Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia

Development and Validation of USM-Insulin Adherence Module for Patients with Type 2 Diabetes Mellitus

Background

Many patients with type 2 diabetes mellitus (T2DM) do not achieve the desired glycaemic control despite being treated with insulin. Studies found this due to an improper understanding of insulin function, its intensification process and patients' negative perspective on insulin. We developed an education module to enhance adherence to insulin therapy.

Methods

This study applied a mixed design. It was conducted in three phases: i) Phase I: literature search and focus group discussions (FGDs), ii) Phase II: module development and iii) Phase III: content and face validation of Universiti Sains Malaysia-Insulin Adherence Module (USM-IAM). FGDs were used to gather patients' opinions. All researchers repeatedly discussed about the module content and arrangement, the words and images used, and the grammar in producing the final draft. Specialists and target audience performed content and face validation of the module.

Results

Thirty-six participants were involved in the FGDs. Data saturation was achieved at the 4th FGD. Three themes emerged from qualitative data analysis and were incorporated into the module. USM-IAM was finalised with five units. The content validity index (CVI) was 0.92, while face validity agreements were between 86% and 97%.

Conclusion

The CVI and face agreement for USM-IAM exceed the cut-off point for a sound module. It has good potential to be used as a resource for educating patients in enhancing insulin adherence.

A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes

BACKGROUND

Antidiabetic medication adherence is a key aspect for successful control of type 2 diabetes mellitus (T2DM). This systematic review aims to provide an overview of the associations between socioeconomic factors and antidiabetic medication adherence in individuals with T2DM.

METHODS

A study protocol was established using the PRISMA checklist. A primary literature search was conducted during March 2022, searching PubMed, Embase, Web of Science, as well as WorldCat and the Bielefeld Academic Search Engine. Studies were included if published between 1990 and 2022 and included individuals with T2DM. During primary screening, one reviewer screened titles and abstracts for eligibility, while in the secondary screening, two reviewers worked independently to extract the relevant data from the full-text articles.

RESULTS

A total of 15,128 studies were found in the primary search, and 102 were finally included in the review. Most studies found were cross-sectional (72) and many investigated multiple socioeconomic factors. Four subcategories of socioeconomic factors were identified: economic (70), social (74), ethnical/racial (19) and geographical (18). The majority of studies found an association with antidiabetic medication adherence for two specific factors, namely individuals' insurance status (10) and ethnicity or race (18). Other important factors were income and education.

CONCLUSIONS

A large heterogeneity between studies was observed, with many studies relying on subjective data from interviewed individuals with a potential for recall bias. Several socioeconomic groups influencing medication adherence were identified, suggesting potential areas of intervention for the improvement of diabetes treatment adherence and individuals' long-term well-being.

Medication Adherence and its Predictors among Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Medication adherence is vital in managing noncommunicable diseases like diabetes. Illness perception and an individual's knowledge regarding the disease may influence medication adherence. The present study aimed to assess the prevalence and predictors of medication adherence among type 2 diabetic patients. A cross-sectional study was conducted among 400 diabetes mellitus patients attending an outdoor patient department (OPD) of a tertiary care hospital in North India. Brief Medication Questionnaire (BMQ) and Brief Illness Perception Questionnaire (B-IPQ) were used to study medication adherence and illness perception, respectively. Descriptive and analytic statistics were computed using Epi Info software for Windows (CDC, Atlanta, GA, USA). The prevalence of medication adherence was 79.5% (82/400). The odds of medication adherence increased with higher age (odds ratio [OR] = 1.8 [1.1-2.9]) and more duration of illness (OR = 1.8 [1.0-3.2]) Patients having good knowledge of diabetes were more likely to adhere to medications. [OR=1.8(1.1-3.1). Diabetes medicine-adherent patients had a higher perceived understanding of the disease, felt having lesser negative consequences, and were less concerned about the illness than their counterparts. A high proportion adhered to diabetes medication. The guiding factors to further improve medication adherence are age, duration of illness, illness perception, and knowledge regarding the disease.

Issues and challenges in diabetic neuropathy management: A narrative review

Diabetic neuropathy (DN) is a devastating disorder with an increasing prevalence globally. This epidemic can pose a critical burden on individuals and com-munities, subsequently affecting the productivity and economic output of a country. With more people living a sedentary lifestyle, the incidence of DN is escalating worldwide. Many researchers have relentlessly worked on ways to combat this devastating disease. Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN. Unfortunately, most of these therapies are only partially effective. Worse still, some are associated with unfavorable side effects. This narrative review aims to highlight current issues and challenges in the management of DN, especially from the perspective of molecular mechanisms that lead to its progression, with the hope of providing future direction in the management of DN. To improve the approaches to diabetic management, the suggested resolutions in the literature are also discussed in this review. This review will provide an in-depth understanding of the causative mechanisms of DN, apart from the insights to improve the quality and strategic approaches to DN management.

Prevalence and reasons influenced medication non-adherence among diabetes patients: A mixed-method study

Objectives

This study aimed to identify the prevalence of medication non-adherence (MNA) and to explore the reasons that influenced MNA among diabetes patients.

Design

This study used the explanatory mixed-method design. Phase one comprised of a cross-sectional study followed by phase two of a qualitative study.

Setting

This study took place at two public hospitals in the Klang Valley, Malaysia.

Participants

About 427 diabetes patients were recruited and 399 of them completed the study. The inclusion criteria were those with age more than 18 years and above, Malaysian citizen, able to understand Malay or English, and were diagnosed with diabetes mellitus for more than one year. The exclusion criteria were those with an intellectual disability and pregnant women. Phase two involved 12 participants recruited from non-adherent patients in phase one of the study.

Results

About 46.6% of the patients failed to adhere to the medication. Malays (OR: 1.66, 95%CI: 1.09 to 2.51, p = 0.017), single/widow or divorced (OR: 1.79, 95%CI: 1.05 to 3.05, p = 0.031) and poor HbA1c (OR: 2.57, 95% CI: 1.61 to 4.10, p =  < 0.01) were associated with medication non-adherence. Five main categories emerged as the reasons for medication non-adherence, including perceived benefit of Complementary and Alternative medicine, attitude towards drawback of western medication, poor healthcare providers and patients' relationship, undesirable emotional response towards medication intake, as well as restraints in daily routine and cognitive function.

Conclusions

There are many reasons for patients' non-adherence to their anti-diabetes medication. These findings are important in identifying the factors that influenced non-adherence to recommend reliable patient-centred care strategies in improving medication non-adherence among patients with diabetes.

Factors Contributing to Noncompliance With Diabetic Medications and Lifestyle Modifications in Patients With Type 2 Diabetes Mellitus in the Eastern Province of Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is defined as a chronic medical condition in which the blood glucose level remains high. The risk factors of T2DM are high body mass index due to obesity or being overweight, genetics, and certain medical conditions. Lifestyle modification plays a crucial role in T2DM regulation and prevention, and if it is not controlled well by either lifestyle modification or DM regulatory medications, it may lead to medical complications ranging from mild to life-threatening complications.

AIM

The purpose of this study is to find the contributory factors of noncompliance with oral antidiabetic drugs and lifestyle modifications in patients with T2DM in the eastern province of Saudi Arabia. This will help control one of the most widespread comorbidities that might otherwise be a significant burden on patients' health and financial status as well as on the government.

METHODOLOGY

A cross-sectional questionnaire study was conducted on T2DM patients in the eastern province of Saudi Arabia through a link distributed on social media, and the contributory factors of noncompliance to diabetes medication and lifestyle modification were evaluated.

RESULTS

A total of 426 participants were included in the study. Regarding compliance with DM medications, 199 (46.7%) participants were adherent to their medications, 148 (34.7%) were not adherent to their medication, 42 (9.9%) were sometimes adherent, and 37 (8.7%) were mostly adherent to their medication. Regarding lifestyle modification, the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. According to the participants, the most reported factors contributing to noncompliance with DM medications and lifestyle modifications were forgetfulness, lack of knowledge about diabetes and the importance of controlling it, side effects of the medications, and difficulty in following a healthy diet. Regarding the influence of sociodemographic variables on the level of adherence in T2DM patients, factors such as age, marital status, occupation, comorbidities, diagnosis period, and previous complaints of DM complications showed significant associations with compliance with DM medication.

CONCLUSION

The findings of this study revealed that the level of adherence to DM medications among T2DM patients in the eastern province was suboptimal. Although free medicines were available with a high level of healthcare access through government primary healthcare centers (PHCCs), poor adherence was observed. This study highlighted that medication adherence might be affected by age, marital status, occupation, chronic diseases, diagnosis period, and previous complaints of DM complications. Regarding lifestyle modification, this study showed that the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. Our recommendation is to measure the presence of dietician clinics, patient relationships with their healthcare providers, and their effect on patient compliance with DM medications. Further research is needed to include other factors that could influence adherence, such as patient-healthcare provider communication. Moreover, it is suggested that PHCCs discuss with noncompliant patients the reasons that prevent them from adhering to their medication and lifestyle modifications as part of their care plan.

