DRUG NON-ADHERENCE IN TYPE 2 DIABETES MELLITUS; PREDICTORS AND ASSOCIATIONS

Authors

  • Nadia Shams Rawal Institute of Health Sciences Islamabad
  • Sadia Amjad Benazir Bhutto Shaheed Hospital, Rawalpindi
  • Naresh kumar Dow University of Health Sciences, Karachi
  • Waqar Ahmed Department of Medicine, Rawal Institute of Health Sciences, Islamabad
  • Faiza Saleem International Medical City Hospital, East Riffa

Abstract

Background: Diabetes being a serious health issue faced by developing countries with drug adherence having pivot role for recommended glycaemic target. This study aims to determine drug non-adherence in type 2 diabetics and its predictors and associations. Methods: This cross sectional study was conducted after ethical approval at Medicine Dept. Rawal Institute of Health Sciences Islamabad over 10 months duration. Demographic details, duration of diabetes, education, socioeconomic class, glycaemic control, mode of anti-diabetic therapy, number of medications and other modes of therapy documented. Michigan Diabetes Knowledge Questionnaire applied with outcome as good, acceptable and poor knowledge. Drug adherence was assessed by Morisky Medication Adherence Scale (non-adherence at <6 points). Data analysed via SPSS version 17 with significant p-value <0.05. Results: Among 183 diabetics there were 43 (23.5%) males and 140 (76.5%) females. Mean age was 56.6±10.6 years and mean duration of diabetes 8.4±6.57 years. One hundred and fourteen (62%) cases were non-adherent. Diabetes knowledge was poor in 76 (41.5 %), acceptable in 76 (41.5 %) and good in 31 (16.9%). Un-satisfactory glycaemic control present in 149 (81.4%). Non-adherence was found to be associated with poor glycaemic control, poor dietary adherence, poly-pharmacy, illiteracy, practicing other modes of therapy and poor diabetes knowledge (p<0.05). Conclusion: Non-adherence to medication in type 2 diabetics needs to be addressed. Suggested contributory factors are illiteracy, practicing other modes of therapy, poor diabetes knowledge and poly-pharmacy. Public awareness programs, self-monitoring of blood sugars, regular follow-up visits with focus at patient education may improve glycaemic control and diabetes related complications.Keywords: Diabetes mellitus, drug adherence, diabetes knowledge, glycaemic control, poly-pharmacy

Author Biography

Nadia Shams, Rawal Institute of Health Sciences Islamabad

Assistant Professor,Depaartment of Medicine

References

International Diabetes Federation. Diabetes Atlas. 6th ed. Brussels, Belgium: International Diabetes Federation: 2013.

Ahmed K, Muhammad Z, Qayum I. Prevalence of Cutaneous Manifestations of Diabetes Mellitus. J Ayub Med Coll Abbottabad 2009;21(2):76–78.

Qidwai W, Ashfaq T. Imminent epidemic of diabetes mellitus in Pakistan: issues and challenges for health care providers. J Liaquat Univ Med Health Sci 2010;9(3):112–13.

American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care 2016;39:S1–106.

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care 2005:43(6):521–30.

Ho PM, Bryson CL, Rumsfeld JS. Medication Adherence: Its Importance in Cardiovascular Outcomes. Circulation 2009;119(23):3028–35.

Peterson AM, Nau DP, Cramer JA, Benner J, Gwadry-Sridhar F, Nichol M. A checklist for medication compliance and persistence studies using retrospective databases. Value Health 2007;10(1):3–12.

Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart MA, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med 2010;25(4):284–90.

Shin J, McCombs JS, Sanchez RJ, Udall M, Deminski MC, Cheetham TC. Primary Non-adherence to medications in an integrated healthcare setting. Am J Manag Care 2012;18(8):426–34.

Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ 2008;336(7653):1114–17.

Safeer R, Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician 2005;72(3):463–68.

Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, et al. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care 2005;28(11):2673–79.

