MEDICATION ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS - A CROSS-SECTIONAL STUDY
Objective: This study was conducted to determine the adherence of medications among type 2 diabetes mellitus (DM) patients. To evaluate adherence to therapy and study factors associated with non-adherence and adherence in patients with type II DM.
Methods: A cross-sectional, observational study was conducted for 6 months in three hospitals. A total of 200 type II diabetic patients, who were on anti-diabetic drug therapy for at least 6 months, were enrolled. Blood glucose was measured and details of drug therapy were noted. Medication adherence was assessed using the Morisky Medication Adherence Scale and adherence scores were calculated.
Results: Only 15% had high medication adherence, while 24% had moderate and 61% had low medication adherence. Only 30% were having optimally controlled glycemic levels, whereas 70% were having uncontrolled glycemic levels. Medication adherence scores were lower (reflecting lower adherence) in type II patients with uncontrolled glycemic levels than those having optimally controlled glycemic levels, but this difference was not statistically significant.
Conclusion: Overall, medication adherence was low in type II diabetic patients. The study shows that to improve medication adherence, better counseling and health education of patients are required. Although several patients were adherent to therapy, adherent patients are more preferably to achieve glycemic control than nonadherent patients. Greater efforts are needed to facilitate diabetes self-management behaviors to improve patient outcomes.
2. Perry M. Early detection of Type 2 diabetes: The role of the community nurse. Br J Community Nurs 2001;6:176-9.
3. WHO. Adherence to Long Term Therapies, Time for Action. Geneva: World Health Organization; 2003. p. 221.
4. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care 2004;27:1218-24.
5. Campbell SM, Roland MO, Middleton E, Reeves D. Improvements in quality of clinical care in english general practice 1998-2003: Longitudinal observational study. BMJ 2005;331:1121.
6. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: Three decades of research. A comprehensive review. J Clin Pharm Ther 2001;26:331-42.
7. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999;47:555-67.
8. Mann DM, Ponieman D, Leventhal H, Halm EA. Predictors of adherence to diabetes medications: The role of disease and medication beliefs. J Behav Med 2009;32:278-84.
9. Al-Qazaz HKh, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky DE, et al. The eight-item morisky medication adherence scale MMAS: Translation and validation of the Malaysian version. Diabetes Res Clin Pract 2010;90:216-21.
10. Al-Qazaz HK, Hassali MA, Shafie AA, Syed Sulaiman SA, Sundram S. Perception and knowledge of patients with Type 2 diabetes in Malaysia about their disease and medication: A qualitative study. Res Social Adm Pharm 2011;7:180-91.
11. Fawzi W, Abdel Mohsen MY, Hashem AH, Moussa S, Coker E, Wilson KC, et al. Beliefs about medications predict adherence to antidepressants in older adults. Int Psychogeriatr 2012;24:159-69.
12. Zyoud SH, Al-Jabi SW, Sweileh WM, Morisky DE. Relationship of treatment satisfaction to medication adherence: Findings from a cross-sectional survey among hypertensive patients in Palestine. Health Qual Life Outcomes 2013;11:191.
13. Zyoud SH, Al-Jabi SW, Sweileh WM, Wildali AH, Saleem HM, Aysa HA, et al. Health-related quality of life associated with treatment adherence in patients with hypertension: A cross-sectional study. Int J Cardiol 2013;168:2981-3.
14. Sweileh WM, Ihbesheh MS, Jarar IS, Sawalha AF, Abu Taha AS, Zyoud SH, et al. Differences in medication adherence, satisfaction and clinical symptoms in schizophrenic outpatients taking different antipsychotic regimens. Curr Drug Saf 2011;6:285-90.
15. Sweileh WM, Ihbesheh MS, Jarar IS, Sawalha AF, Abu Taha AS, Zyoud SH, et al. Antipsychotic medication adherence and satisfaction among palestinian people with schizophrenia. Curr Clin Pharmacol 2012;7:49-55.
16. 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;30:876-83.
17. Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with Type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence 2013;7:525-30.
18. Choudhry NK, Shrank WH, Levin RL, Lee JL, Jan SA, Brookhart MA, et al. Measuring concurrent adherence to multiple related medications. Am J Manag Care 2009;15:457-64.
19. Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr. Selby JV. Hypoglycemic episodes and risk of dementia in older patients with Type 2 diabetes mellitus. JAMA 2009;301:1565-72.
20. de Galan BE, Zoungas S, Chalmers J, Anderson C, Dufouil C, Pillai A, et al. Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with Type 2 diabetes: The action in diabetes and vascular disease: Preterax and diamicron modified release controlled evaluation (ADVANCE) trial. Diabetologia 2009;52:2328- 36.
21. Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: Principles of pathogenesis and therapy. Lancet 2005;365:1333-46.
22. ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with Type 2 diabetes. N Engl J Med 2008;358:2560- 72.
23. Hermansen K, Mortensen LS, Hermansen ML. Combining insulins with oral antidiabetic agents: Effect on hyperglycemic control, markers of cardiovascular risk and disease. Vasc Health Risk Manag 2008;4:561- 74.
24. Adepu SP, Sam S, Omankuttan C, Ramnath KV, Yashashwini Y. Assessment of pharmacist mediated education on medication adherence behavior in Type 2 diabetes mellitus patients in the south Indian rural population. Int J Pharm Pharm Sci 2008;10:39-43.
25. Rabba AK, Algiers WS, Ahmed NJ, Alkharfy KM. Medication adherence in Type2 diabetic patients: A study in Saudi Arabia. Int J Pharm Pharm Sci 2007;9:247-50.
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