Prevalence of Medication Non-Adherence and Associated Factors among Diabetic Patients in A Tertiary Hospital at Debre Markos, Northwest Ethiopia

Background

Non-adherence to prescribed medications is possibly the most common reason for poor treatment outcomes among people with diabetes although its rate is highly variable. Data on the magnitude of medication non-adherence and associated factors are scarce in the study area. This study aimed to assess the rate of non-adherence and associated factors among diabetic patients at Debre Markos Comprehensive Specialized Hospital.

Methods

A cross-sectional study was conducted from June 17 to July 17, 2021. Study participants were selected using a simple random sampling technique. Data were collected with a pre-tested structured questionnaire and entered into SPSS version 25. Logistic regression was utilized to determine predictors of medication non-adherence at a significance level of ≤ 0.05.

Results

A total of 176 study participants were enrolled in the study. About 59% of the study participants had type-2 diabetes mellitus. The prevalence of non-adherence to anti-diabetic medications was found to be 41.5%. Male sex, rural residence, being divorced, being merchant, self- or family-borne medical cost, and presence of comorbidities were significantly associated with increased rate of non-adherence to anti-diabetic medications.

Conclusion

The prevalence of non-adherence to medications among diabetic patients is significantly high in the study area. Public health measures should be strengthened to decrease nonadherence among diabetic patients.

Factors Influencing Therapeutic Observance in Diabetic Subjects in the Province of Essaouira (Morocco): A Cross-Sectional Study

Background

Therapeutic observance remains a major problem in managing diabetic subjects, just like in other pathologies treated by medication and lifestyle modification. This study aims to determine the rate of therapeutic observance among diabetic subjects in the province of Essaouira and to identify the factors that influence it.

Methods

A cross-sectional questionnaire survey was conducted among 498 type 1 and 2 diabetic subjects, regularly being checked at different health centers in the province of Essaouira (Morocco).

Results

Almost a quarter of the surveyed subjects (23.3%) had poor observance. The results of the binary logistic regression model show that, in order of importance, observance is associated with six factors: Availability and access to medical treatment (Odds Ratio OR: 3; 95% CI confidence interval [1.78-5.03]); the side effects related to the treatment (OR: 2.60; 95% CI [1.65-4.09]); the family support (OR: 1.58 ; 95% CI [0.95-2.61]); duration of diabetes (OR: 0.55 ; 95% CI [0.34-0.88]); the age (OR: 0.50 ; 95% CI [0.30-0.82]); awareness level about the disease (OR: 0.43 ; 95% CI [0.21-0.90]).

Conclusion

The results of the present study have allowed us to identify several factors that can influence therapeutic observance, that prove necessary to be considered and acted upon.

Type 2 diabetes mellitus patients' lived experience at a tertiary hospital in Ekiti State, Nigeria

Diabetes mellitus is a complex and chronic metabolic disorder that is associated with multiple complications and disabilities. This contributes to increased mortality and poor quality of life among affected individuals. The study explored the lived experience of patients with type 2 diabetes mellitus at a Teaching Hospital in Ekiti State, Nigeria. A mixed method of qualitative and quantitative design was adopted. For the quantitative aspect, a convenience sampling technique was employed while the instrument used was an adapted questionnaire. For the qualitative aspect, focus-group discussion involving twenty-four participants was conducted, and the sample size was determined by data saturation. Qualitative data was analyzed using thematic transcription. Findings revealed that 55.6% of the participants were females while 63.5% had tertiary education. Majority (18 of 24) of the respondents experienced body weakness, frequent urination and excessive thirst when diagnosed of diabetes mellitus and later experienced occasional body weakness, burning sensation, tingling and numbness of the feet, fatigue, loss of libido, and occasional visual disturbance. Two-third of the participants reported being indifferent when they were informed about their condition. However, majority of the participants perceived that the cause of diabetes mellitus was heredity. More than two-third of the participants did not experience reduction in their normal daily activities but rather experienced occasional emotional disturbances, anxiety and challenges with self-management of diabetes and this was associated with maintaining a normo-glycemic state due to the financial implications of drugs and dietary modifications.

Medication Regimen Complexity and Medication Burden Among Patients With Type 2 Diabetes Mellitus: A Retrospective Analysis

Introduction: Most type 2 diabetes mellitus (T2DM) patients with chronic conditions require multiple medications to achieve and maintain good glycemic control. Objective: This study assessed medication burden, regimen complexity, and adherence among T2DM patients and evaluate its association with glycemic control. Method: We analyzed data of 2,696 T2DM patients at public health clinics in Malaysia from January 2018 until May 2019. Medication burden was based on medication count, regimen complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and adherence was measured using proportion of days covered (PDC) formula. Logistic regression models were used to compute unadjusted and adjusted odds ratio (aOR) with 95% confidence interval (CI) for association between the medication parameters and glycemic control (HbA1c ≤ 7.0%) over a 90-day period. Results: The cohort mean age was 60.4 years old (±10.8) and 62.9% were female. Overall, the average medication count was 4.8 with MRCI score of 15.1. Mean adherence score (PDC) was 90%. High medication count and MRCI scores were associated with lower odds of achieving good glycemic control (aOR 0.88; 95% CI 0.82, 0.94 and aOR 0.89; 95% CI 0.87, 0.92, respectively) while inverse association was observed between adherence and HbA1c level (aOR 2.7, 95% CI 1.66, 5.19). Similar findings were observed for diabetes-specific measures. Conclusions: High medication count, high regimen complexity, and low medication adherence were associated with poor glycemic control over the 3-month follow-up period. These parameters could be used to identify patients with complex pharmacotherapy regimens so that targets for intervention can be taken to achieve optimum outcomes and ease of self-care.

Insulin Adherence and Associated Factors in Patients with Type 2 Diabetes Mellitus Treated in Klang Primary Health Care Centres

Background

Insulin therapy is necessary for patients with type 2 diabetes mellitus (T2DM) to reach the targeted glycaemic level and prevent complications. This study aimed to determine the proportion of adherence to insulin therapy and the associated factors in patients with T2DM.

Methods

A cross-sectional study was conducted among 249 patients with T2DM who had been on insulin therapy for at least 2 months in primary care centres of the Ministry of Health in Klang, Malaysia. A validated insulin adherence questionnaire for diabetes mellitus (DM) was used to assess insulin adherence. Data on the sociodemographic characteristics, disease-related factors, treatment-related factors and clinical parameters were extracted from medical records and interviews with patients.

Results

The adherence to insulin therapy was 8.43%. The factors associated with insulin adherence were self-monitoring of blood glucose (SMBG) (adjusted odds ratio [AOR]: 5.39; 95% confidence interval (CI): 1.20, 24.13; P = 0.028), exercise (AOR: 3.38; 95% CI: 1.37, 10.03; P = 0.029) and the number of daily insulin injections (AOR: 1.63; 95% CI: 1.09, 2.44; P = 0.017).

Conclusion

The adherence to insulin therapy in primary health care centres in Malaysia was very poor. Patients who practiced SMBG, exercised and frequent daily insulin injections were significantly more adherent to insulin therapy.

Factors Associated With Medication Compliance in Elderly Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study

The average age of patients with type 2 diabetes in Japan is over 70 years. Elderly patients tend to have poor medication compliance, therefore, it is important to understand their individual situations to improve medication compliance, the treatment of their diabetes, and their quality of life (QOL). This study aimed to identify factors associated with medication compliance in elderly type 2 diabetic patients. A cross-sectional study based on questionnaires was conducted on type 2 diabetes patients aged 65 years or older. The participants were recruited from patients who visited three dispensing pharmacies in the Shinagawa area of Tokyo between March 1 and September 30, 2019. The questionnaire consisted of patient information (sex, age, medication compliance status, knowledge of drug effects, and side effects), 12-Item Short Form Survey quality of life rating scale (SF-12), and Diabetes Treatment Satisfaction Questionnaire (DTSQ). Factors related to medication compliance were then evaluated. In all, there were 47 respondents: 31 males and 16 females. Four factors were found to be associated with medication compliance in elderly type 2 diabetic patients: medication storage (P = 0.01), knowledge of drug effects (P < 0.001), knowledge of side effects (P = 0.026), and physical functioning: (PF) (P = 0.045), a subscale of SF-12. Furthermore, the strength of the association between these four factors and medication compliance was calculated using Cramer's V coefficient of association. Knowledge of drug effects was the most strongly associated (knowledge of drug effects: V = 0.559; knowledge of side effects: V = 0.464; medication storage: V = 0.451; PF: V = 0.334). Because diabetes mellitus has no subjective symptoms and treatment effects are not felt to a great extent, it is difficult to motivate patients to consistently adhere to medication. When pharmacists provide medication guidance to elderly patients with type 2 diabetes mellitus, it is important to provide sufficient information to ensure they fully understand the drug effects to maintain medication compliance.