Funnell MM. Overcoming barriers to the initiation of insulin therapy. Clin Diabetes 2007;25(1):36–8.

Al-Qazaz Hkh, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, et al. Diabetes knowledge, medication adherence and glycaemic control among patients with type 2 diabetes. Int J Clin Pharm 2011;33(6):1028–35.

Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, et al. Effect of medication non-adherence on hospitalization and mortality among patients with diabetes mellitus. Arch Int Med 2006;166(17):1836–41.

Shamsi A, Khodaifar F, Arzaghi SM, Sarvghadi F, Ghazi A. Is there any relationship between medication compliance and affective temperaments in patients with type 2 diabetes? J Diabetes Metab Disord 2014;13(1):96.

Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care 2004;27(5):1218–24.

Garcia-Perez LE, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to Therapies in Patients with Type 2 Diabetes. Diabetes Ther 2013;4(2):175–94.

Asaad G, Sadegian M, Lau R, Xu Y, Soria-Contreras DC, Bell RC, et al. The reliability and validity of the Perceived Dietary Adherence Questionnaire for people with Type 2 Diabetes. Nutrients 2015:7(7):5484–96.

Fitzgerald JT, Funnell MM, Hess GE, Barr PA, Anderson RM, Hiss RG, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care 1998;21(5):706–10.

Rafique G, Azam SI, White F. Diabetes knowledge, beliefs and practices among people with diabetes attending a university hospital in Karachi, Pakistan. East Mediterr Health J 2006;12(5):590–98.

Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24(1):67–74.

Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348–54.

Imtiaz S, Ullah H, Rasool MF, Hashmat F, Saleem M, Khan N. Assessment of compliance of diabetic patients at Nishtar Hospital Multan, Pakistan. Gomal J Med Sci 2014;12(2):84–8.

Riaz M, Basit A, Fawwad A, Yakoob Ahmedani M, Ali Rizvi Z. Factors associated with non-adherence to insulin in patients with type 1 diabetes. Pak J Med Sci 2014;30(2):233–39.

Tiv M, Viel JF, Mauny F, Eschwege E, Well A, Fournier C, et al. Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study. PLoS One 2012;7(3):e32412.

West JD, Goldberg KL. Diabetes self-care knowledge among outpatients at a veterans affairs medical center. Am J Health Sys Pharm 2002;59(9):849–52.

Gregoire JP, Sirois C, Blanc G, Poirier P, Moisan J. et al. Persistence patterns with oral anti-diabetes drug treatment in newly treated patients--a population-based study. Value Health 2010;13(6):820–8.

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.

Rafique G, Sheikh F. Identifying needs and barriers to Diabetes Education in Patients with Diabetes. J Pak Med Assoc 2006;56(8):347–52.

Shams N, Osmani MH. Newly diagnosed anemia in admitted diabetics, frequency, etiology and associated factors. J Coll Physicians Surg Pak 2015;25(4):242–6.

Lau DT, Nau DP. Oral anti-hyperglycaemic medication non-adherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care 2004;27(9);2149–53.

Sweileh WM, Zyoud SH, AbuNab RJ, Deleq MI, Enaia MI, Nassar SM, et al. Influence of patients’ disease knowledge and beliefs about medicines on medication adherence: findings from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine. BMC Public Health 2014;14:94.

Parimalakrishnan S, Dussa K, Sahay R. Assessment of diabetes knowledge using diabetes knowledge questionnaire among people with type 2 diabetes mellitus. Asian J Pharm Clin Res 2015;8(2):254–56.

Berhe KK, Gebru HB, Kahsay HB, Kahsay AA. Assessment of Diabetes Knowledge and its Associated Factors among Type 2 Diabetic Patients in Mekelle and Ayder Referral Hospitals, Ethiopia. J Diabetes Metab 2014:5(5):1000378.

Jimmy B, Jose J. Patient Medication Adherence: Measures in Daily Practice. Oman Med J 2011;26(3):155–9.

Published

2016-06-01

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