 42(3): 200-9.
[3]
Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care 2004; 27(5): 1218-24.
[http://dx.doi.org/10.2337/diacare.27.5.1218] [PMID: 15111553]
[http://dx.doi.org/10.2337/diacare.27.5.1218] [PMID: 15111553]
[4]
Vervloet M, van Dijk L, Santen-Reestman J, van Vlijmen B, Bouvy ML, de Bakker DH. Improving medication adherence in diabetes type 2 patients through Real Time Medication Monitoring: A randomised controlled trial to evaluate the effect of monitoring patients’ medication use combined with short message service (SMS) reminders. BMC Health Serv Res 2011; 11: 5.
[http://dx.doi.org/10.1186/1472-6963-11-5] [PMID: 21219596]
[http://dx.doi.org/10.1186/1472-6963-11-5] [PMID: 21219596]
[5]
Medi RK, Mateti UV, Kanduri KR, Konda SS. Medication adherence and determinants of non-adherence among South Indian diabetes patients. J Soc Health Diabetes 2015; 3: 48-51.
[http://dx.doi.org/10.4103/2321-0656.140892]
[http://dx.doi.org/10.4103/2321-0656.140892]
[6]
Akari S, Mateti UV, Kunduru BR. Health-care cost of diabetes in South India: A cost of illness study. J Res Pharm Pract 2013; 2(3): 114-7.
[http://dx.doi.org/10.4103/2279-042X.122382] [PMID: 24991617]
[http://dx.doi.org/10.4103/2279-042X.122382] [PMID: 24991617]
[7]
Haynes R, McDonald H, Garg A, Montague P. Cochrane database of systematic reviews interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev 2002; (2): CD000011.
[8]
Sackett DL, Haynes RB, Gibson ES, Taylor DW, Roberts RS, Johnson AL. Patient compliance with antihypertensive regimens. Patient Couns Health Educ 1978; 1(1): 18-21.
[http://dx.doi.org/10.1016/S0738-3991(78)80033-0] [PMID: 10238880]
[http://dx.doi.org/10.1016/S0738-3991(78)80033-0] [PMID: 10238880]
[9]
Kalubowila KC. Weekly epidemiological report. Epidemiol Unit Minist Heal Nutr Indig Med 2016; 43(12): 1-2.
[10]
Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care 2002; 25(6): 1015-21.
[http://dx.doi.org/10.2337/diacare.25.6.1015] [PMID: 12032108]
[http://dx.doi.org/10.2337/diacare.25.6.1015] [PMID: 12032108]
[11]
Pollack MF, Purayidathil FW, Bolge SC, Williams SA. Patient-reported tolerability issues with oral antidiabetic agents: Associations with adherence; treatment satisfaction and health-related quality of life. Diabetes Res Clin Pract 2010; 87(2): 204-10.
[http://dx.doi.org/10.1016/j.diabres.2009.11.023] [PMID: 20036433]
[http://dx.doi.org/10.1016/j.diabres.2009.11.023] [PMID: 20036433]
[12]
Kalyango JN, Owino E, Nambuya AP. Non-adherence to diabetes treatment at Mulago Hospital in Uganda: Prevalence and associated factors. Afr Health Sci 2008; 8(2): 67-73.
[PMID: 19357753]
[PMID: 19357753]
[13]
Shaimol T, Biju CR, Anilasree BP, Jayakrishnan SS, Babu G. Medication adherence to oral hypoglycemic agents in type 2 diabetic patients. JPRCP 2014; 4(2): 8-12.
[14]
Danaei G, Finucane MM, Lu Y, et al. Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: Systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants. Lancet 2011; 378(9785): 31-40.
[http://dx.doi.org/10.1016/S0140-6736(11)60679-X] [PMID: 21705069]
[http://dx.doi.org/10.1016/S0140-6736(11)60679-X] [PMID: 21705069]
[15]
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3(11)
[http://dx.doi.org/10.1371/journal.pmed.0030442] [PMID: 17132052]
[http://dx.doi.org/10.1371/journal.pmed.0030442] [PMID: 17132052]
[16]
Adisa R, Fakeye TO, Fasanmade A. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in southwestern Nigeria. Pharm Pract (Granada) 2011; 9(2): 72-81.
[http://dx.doi.org/10.4321/S1886-36552011000200003] [PMID: 24688612]
[http://dx.doi.org/10.4321/S1886-36552011000200003] [PMID: 24688612]
[17]
Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): Development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes 2013; 11: 138.
[http://dx.doi.org/10.1186/1477-7525-11-138] [PMID: 23937988]
[http://dx.doi.org/10.1186/1477-7525-11-138] [PMID: 23937988]
[18]
Sabatâe E. Adherence to long-term therapies: Evidence for action World Health Organization 200 2003; 2(4): 323.