Determinants of Poor Treatment Adherence among Patients with Type 2 Diabetes and Limited Health Literacy: A Scoping Review

Prevention of complications and successful control of diabetes require preventive and therapeutic measures. Patients' nonadherence to medication and diet regimens and healthcare protocols is associated with significant therapeutic and economic consequences. The present scoping review aims to identify determinants of poor treatment adherence among patients with type 2 diabetes and limited health literacy in 2021. This scoping review was conducted in five stages: designing a research question, searching and extracting related studies, selecting related studies, tabulating information, and reporting results. Data were collected from six foreign electronic databases (Embase, Science Direct, PubMed, Google Scholar, Scopus, and Web of Science) and four Iranian electronic databases (MagIran, SID, IranDoc, and IranMedex) using keywords "Type 2 diabetes", "barriers", "treatment", "medication", "adherence", "non-adherence", "limited adherence", and "limited health literacy" from January 2010 to November 2021. From an initial 146 articles, 18 articles were eligible for review. Eighteen studies involving 3925 patients with T2DM from eight countries were included. The prevalence of nonadherence ranged from 42% to 74.3%. Barriers to treatment adherence, which were common among the articles, included economic problems, poor communication with healthcare team, lack of family support, lack of knowledge, misconceptions, and limited health literacy. The results of the present study provided modifiable and nonmodifiable factors affecting treatment adherence among patients with type 2 diabetes. Modifiable factors are essential by performing appropriate interventions with the target group and health professionals.

Perceptions with Type 2 Diabetes Mellitus of the Value of Prescribed Medications Among Malaysian Adults: A Qualitative Study

PURPOSE

Previous studies show that customer loyalty and purchase intentions were influenced by perceived product value, but little is known about the factors that influence patients' perceptions of the value of their subsidized prescriptions, when purchasing of medications were not required, and how these factors influence their medication adherence. Hence, this study aims to investigate perceptions of patients receiving subsidized medications regarding the value of their medication.

PATIENTS AND METHODS

This qualitative study involved semi-structured, face-to-face interviews with patients diagnosed with type 2 diabetes mellitus at a government district hospital in Selangor state, Malaysia between June to September 2019. Using purposive sampling, patients were identified at an out-patient pharmacy during prescription refill. They were asked how they perceived the value of their medication. Interviews were audio recorded and then transcribed verbatim for thematic analysis.

RESULTS

A total of thirty patients were interviewed. Patients' perceptions on the value of medications were influenced by several factors such as trust, how the medications impact on their physical and social well-beings, and the perceived sacrificed made when the medications were procured and used. Perceptions on medication values were influenced by the recommendation received from someone they trust such as their doctors or significant others. It was also influenced by their perceptions of how the medication helps to improve their disease symptoms and affect their religious and social activities. Other factors include the perceived worth of the sacrifices made to access and use the medication.

CONCLUSION

Identifying factors that may influence patients' perceived value of the medication may help improve healthcare practices.

Medication Adherence of Persons with Type 2 Diabetes in Malaysia: A Scoping Review and Meta-Analysis

Objective

This is a scoping review of Malaysian scientific studies on medication adherence among persons with type 2 diabetes mellitus (T2DM).

Methodology

We conducted a bibliographic search of PubMed, Scopus and Google Scholar using the following keywords: "medication adherence," "drug compliance," "DMTAC" and "Malaysia." The search covered all publications up to 31 December 2021. Eligible articles were original studies conducted in Malaysia that measured or quantified medication adherence among persons with T2DM.

Results

We identified 64 eligible studies published between 2008 to 2021. Most studies included patients with T2DM in ambulatory facilities. Five studies were qualitative research. The quantitative research publications included clinical trials, and cross-sectional, validation, retrospective and prospective cohort studies. Thirty-eight studies used medication adherence scales. The Morisky Medication Adherence Scale (MMAS-8, used in 20 studies) and Malaysian Medication Adherence Scale (MALMAS, used in 6 studies) were the most commonly used tools. There were 6 validation studies with 4 medication adherence scales. A meta-analysis of 10 studies using MMAS-8 or MALMAS revealed that the pooled prevalence of low medication adherence is 34.2% (95% CI: 27.4 to 41.2, random effects model). Eighteen publications evaluated various aspects of the Diabetes Medication Therapy Adherence Clinics (DMTAC).

Conclusion

This scoping review documented extensive research on medication adherence among persons with diabetes in Malaysia. The quantitative meta-analysis showed a pooled low medication adherence rate.

Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates

Background: Patients with chronic diseases often experience difficulty adhering to recommended treatments as instructed by their healthcare professionals. Recently, diabetes has been associated with the severity of the novel coronavirus disease (Covid-19), which raises the importance of improving medication adherence for diabetic patients to enhance the right use of antidiabetics amid the Covid-19 pandemic.

Methods: This work assesses medication adherence among type 2 diabetes mellitus patients in the United Arab Emirates (UAE) and identifies the set of key demographic and health factors significantly associated with medication adherence. A descriptive cross-sectional study was conducted on an appropriate sample of type 2 diabetic patients in the UAE, with 180 patients of both genders and various social levels. A validated version of the eight-item Morisky Medication Adherence Scale (MMAS) was used for data collection.

Results:  The average MMAS score was 4.88, with 95% confidence intervals (CI) 4.6 and 5.2. 61.67% (n=111), 28.89% (n=52), and 9.44% (n=17) of patients were categorized into low, medium, and high adherent groups, respectively. These findings indicate that a high level of non-compliance to antidiabetic regimens among the population in the UAE.

Conclusions: Patients demonstrated low level of compliance to antidiabetic regimens. Therefore, they must receive up-to-date knowledge about the disease and the treatment and enable easy access to their health care providers to enhance medication adherence.

Medication adherence and quality of life among type-2 diabetes mellitus patients in India

BACKGROUND

Diabetes mellitus (DM) is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention. However, there is a paucity of data about adherence to antidiabetic drugs among patients with type-2 (T2)DM in Uttarakhand, India. Outpatient research reported that more than 50% of patients do not adhere to the correct administration and appropriate medicine dosage. It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life (QoL) and vice versa.

AIM

To assess the adherence to antidiabetic medication and QoL among patients with T2DM.

METHODS

This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand, India. The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.

RESULTS

Two hundred seventy-seven patients suffering from T2DM participated in the study. Their mean age was 50.80 (± 10.6) years, 155 (56%) had a poor adherence level and 122 (44%) had a good adherence level to antidiabetic medications. After adjusting for sociodemographic factors, multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health, with beta scores of 0.36 and 0.34, respectively (both P = 0.000) points compared with nonadherent patients.

CONCLUSION

There was an association between medication adherence and QoL in patients with T2DM. Hence, there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.

Prevalence of poor medication adherence in type 2 diabetics in North Africa. Systematic review and meta-analysis

INTRODUCTION

Medication adherence is the cornerstone of the successful drug management of a chronic disease.

AIM

To develop a systematic review and meta-analysis of the prevalence and the factors associated with non-adherence in patients with type 2 diabetes in North African countries.

METHODS

A literature search was conducted on Medline via Pubmed with a complementary search on Google Scholar. The meta-analysis was conducted using the Metaprop function of R software. The Cochrane Q test and Higgins I² statistic were used to estimate the heterogeneity.

RESULTS

In total, 16 studies measuring the prevalence of medication adherence in North African countries were selected in this systematic review. The combined prevalence of non-adherence was 38% (95% CI 30%-47%) with a random-effects model. The meta-analysis revealed a significant heterogeneity between studies (I² = 96%, p <0.01). Factors associated with non-adherence in type 2 diabetics were education level, social security coverage, therapeutic education, cost of medication, socioeconomic level, the duration of diabetes, unbalanced diabetic diet, polypharmacy, female gender, family support and age.

CONCLUSION

The combined prevalence of non-adherence among type 2 diabetics in North Africa was high and multifactorial, requiring global and integrated management by patients, physicians and pharmacists.

Family support and medication adherence among adult type 2 diabetes: Any meeting point?

Background

Serious disability diabetes mellitus (DM) cause for patients and their support system-family and friends are enormous. It remains an important public health challenge, despite effective medical therapies for its management; patients' poor adherence remains a global problem.

Objective

The study assessed the relationship between family support and medication adherence among adult Type 2 DM (T2DM) attending family medicine clinic of a rural tertiary hospital.

Methodology

This was an analytic cross-sectional hospital-based study carried out among 367 patients selected by systematic random sampling method. Relevant data collected through a semi-structured questionnaire and clinical data recorded and fasting plasma glucose (FPG) were utilized for the study. Data were analyzed using SPSS version 16.

Results

The mean (standard deviation) age of respondents was 61.7 ± 11.4 years. Those with strong family support that achieved medium/high (Morisky Medication Adherence Scale-8 > 6) level of medication adherence (odds ratio [OR] [95% confidence interval (CI)] = 1 6.4 [9.1-29.6], P < 0.001) constituted 69.5% of respondents. Family support was also found to have a direct relationship to glycemic control (FPG < 7.1 mmol/l), 65.7% of those with strong family support achieved good glycemic control, P < 0.001, OR (95% CI) = 17.4 (9.2-37.2). The level of medication adherence was noted to be directly related to glycemic control, 79.4% of those with medium/high medication adherence had good glycemic control, OR (95% CI) = 25.0 (14.4-43.6), P < 0.001. Strong family support leads to higher medication adherence level which resulted into better glycemic control.

Conclusion

Family support improves medication adherence and glycemic control. Physicians should explore patients' family support system to improve medication adherence level and better management outcome of chronic diseases especially T2DM.

Determinants of Treatment Adherence Among Patients Living With Noncommunicable Diseases: A Mixed-Method Study in a Rural Area of West Bengal

The multisectoral impact of the COVID-19 pandemic can impair treatment adherence of patients with noncommunicable diseases (NCDs). This mixed-method study, conducted from November 2020 to January 2021, assessed the quantum of their treatment adherence and its determinants in rural West Bengal. Quantitative data were collected from 213 NCD patients while qualitative exploration for barriers of treatment adherence was conducted as 6 in-depth Interviews. Treatment adherence was assessed by “Medication Compliance Questionnaire” and “Adherence to Healthy Lifestyle and Follow-up Advice” Questionnaire. A total of 39.4% were nonadherent to medications while 67.1% had nonadherence to healthy lifestyle and follow-up advice. Significant predictors associated with nonadherence were increasing age, female gender, lower socioeconomic status, decreasing patient empowerment, and decreasing trust in the medical profession. Economic crisis, fear of contagion, and nonavailability of investigation facilities were some new emerging barriers in addition to preexisting barriers of treatment adherence. Therefore, measures for improving patient empowerment and patient–provider relationship by motivation and counseling, taking proper care of vulnerable patients affected by the pandemic, and correcting deficiencies at the health-system level should be given utmost priority.

Impact of pharmacist insulin injection re-education on glycemic control among type II diabetic patients in primary health clinics

Background

Insulin injection technique re-education and diabetes knowledge empowerment has led to improved glycemic control.

Objectives

To evaluate the impact of pharmacist's monthly re-education on insulin injection technique (IT), lipohypertrophy, patients' perception on insulin therapy and its effect on glycaemic control.

Methods

This randomized controlled, multi-centered study was conducted among type 2 diabetics from 15 government health clinics. 160 diabetics with baseline HbA1_C ≥ 8% and unsatisfactory IT technique were randomized into control or intervention group. Control group received standard pharmacist counselling during initiation and at 4th month. Intervention group received monthly counselling and IT re-education for 4 months. Assessment of diabetes, IT knowledge, adherence and perception towards diabetes were conducted using validated study tools Insulin Treatment Appraisal Scale (ITAS) and Medication Compliance Questionnaire (MCQ)).

Results

139 patients completed the study; control group (69), intervention group (70). In control group, all outcomes shown improvement except for patient's perception. Mean HbA1_C decreased 0.79% ± 0.24 (p = 0.001). In intervention group, all outcomes improved significantly. HbA1c reduces significantly by 1.19% ± 0.10 (p < 0.001). Monthly re-education improved patient's perception towards insulin therapy (ITAS score reduced 1.44 ± 2.36; p = 0.021). Between groups, interventional arm shown significantly better improvement in all outcomes. Improvement was shown in IT technique (+2.02 score; p < 0.001), medication adherence (+1.48 score; p < 0.001) and ITAS (-1.99 score; p = 0.037). Mean HbA1_C reduced an additional of 0.63% (p = 0.008) compared to control arm.

Conclusion

Re-education is more effective in increasing adherence, reducing lipohypertrophy, improving injection technique and patient's perception on insulin therapy, thereby providing better glycaemic control.

Assessment of medication adherence and quality of life among patients with type 2 diabetes mellitus in a tertiary hospital in Kelantan, Malaysia

Introduction: Previous studies have reported the relationship between medication adherence and quality of life are interrelated. However, many of the results were found to be conflicting. This study aimed to assess the level and association of medication adherence and quality of life among type 2 diabetes mellitus patients in Raja Perempuan Zainab II Hospital, Kelantan, Malaysia. Materials and methods: A cross-sectional survey was conducted among adult type 2 diabetes mellitus patients on treatment for over 1 year using convenience sampling at outpatient.  Medication Compliance Questionnaire (MCQ) and revised Diabetes Quality of Life Questionnaire (DQOL) instrument were self-administered to eligible subjects. Data were analysed using GNU PSPP version 0.8.5 and reported for descriptive statistics as well as correlation of both parameters. Results: A total of 200 patients were recruited and they were mostly at the age of 40 to 60 years old. The mean (SD) score for MCQ was 26.0 (1.6) with the majority of them were non-adherent (55.0%, n=110). The mean (SD) score for overall revised DQOL instrument was 25.5 (8.9) while each domain of “satisfaction”, “impact” and “worry” had mean (SD) scores of 12.0 (5.0), 7.7 (3.4) and 5.9 (2.7), respectively. The scores obtained were only approximately half of the possible range of scores for QoL. There was no significant correlation between total score of medication adherence and quality of life when tested using Pearson’s correlation (r=-0.083, p=0.240). Independent t-test also demonstrated no significant relationship between medication adherence status and quality of life (p=0.883). Conclusion: Type 2 diabetes mellitus patients in our setting had unsatisfactory adherence but exhibited acceptable quality of life. We observed that both variables were not associated with one another. Further research is warranted to identify potential factors affecting non-adherence to medication.

Medication Adherence in Type 2 Diabetes Mellitus: A Qualitative Exploration of Barriers and Facilitators From Socioecological Perspectives

Adherence to antidiabetic medications (ADMs) remains a serious challenge among type 2 diabetes mellitus (T2DM) patients. Factors affecting medication adherence are not fully understood in Nigeria. This qualitative study explored patients' views on barriers and facilitators of medication adherence. Data collection was through face-to-face, semistructured, in-depth interviews conducted on 25 purposively sampled patients attending a public tertiary hospital. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis based on socioecological framework. NVIVO version 10 identified more codes. Most commonly identified barriers were organizational (clinic structure), personal (perception of T2DM as a dangerous illness), interpersonal (lack of spousal support), and community (concerns about taking ADMs in social gatherings). It was observed that female patients received more spousal support than the males. The facilitators of adherence include perceiving medication-taking a routine, the need to live longer, having savings for ADMs, purchasing medications to last until the next clinic visit. This study identified barriers and facilitators unique to Nigerian T2DM patients. Interventions anchored on these factors would improve medication adherence.

Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates

Background: Patients with chronic diseases often experience difficulty adhering to recommended treatments as instructed by their healthcare professionals. Recently, diabetes has been associated with the severity of the novel coronavirus disease (Covid-19), which raises the importance of improving medication adherence for diabetic patients to enhance the right use of antidiabetics amid the Covid-19 pandemic. Methods: This work assesses medication adherence among type 2 diabetes mellitus patients in the United Arab Emirates (UAE) and identifies the set of key demographic and health factors significantly associated with medication adherence. A descriptive cross-sectional study was conducted on an appropriate sample of type 2 diabetic patients in the UAE, with 180 patients of both genders and various social levels. A validated version of the eight-item Morisky Medication Adherence Scale (MMAS) was used for data collection. Results:  The average MMAS score was 4.88, with 95% confidence intervals (CI) 4.6 and 5.2. 61.67% (n=111), 28.89% (n=52), and 9.44% (n=17) of patients were categorized into low, medium, and high adherent groups, respectively. These findings indicate that a high level of non-compliance to antidiabetic regimens among the population in the UAE. Conclusions : Patients demonstrated low level of compliance to antidiabetic regimens. Therefore, they must receive up-to-date knowledge about the disease and the treatment and enable easy access to their health care providers to enhance medication adherence.

The impact of weight loss related to risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibitor

Background

Sodium–glucose cotransporter 2 inhibitor (SGLT2i) use reduces body weight (BW) in patients with type 2 diabetes mellitus (T2DM). Obesity and T2DM are strong risk factors of new-onset atrial fibrillation (AF). However, whether BW loss following SGLT2i treatment reduces AF risk in patients with T2DM remains unclear.

Methods

We used a medical database from a multicenter health care provider in Taiwan, which included 10,237 patients with T2DM, from June 1, 2016 to December 31, 2018, whose BW data at baseline and at 12 weeks of SGLT2i treatment were available. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the SGLT2i, or the end of the study period, whichever occurred first.