[19]
Schmitt A, Reimer A, Hermanns N, et al. Assessing diabetes self-management with the diabetes self-management questionnaire (DSMQ) Can help analyse behavioural problems related to reduced glycaemic control. PLoS One 2016; 11(3)
[http://dx.doi.org/10.1371/journal.pone.0150774] [PMID: 26938980]
[http://dx.doi.org/10.1371/journal.pone.0150774] [PMID: 26938980]
[20]
Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 2000; 42(3): 241-7.
[http://dx.doi.org/10.1016/S0920-9964(99)00130-9] [PMID: 10785582]
[http://dx.doi.org/10.1016/S0920-9964(99)00130-9] [PMID: 10785582]
[21]
Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med 2006; 166(17): 1836-41.
[http://dx.doi.org/10.1001/archinte.166.17.1836] [PMID: 17000939]
[http://dx.doi.org/10.1001/archinte.166.17.1836] [PMID: 17000939]
[22]
Eby EL, Bajpai S, Faries DE, Haynes VS, Lage MJ. The association between adherence to insulin therapy and health care costs for adults with type 2 diabetes: Evidence from a U.S. retrospective claims database. J Manag Care Spec Pharm 2020; 26(9): 1081-9.
[http://dx.doi.org/10.18553/jmcp.2020.26.9.1081] [PMID: 32857656]
[http://dx.doi.org/10.18553/jmcp.2020.26.9.1081] [PMID: 32857656]
[23]
Sankar UV, Lipska K, Mini GK, Sarma PS, Thankappan KR. The adherence to medications in diabetic patients in rural Kerala, India. Asia Pac J Public Health 2015; 27(2): NP513-23.
[http://dx.doi.org/10.1177/1010539513475651] [PMID: 23417905]
[http://dx.doi.org/10.1177/1010539513475651] [PMID: 23417905]
[24]
Mody R, Yu M, Nepal B, Konig M, Grabner M. Adherence and persistence among patients with type 2 diabetes initiating dulaglutide compared with semaglutide and exenatide BCise: 6-month follow-up from US real-world data. Diabetes Obes Metab 2020; 1-10.
[http://dx.doi.org/10.1111/dom.14195] [PMID: 32945083]
[http://dx.doi.org/10.1111/dom.14195] [PMID: 32945083]
[25]
Shams ME, Barakat EA. Measuring the rate of therapeutic adherence among outpatients with T2DM in Egypt. Saudi Pharm J 2010; 18(4): 225-32.
[http://dx.doi.org/10.1016/j.jsps.2010.07.004] [PMID: 23960731]
[http://dx.doi.org/10.1016/j.jsps.2010.07.004] [PMID: 23960731]
[26]
Yusuff KB, Obe O, Joseph BY. Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria. Pharm World Sci 2008; 30(6): 876-83.
[http://dx.doi.org/10.1007/s11096-008-9243-2] [PMID: 18784982]
[http://dx.doi.org/10.1007/s11096-008-9243-2] [PMID: 18784982]
[27]
Badi S, Abdalla A, Altayeb L, Noma M, Ahmed MH. Adherence to antidiabetic medications among sudanese individuals with type 2 diabetes mellitus: A cross-sectional survey. J Patient Exp 2020; 7(2): 163-8.
[http://dx.doi.org/10.1177/2374373519831073] [PMID: 32851136]
[http://dx.doi.org/10.1177/2374373519831073] [PMID: 32851136]
[28]
Brenner S, Oberaigner W, Stummer H. In guidelines physicians trust? Physician perspective on adherence to medical guidelines for type 2 diabetes mellitus. Heliyon 2020; 6(8): e04803.
[http://dx.doi.org/10.1016/j.heliyon.2020.e04803] [PMID: 32939405]
[http://dx.doi.org/10.1016/j.heliyon.2020.e04803] [PMID: 32939405]
[29]
Jiraporncharoen W, Pinyopornpanish K, Junjom K, et al. Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an outpatient primary care clinic in Chiang Mai, Thailand. BMC Fam Pract 2020; 21(1): 173.
[http://dx.doi.org/10.1186/s12875-020-01233-7] [PMID: 32825811]
[http://dx.doi.org/10.1186/s12875-020-01233-7] [PMID: 32825811]
[30]
Brunisholz KD, Conroy MB, Belnap T, Joy EA, Srivastava R. Measuring adherence to U.S. preventive services task force diabetes prevention guidelines within two healthcare systems. J Healthc Qual 2021; 43(2): 119-25.
[http://dx.doi.org/10.1097/JHQ.0000000000000281] [PMID: 32842020]
[http://dx.doi.org/10.1097/JHQ.0000000000000281] [PMID: 32842020]