Results

The patients’ baseline body mass index (BMI) was 28.08 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm$$\end{document}± 4.88 kg/m². SGLT2i treatment was associated with a BW loss of 1.35 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm$$\end{document}± 3.28 kg (1.78%\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm$$\end{document}± 4.47%). There were 37.4%, 47.0%, and 15.6% of patients experienced no-BW loss (n = 3832), BW loss 0.0–4.9% (n = 4814), and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\ge$$\end{document}≥ 5.0% (n = 1591) following SGLT2i treatment, respectively. Compared with patients with baseline BMI < 23 kg/m², AF risk significantly increased in patients with baseline BMI \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\ge$$\end{document}≥ 27.5 kg/m² (P for trend = 0.015). Compared with those without BW loss after SGLT2i treatment, AF risk significantly decreased with a BW loss of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\ge$$\end{document}≥ 5.0% (adjusted hazard ratios [95% confidence intervals]: 0.39[0.22–0.68]). Use of diuretics, old age, high-dose SGLT2i, higher estimated glomerular filtration rate, and baseline BMI were independent factors associated with a BW loss of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\ge$$\end{document}≥ 5.0% following SGLT2i initiation. By contrast, neither baseline BMI nor BW loss after SGLT2i treatment predicted major cardiovascular adverse events or heart failure hospitalization risk (P for trend > 0.05).

Conclusion

BW loss of ≥ 5.0% following SGLT2i treatment was associated with a lower risk of new-onset AF in patients with T2DM in real-world practice.

Medication adherence status among patients with neurological conditions and its association with quality of life

Background/Aim

Medication non-adherence may cause significant morbidity and mortality in patients with chronic diseases and may increase the economic burden on the healthcare system. The prevalence of neurological disorders is increasing in Malaysia; however, comprehensive data on medication adherence among Malaysian patients with these disorders is limited. This study was conducted to determine the association of medication non-adherence with quality of life in patients with neurological problems.

Methods

A cross-sectional survey was performed in 370 patients diagnosed with epilepsy, Parkinson's disease, stroke and Alzheimer's disease at Neurology clinic. Patients aged 18 years or older, without documented physical or psychiatric illness such as schizophrenia and major depression, were included. Patient-administered questionnaires, such as the Malaysian Medication Adherence Scale and Medication Possession Ratio were used to determine medication adherence. An established EQ-5D-3L questionnaire was used to determine quality of life. Data were analysed using descriptive and inferential analysis.

Results

The overall prevalence of medication non-adherence among patients with neurological disorders was 59.2%. Among these neuromedical diseases, 69.2% (n = 9/13) of Alzheimer's disease, 66.7% (n = 98/147) of epilepsy, 62.1% (n = 36/58) of Parkinson's disease and 48.7% (n = 74/152) of stroke patients were found non-adherent. There was a significant difference in EQ-5D index scores (p = 0.041) between adherent and non-adherent patients.

Conclusion

A high prevalence of medication non-adherence was found among patients with neurological disorders. The rate of non-adherence varied among different neurological conditions. There was a significant difference in quality of life between adherent and non-adherent patients.

Adherence to the National Guidelines for Follow-Up Protocol in Subjects with Type 2 Diabetes Mellitus in Greece: The GLANCE Study

INTRODUCTION

Physician adherence, or lack therefore, to diabetes care and follow-up guidelines may be linked to the rates of achieving suboptimal glycaemic, blood pressure and lipid targets in people with type 2 diabetes mellitus (T2DM). In this cross-sectional study we evaluated physician adherence to the patient follow-up protocol (PFP) of the 2017 Hellenic Diabetes Association (HDA) guidelines and also assessed glycated haemoglobin (HbA_1c), blood pressure and lipid control achievement rates in the routine care setting in Greece.

METHODS

Eligible subjects were adults with T2DM receiving oral hypoglycaemic agents (OHAs) for ≥ 1 year who had ≥ 2 HbA_1c measurements in the previous year and an HbA_1c target < 7%. Overall adherence at the subject level was defined as the percentage of the 62 HDA PFP items that had been met during the past year.

RESULTS

Between June and December 2018, 601 eligible subjects (54.6% men; mean age 65.2 years; median T2DM duration 5.9 years, of whom 96.5% had ≥ 1 medical condition/comorbidity), were enrolled into the study by 53 hospital- and office-based endocrinologists, internists and general practitioners. The main OHAs prescribed at enrolment were metformin (91.0%), dipeptidyl peptidase-4 inhibitors (60.7%), sodium-glucose co-transporter-2 inhibitors (23.5%) and sulphonylureas (16.3%). Mean overall physician adherence to the PFP was 43.6%. Predictors of greater higher physicans' adherence were female sex (p = 0.026), > 3 medical conditions/comorbidities (p = 0.043) and diabetic complications (p < 0.001). HbA_1c, low-density lipoprotein-cholesterol, systolic/diastolic blood pressure and composite metabolic targets were achieved by 82.1, 57.0, 42.6 and 21.6% of subjects, respectively.

CONCLUSIONS

In Greek routine care, physician adherence to the PFP of the 2017 HDA guidelines is suboptimal. Future efforts should focus on identifying the barriers to an adequate adherence by physicians to the full PFP, with the aim to provide optimal patient care.

Development and validation of Malaysia Medication Adherence Assessment Tool (MyMAAT) for diabetic patients

Medication non-adherence remains a significant barrier in achieving better health outcomes for patients with chronic diseases. Previous self-reported medication adherence tools were not developed in the context of the Malaysia population. The most commonly used tool, MMAS-8, is no longer economical because it requires a license and currently every form used is charged. Hence, there is a need to develop and validate a new medication adherence tool. The Malaysia Medication Adherence Assessment Tool (MyMAAT) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. The face and content validities of the MyMAAT was established by a panel of experts. A total of 495 patients with type 2 diabetes were recruited from the Ministry of Health facilities consisting of five hospitals and five primary health clinics. A test-retest was conducted on 42 of the patients one week following their first data collection. Exploratory factor analysis was performed to evaluate the validity of the MyMAAT. The final item for MyMAAT was compared with SEAMS, HbA_1c%, Medication Possession ratio (MPR) score, and pharmacist’s subjective assessment for its hypothesis testing validity. The MyMAAT-12 achieved acceptable internal consistency (Cronbach’s alpha = 0.910) and stable reliability as the test-retest score showed good to excellent correlation (Spearman’s rho = 0.96, p = 0.001). The MyMAAT has significant moderate association with SEAMS (Spearman’s rho = 0.44, p = < 0.001) and significant relationship with HbA1c (< 8% and ≥ 8%) (χ²(1) = 13.4, p < 0.001), MPR (χ²(1) = 13.6, p < 0.001) and pharmacist’s subjective assessment categories (χ²(1) = 31, p < 0.001). The sensitivity of MyMAAT-12, tested against HbA1c% was 72.9% while its specificity was 43%. This study demonstrates that the MyMAAT-12 together with other methods of assessment may make a better screening tool to identify patients who were non-adherence to their medications.

Association of Health Literacy and Nutritional Status Assessment with Glycemic Control in Adults with Type 2 Diabetes Mellitus

While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg/m²) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R² = 0.21; p < 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.

Can patients make heads or tails of enhanced primary health care (EnPHC)? Experience through their own journey

Background

Implementation of the new Enhanced Primary Health Care (EnPHC) intervention aims to improve service quality and experience at primary healthcare clinics; especially to newly diagnosed patients. This was achieved by restructuring and improving existing services to better manage non-communicable diseases amongst patients. Objectives of this study are to explore patients’ experiences of the EnPHC intervention, to document their feedback and to determine effects of EnPHC intervention on patients.

Methods

This phenomenological qualitative study focussed on patients’ experiences in relation to EnPHC interventions. Participants were purposely selected from a group of patients who attended the eight intervention primary healthcare clinics in Johor and Selangor regularly for treatment. Data collection was conducted between April to July 2018. Semi-structured interviews were conducted at average an hour per interview for four to five patients per clinic. Interviews were audio recorded, transcribed verbatim, coded and analysed using a thematic analysis approach.

Results

A total of 35 patients participated. Analysis revealed five main themes about patient experiences receiving the EnPHC intervention. These are: (1) health assessment in disease progress monitoring, (2) patient-doctor relationship and continuity of care, (3) professionalism in service delivery, (4) ensuring compliance in achieving health targets and (5) communication skills. Each theme represents an important aspect of the service, how it should be delivered within the patient expectations and how it can improve patient’s health through their lens.

Conclusion

Even though patients were not able to exactly identify the EnPHC intervention components implemented, they are able to describe the process changes that occurred; enabling them to improve their healthcare status. Engagement is necessary to better inform patients of the EnPHC intervention, its purpose, mechanisms, changes and importance for healthcare. It would reduce resistance and increase awareness amongst patients at the clinic.

Benefits of Brief Group Cognitive Behavioral Therapy in Reducing Diabetes-Related Distress and HbA1c in Uncontrolled Type 2 Diabetes Mellitus Patients in Thailand

This study evaluated the short-term efficacy of brief group cognitive behavioral therapy (BG-CBT) in reducing diabetes-related distress (DRD), lowering hemoglobin A1c (HbA1c), improving food consumption behavior, increasing physical activity, and improving medication adherence behavior. A quasi-experimental pretest/post-test design with follow-up assessments was used with an experimental and a control group. Participants were patients with uncontrolled type 2 diabetes mellitus (T2DM) and moderate or high diabetes-related distress recruited from the Diabetes Mellitus Clinic of Hang Dong Hospital, Chiang Mai, Thailand. Fifty-six eligible participants were purposively selected and enrolled, then randomly assigned to either the BG-CBT group or the control group. The BG-CBT group received six brief weekly sessions of cognitive behavioral group therapy, while the control group received conventional care. Baseline data were collected at week 0 (pretest) and at week 6 (post-test), including food consumption behavior, physical activity, and adherence to medication regimes, as well as a blood examination to determine levels of HbA1c at the week 12 follow-up. DRD was assessed using the Diabetes Distress Scale (DDS-17) and analyzed using descriptive statistics, including pair t-test and independence t-test results. The BG-CBT had a significant effect on the amelioration of diabetes distress, improvement of food consumption behavior, and reduction of HbA1c levels, demonstrating the effectiveness of BG-CBT in maintaining diabetes control in people with T2DM-related distress.

A cross-sectional study on the rate of non-adherence to anti-seizure medications and factors associated with non-adherence among patients with epilepsy

Background

Non-adherence to anti-seizure medication (ASM) therapy is an important contributing factor to the higher mortality rate and treatment failure of epilepsy. This study aimed to determine the rate and factors associated with non-adherence to ASM therapy through the WHO five dimensions of medication adherence framework.

Methods

We conducted a cross-sectional study at an outpatient Neurology Clinic of a tertiary government hospital in Malaysia. Between March and July 2019, we identified 217 patients with a confirmed diagnosis of epilepsy, receiving oral ASM therapy and able to administer their medications. We performed a semi-structured interview to gather information on sociodemographic background, clinical and medication history, and perceptions on healthcare services. Adherence to ASM therapy was evaluated using the Medication Compliance Questionnaire (MCQ). Patient’s illness perception was assessed by the Brief Illness Perception Questionnaire (B-IPQ).

Results

208 patients participated in this study. The median age of the study participants was 35 years (IQR 26–44). 58.2% were females and majority, 55.8%, were from the Malay ethnic group. Based on the MCQ scoring, 89 patients (42.8%) were non-adherent. Multiple logistic regression demonstrated that being employed or students (adjusted odds ratio [aOR] 2.26, 95%CI: 1.19–4.29 p = 0.012) and having an average or below average perceived access to pharmacy services (aOR 2.94, 95%CI: 1.38–6.24, p = 0.005) were significant contributors to non-adherence.

Conclusion

Being employed or students and having an average or below average perceived access to pharmacy services were associated with ASM non-adherence Efforts to improve ASM adherence should adopt a comprehensive approach considering the success of adherence is contingent on the interrelationship of multiple dimensions.

Adherence to Oral Hypoglycemic Drugs among Type 2 Diabetic Patients in a Resource-Poor Setting

Objective:

Diabetes mellitus is a growing public health problem in many countries including Ghana. Adherence to drugs, especially among patients with type 2 diabetes mellitus (T2DM) is often poor is some resource-poor settings. The objective of this study was to assess adherence to oral hypoglycemic drugs and factors that affect adherence among patients with T2DM in the Volta Region of Ghana.

Methods:

The study was cross-sectional and conducted among 400 patients with T2DM attending diabetic clinics at 4 randomly selected hospitals in the Volta Region of Ghana between January 10 and March 30, 2015. Patients were interviewed using a structured questionnaire and other data collection tools to determine the commonest self-reported reason(s) for nonadherence. Adherence was assessed using the 8-item Morisky Medication Adherence Scale. Multivariate analysis was performed between adherence and statistically significant patient variables.

Results:

Adherence to oral hypoglycemic drugs among T2DM patients was 47.75%. The odds of adherence with fasting blood glucose between 1 and 6 mmol/L was approximately two-fold (adjusted odd ratio [aOR] =1.92, confidence interval [CI]: 1.11–3.32) versus the odds of having fasting blood glucose of above 10 mmol/L. The odds of adherence among patients with tertiary education was approximately three-fold (aOR = 3.01 CI: 1.44–6.269) versus patients with no formal education. The commonest self-reported reason for nonadherence was forgetfulness.

Conclusion:

Adherence to oral hypoglycemic drugs among T2DM patients in the current study was sub-optimal. Therefore, in such settings, management of T2DM must include strategies to identify nonadherent patients, and regular patient education and counseling.

Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes

INTRODUCTION

The prevalence of type 2 diabetes mellitus (T2D) has increased considerably while the outcome of diabetic management is suboptimal. In order to promote diabetic management, associated factors for adherence to medications, diet, and physical activity (PA) need to be more clearly identified amongst patients with T2D.

METHODS

This cross-sectional study was conducted on 206 men and 294 women amongst patients with diabetes who were registered in ten special diabetic clinics in Shiraz, Iran from November 2018 to April 2019. Levels of adherence to medication, Mediterranean diet (MD), and physical activity were measured with validated and appropriate questionnaires.

RESULTS

Mean age (± SD) was 56.92 ± 0.52 years and 294 (58.8%) were female. Data showed that reduced adherence to medication, MD, and PA increased glycated hemoblobin (HbA1c). Adherence to medication among low, moderate, and high levels was 27.2%, 59.2%, and 13.6%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, divorced widow, smoker, and ex-smoker had a significant influence on adherence to medication, P = 0.017, P = 0.018, P = 0.008. P = 0.045, P = 0.026, P < 0.004, and P = 0.001, respectively. In addition, adherence to MD among low, moderate, and high levels was 5.4%, 77.2%, and 17.4%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, and smoker had a significant influence on adherence to MD, P = 0.011, P = 0.046, P = 0.002, P < 0.001, and P = 0.032, respectively. Furthermore, adherence to PA among low, moderate, and high levels was 21%, 68.6%, and 10.4%, respectively. Only the non-smoker factor played a significant role in PA adherence, P = 0.010.

CONCLUSION

Levels of adherence to medications, diet, and PA amongst patients with T2D are not within the acceptable range. Recognized associated factors that contribute to adherence might improve diabetes management and allow one to tailor the appropriate message to improve glycemic indices.

Usability and Utility of a Mobile App to Improve Medication Adherence Among Ambulatory Care Patients in Malaysia: Qualitative Study

BACKGROUND

To date, several medication adherence apps have been developed. However, the existing apps have been developed without involving relevant stakeholders and were not subjected to mobile health app guidelines. In addition, the usability and utility of these apps have not been tested with end users.

OBJECTIVE

This study aimed to describe the usability and utility testing of a newly developed medication adherence app-Med Assist-among ambulatory care patients in Malaysia.

METHODS

The Med Assist app was developed based on the Theory of Planned Behavior and the Nielson usability model. Beta testing was conducted from March to May 2016 at a primary care clinic in Kuala Lumpur. Ambulatory care patients who scored ≥40% on the electronic health literacy scale, were aged ≥21 years, and were taking two or more long-term medications were recruited. Two rounds of in-depth interviews were conducted with each participant. The first interview, which was conducted upon participant recruitment, was to assess the usability of Med Assist. Participants were asked to download Med Assist on their phone and perform two tasks (register themselves on Med Assist and enter at least one medication). Participants were encouraged to "concurrently think aloud" when using Med Assist, while nonverbal cues were observed and recorded. The participants were then invited for a second interview (conducted ≥7 days after the first interview) to assess the utility of Med Assist after using the app for 1 week. This was done using "retrospective probing" based on a topic guide developed for utilities that could improve medication adherence.

RESULTS

Usability and utility testing was performed for the Med Assist app (version P4). A total of 13 participants were recruited (6 men, 7 women) for beta testing. Three themes emerged from the usability testing, while three themes emerged from the utility testing. From the usability testing, participants found Med Assist easy to use and user friendly, as they were able to complete the tasks given to them. However, the details required when adding a new medication were found to be confusing despite displaying information in a hierarchical order. Participants who were caregivers as well as patients found the multiple-user support and pill buddy utility useful. This suggests that Med Assist may improve the medication adherence of patients on multiple long-term medications.

CONCLUSIONS

The usability and utility testing of Med Assist with end users made the app more patient centered in ambulatory care. From the usability testing, the overall design and layout of Med Assist were simple and user friendly enough for participants to navigate through the app and add a new medication. From the participants' perspectives, Med Assist was a useful and reliable tool with the potential to improve medication adherence. In addition, utilities such as multiple user support and a medication refill reminder encouraged improved medication management.

Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study

Background

In Cambodia, the age-standardized prevalence of diabetes mellitus has increased in both men and women. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia.

Methods

A cross-sectional study was conducted in 2017 using a structured questionnaire for face-to-face interviews by trained interviewers. The participants were people with diabetes mellitus who were the active members of a peer educator network, lived in poor urban areas of Phnom Penh, and attended weekly educational sessions during the survey period. Diabetes medication adherence was measured using four items of modified Morisky Medication Adherence Scale. Participants were classified into two groups based on their adherence score: 0 (high adherence) and from 1 to 4 (medium or low adherence). Sociodemographic characteristics; medical history; accessibility to health services; and knowledge, attitude, and practices related to diabetes mellitus were examined. A multiple logistic regression analysis was conducted adjusting for sex, age, marital status, and education levels.

Results

Data from 773 people with diabetes were included in the analyses. Of the total, 49.3% had a high level of diabetes medication adherence. A high level of adherence was associated with higher family income (≥50 USD per month) (adjusted odds ratio [AOR] = 5.00, 95% confidence interval [CI] = 2.25–11.08), absence of diabetes mellitus-related complications (AOR = 1.66, 95% CI = 1.19–2.32), use of health services more than once per month (AOR = 2.87, 95% CI = 1.64–5.04), following special diet for diabetes mellitus (AOR = 1.81, 95% CI = 1.17–2.81), and absence of alcohol consumption (AOR = 13.67, 95% CI = 2.86–65.34).

Conclusions

High diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors. It would be crucial to improve affordable access to regular follow-ups including promotion of healthy behaviors through health education and control of diabetes mellitus-related complications.

Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan

Background

The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan.

Methods

This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient’s possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications.

Results

Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50–<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period.

Conclusions

We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50–<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.

Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus

Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia’s unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8–18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3–8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5–39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1–32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.

An evaluation of adherence to anti-diabetic medications among type 2 diabetic patients in a Sudanese outpatient clinic

Introduction

Adherence to anti-diabetic medication is a known cornerstone in the management of type 2 diabetic patients. We sought to assess the factors associated with adherence to medication s among type 2 diabetic patients being followed up in a Sudanese outpatient clinic.

Methods

This cross-sectional study conducted among 102 patients with type 2 diabetes attending an outpatient clinic in Omdurman, Sudan during the period from June to December 2017. Participants were interviewed using a structured questionnaire to collect demographic data, number, and type of medications, polypharmacy, medications side effects, financial problems and education regarding drug used. The study of participants’ adherence to anti-diabetic medications was assessed using a validated questionnaire asking the patients about the percent and self-rating of adherence (Excellent, very good, good, fair and poor). The Statistical Package for Social Sciences (SPSS) was used to compare the adherent patients and their counterparts. A P-value < 0.05 was considered significant.

Results

The study results summarized the following: participants (70.6% women), their mean age was (59.62±9.91) years and nearly 60.8% were housewives, their glycated hemoglobin (mean± SD) was about 10.16±3.14, 37.3%, it implies that the patients were non-adherent to medications. In addition, other groups of patients with medication but non-adherence were younger ones (55.94±9.94 vs. 61.81±9.36, P=0.04) and had shown inadequate glycemic control (11.33±3.05vs. 9.47±3.04, P=0.04), however, this group of patients has reported more drug-related side effects (57.8% vs. 28.1%) because they were taking more drugs compared to their counterparts( F=4.115, P=0.047). The present study found no statistically significant differences in the following factors such as sex, occupation, education level, financial problems and insulin use.

Conclusion

In conclusion, the study revealed that adherence to anti-diabetic medications was sub-optimal among Sudanese type 2 diabetic patients and was associated with higher glycated hemoglobin seen among younger age groups. Besides the above, overdosing of medications and their side effects were evident.

Study of type 2 diabetes management among patients in a Macau primary care setting

Background

In the primary care setting in Macau, type 2 diabetes mellitus (T2DM) is the seventh most common reason for consultation. Inadequate glycaemic control constitutes a major public health problem and is associated with premature death and disability and decreased quality of life. Moreover, this condition substantially increases healthcare expenditures.

Objective

The primary objective was to assess the successful glycaemic control rates, blood pressure (BP) and cholesterol control rates in patients with T2DM in a Macau primary care setting. The secondary objective of this study was to assess the delay of insulin initiation in the Sao Lourence Health Center.

Methods

Patients were stratified according to age (<65 years vs ≥65 years) and sex. Successful glycaemic control was defined as glycated haemoglobin (HbA1c) <7%. Successful cholesterol control was defined as a low-density lipoprotein cholesterol (LDL-C) level <2.6 mmol/L, and BP control was defined as BP <140/90 mm Hg.

Results

Among the 2157 participants included in this study, 1046 (48.5%) patients had HbA1c <7%, 1209 (56.1%) patients had BP <140/90 mm Hg and 1244 (57.7%) patients had LDL-C <2.6 mmol/L. In conclusion, only 403 (18.7%) patients met the targets for all three measures. Of the 235 patients who were on insulin therapy, the mean (±SD) duration from T2DM diagnosis to insulin initiation was 7.47±6.52 years, the mean (±SD) duration from HbA1c not meeting the target (HbA1c ≥7% over 1 year and persistently) to insulin initiation was 3.34±3.66 years and the mean baseline HbA1c was 9.13%. Compared with patients with a longer duration (≥5 years) of HbA1c not meeting the target before insulin initiation, those who started insulin within 1 year of HbA1c not meeting the target had a better glycaemic control rate (40.7% vs 13%).

Conclusions

Nearly half of the patients at Sao Lourence Health Center, a primary care centre in Macau, met the glycaemic control target, but less than one-fifth of patients met all three targets for T2DM control. Moreover, there was a delay in insulin initiation for people with T2DM.

Polypharmacy and oral antidiabetic treatment for type 2 diabetes characterised by drug class and patient characteristics: A Japanese database analysis

Polypharmacy (PP) occurs in patients with type 2 diabetes (T2DM) owing to multimorbidity. We evaluated concomitant PP and medication adherence in T2DM 3 years after initiation of administration of a hypoglycaemic agent using a nationwide claim-based database in Japan. Factors associated with medication PP and imperfect adherence were identified using multivariable logistic regression. PP was defined as using ≥6 medications. Patients with proportion of days covered (PDC) of <80% were defined as having poor medication adherence. A total of 884 patients were analysed. Multivariate analysis revealed that age, total number of consultations and body mass index (BMI) are factors that influence PP. Factors associated with PDC < 80% were 2–3, 4–5 and ≥ 6 medications compared with 1 medication, male sex, <17 consultations and age 50–59 and ≥ 60 years compared with <40 years. In conclusion, older age, high total number of consultations and BMI ≥ 25 kg/m² are risk factors for PP. PP influenced good medication adherence at the end of the observation period.

Predictors of Health-Related Quality of Life Among Patients with Type II Diabetes Mellitus Who Are Insulin Users: A Multidimensional Model

BACKGROUND

Diabetes Mellitus is a progressive, chronic and multifactorial endocrine disorder characterized by elevated serum glucose levels. It has a direct effect to social and health related quality of life.

OBJECTIVE

This study aimed to determine the health-related quality of life among patients with type II diabetes mellitus (T2DM) using insulin therapy.

METHODS

Cross-sectional observational study design was used to collect data from Malaysian patients with T2DM. Subjective and objective assessments were made either by using several questionnaires or each patient's specific medication profile registered to care sites. Study participants were recruited from both public hospitals and community health clinics located in Kuala Lumpur, Malaysia.

RESULTS

A total of 430 patients with T2DM were recruited in this study with a response rate of 94.7%. The oral antidiabetic medication (OAM) group consisted of 63.0% of the study population and the rest (37.0%) were Insulin users. The body mass index and glycosylated hemoglobin patterns were significantly different between groups (P < 0.011 and P < 0.001). Insulin users showed high percentages of healthy body mass index index (44.7%) compared with OAM users (35.8%) and controlled glycemic index (glycosylated hemoglobin ≤7.5%) was significantly (P = 0.001) better among the insulin-user group compared with the OAM group. The Euro Quality of Life-5 dimension domain analysis indicated significant differences with domains of usual work (P < 0.047), pain and discomfort (P < 0.041), and anxiety and depression (P < 0.001) among insulin users versus OAM users. We also observed a significant difference between the groups regarding diet, monitoring, and disease-specific knowledge. The mean (SD) adherence score showed that insulin users were significantly (P < 0.001) more adherent (6.09 [2.98]) than OAM were nonadherent (4.19 [4.68]).

CONCLUSIONS

This study suggests the valuable effect of insulin therapy among patients with T2DM compared with OAMs on health-related quality of life, medication adherence, and health state. Insulin users reported they had better diabetes-related knowledge and treatment adherence characteristics than noninsulin users.

Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon

BACKGROUND

Diabetes mellitus is a growing cause of disease burden globally. Its management is multifaceted, and adherence to pharmacotherapy is known to play a significant role in glycaemic control. Data on medication adherence among affected patients is unknown in Cameroon. In this study, the level of adherence and factors influencing non-adherence to antidiabetic medication among patients with type-2 diabetes was assessed.

METHODS

A hospital-based cross-sectional study among adult patients receiving care in the diabetic clinics of the Limbe and Bamenda Regional Hospitals in Cameroon was conducted. Medication adherence was assessed using the Medication Compliance Questionnaire (MCQ). Factors associated with non-adherence to medication were determined using basic and adjusted multivariable logistic regression models.

RESULTS

A total of 195 patients with type 2 diabetes were recruited. The prevalence of non-adherence to medication was 54.4% [95% confidence interval (CI): 47.1-61.5%]. In multivariable analysis, age > 60 years (aO.R. = 0.48, 95% CI: 0.25-0.94), alcohol consumption (aO.R. = 2.13, 95% CI: 1.10-4.14) and insulin alone therapy (aO.R. = 2.85, 95% CI: 1.01-8.08) were associated with non-adherence. Patients attributed their non-adherence to forgetfulness (55.6%), lack of finances (38.2%) and disappearance of symptoms (14.2%).

CONCLUSIONS

Adherence to anti-diabetic medication is poor in this study with more than half of participants being non-adherent. Urgent interventions are required to tackle this problem in combined efforts to stem this looming diabetes epidemic.

Adherence to Antidiabetic Medications Among Sudanese Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Survey

Background:

Adherence to antidiabetic medications is crucial for optimum glycemic control and decreasing complications. This study aimed to assess adherence to antidiabetic medications and the associated factors among individuals with type 2 diabetes attending Jabir Abu Eliz Diabetes Centre in Khartoum state, Sudan.

Methods:

This was a descriptive cross-sectional study, recruited 213 individuals with type 2 diabetes, and used a pretested questionnaire. Data were analyzed using the Statistical Package of Social Sciences version 21. Logistic regression analysis was used to check for factors that linked to poor adherence to diabetes medication.

Results:

The median duration of antidiabetic medications use was 8 years; 15.0% were highly adherent to diabetes medications, 44.6% were medium adherent, and 40.4% showed low adherence. Main factors and barriers were medication side effects (18.3%), use of herbal medicine (12.3%), and unavailability of medication (7%). Predictors to nonadherence were gender, and housing status (0.043 and 0.042, respectively).

Conclusion:

Level of adherence to diabetes medication was unsatisfactory as only 15% showed high adherence. Predictors of nonadherence were gender, and housing status. Effective interventions should be implemented to improve medication adherence, like appropriate patient education and involvement in the treatment plan.

Effect of patient characteristics on medication adherence among patients with type 2 diabetes mellitus: a cross-sectional survey

Background: The prevalence of diabetes mellitus (DM) is steadily increasing worldwide, with a significant DM population in Asian countries. Adherence to medications is important to achieve good glycaemic control among patients with DM. Thus, patients' adherence to their medication regimen should be determined to optimise DM management. Aims: To determine medication adherence and the relationship between patient profile and medication adherence among patients with type 2 DM (T2DM). Design: Cross-sectional survey. Methods: This study was conducted in a public hospital in Selangor, Malaysia, from December 2016 to June 2017. Data was obtained through administration of the Medication Compliance Questionnaire and an electronic medical records database. Multivariate logistic regression analysis was used to determine the predictors of medication adherence. Results: A total of 232 (95.9% response rate) patients participated in this study. The overall percentage of medication adherence among patients with DM was 55.2%. The majority of participants were female (53.4%), Malay (47.0%), aged 41-64 years (55.2%; mean age, 56.69 years), married (84.5%), unemployed (60.8%) and attended secondary school (53.9%). The factors independently associated with adherence were ethnicity (odds ratio [OR], 1.43; 95% confidence interval [CI]: 1.03-1.99) and haemoglobin A1c (HbA1c) level (OR, 2.71; 95% CI: 1.56-4.72). Conclusions: The medication adherence among patients with DM in a public hospital in Selangor, Malaysia was low. A health intervention emphasising patient-centred care is warranted to improve DM patients' adherence to prescribed medication. Considering that Malaysia has a multi-ethnic population, the patients' ethnicity and their HbA1c levels need to be considered in the implementation of any intervention to improve medication adherence. Impact statement: Medication adherence is influenced by individual patients' characteristics. To improve adherence to the medication regimen, nurses should consider patients' profiles.

Evaluation of medication adherence among Lebanese diabetic patients

Background:

Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications.

Objectives:

The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence.

Methods:

A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20.

Results:

Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively).

Conclusions:

Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence.

Validity and reliability of anti-diabetic medication adherence scale among patients with diabetes in Baghdad, Iraq: a pilot study

BACKGROUND

Medication non-adherence is a common problem among patients with diabetes. Patient-reported medication adherence scales are the most commonly used method to assess patient medication adherence, but up to today there is no specific tool for assessing medication adherence among patients with diabetes in Arab countries. This study aimed to develop and validate a new tool for assessment of adherence to antidiabetic medications among Iraqi patients with diabetes.

METHODS

The Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) consists of eight items. The face and content validity of the IADMAS were established via an expert panel. For convergent validity, the IADMAS was compared with the Medication Adherence Questionnaire (MAQ). For concurrent validity, the IADMAS was compared with glycosylated hemoglobin. A total of 84 patients with types 2 diabetes were recruited from a diabetes center in Baghdad, Iraq. Test-retest reliability was measured by readministering the IADMAS to the same patients 4 weeks later.

RESULTS

Only 80 patients completed the study (response rate: 95%). Reliability analysis of the IADMAS showed a Cronbach's alpha value of 0.712, whereas that of the MAQ was 0.649. All items in the IADMAS showed no significant difference in the test-retest analysis, indicating that the IADMAS has stable reliability. There was no difference in the psychometric properties of the IADMAS and the MAQ. The sensitivity and specificity of the IADMAS were higher than that of the MAQ (100% vs 87.5% and 33.9% vs 29.7%, respectively).

CONCLUSION

The IADMAS developed in this study is a reliable and valid instrument for assessing antidiabetic medication adherence among Iraqi patients.

Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia - a cross-sectional survey

BACKGROUND

Patients' non-adherence to diabetes medication is associated with poor glycemic control and suboptimal benefits from their prescribed medication, which can lead to worsening of medical condition, development of comorbidities, reduced quality of life, elevated health care costs, and increased mortality.

OBJECTIVE

This study aimed to assess medication adherence among patients with diabetes and associated factors in Bisha primary health care centers (PHCCs) in Saudi Arabia.

PATIENTS AND METHODS

A cross-sectional study was conducted with a sample of 375 type 1 and 2 Saudi diabetic patients attending PHCCs under the Health Affairs of the Bisha governorate. The participants were aged 18 years and above, and had been taking diabetes medications for at least 3 months. Pregnant women, patients with mental illnesses, and those who were not willing to participate were excluded. Adherence to diabetes medications was measured using the four-item Morisky Green Levine Medication Adherence Scale (MGLS). All participants completed a self-report questionnaire including sociodemographic and clinical variables. Univariate and multivariate analyses were carried out using SPSS version 22.

RESULTS

Of all the respondents, 134 (35.7%), 161 (42.9%), and 80 (21.4%), patients had high (MGLS score 0), intermediate (MGLS score 1 or 2), and low adherence (MGLS score ≥3), respectively. Factors associated with the level of adherence in univariate analysis were occupational status (P=0.037), current medication (P<0.001), glycated hemoglobin (A1c) (P<0.001), and number of associated comorbidities (P<0.001). In multivariable analyses, A1c <7 (P<0.001) and no associated comorbidities (P<0.003) variables remained significantly associated with adherence.

CONCLUSION

The level of adherence to medication in diabetes mellitus patients in the Bisha PHCCs was found to be suboptimal. The findings point toward the need for better management of primary health care providers' approaches to individual patients, by taking into account their medication adherence levels. Better identification of patients' level of adherence remains essential for successful diabetes treatment.

The role of concordant and discordant comorbidities on performance of self-care behaviors in adults with type 2 diabetes: a systematic review

Background: Most patients with Type 2 diabetes (T2D) have high number of comorbid chronic conditions that can affect their self-care abilities. Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities. Identifying comorbidities that either improve or potentially diminish the individual's capacity to perform effective self-care behaviors is essential to enhance clinical outcomes. One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals. Objective: The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D. Methods: A comprehensive literature search was undertaken to identify published English language articles through the following five electronic databases: PubMed, CINAHL, PsycINFO, ISI Web of Science, and EMBASE. Quantitative studies published from March 2006 to April 2018 were included. Quality of evidence was evaluated using the Joanna Briggs Institutes Critical Appraisal Tools (JBI-CAT) and rated using Quality Assessment Tool for Quantitative Studies (QATQS). Results: The initial database search identified 1,136 articles but only 33 studies that met the inclusion criteria were included. The most common concordant comorbidity was hypertension while depression was the most common discordant condition. Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities. The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension, hyperlipidemia, retinopathy, and heart failure on diabetes self-care behaviors. But, there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors. Conclusions: Concordant comorbidities may improve diabetes self-care, but the evidence is inconclusive. Future research using well designed studies are needed to examine the complex relationship between diabetes self-care and comorbidities.