Poor Adherence to Common Recommendations and Associated Factors among Outpatients with Type 2 Diabetes Mellitus in a Police Hospital of Ethiopia

Abstract Introduction Poor adherence to medication and healthy lifestyle managements, such as diet and regular exercise, remains to be a challenge for patients with type 2 diabetes mellitus. The objective of this study was to assess the pattern of adherence to common recommendations, reasons, and factors associated with poor overall adherence among outpatients with type 2 diabetes mellitus in a police hospital of Ethiopia. Method A facility-based cross-sectional study was done between 15 October 2016 and 15 January 2017. Systematic random sampling method was applied to recruit participants. A semistructured interview guide with an observation checklist was used to collect data. SPSS v.20.0 was used in the analysis. Results Out of 361 participants, over half (56.5%) participants were male and 235 (65.1%) participants were military. Nearly half (49%) of the participants were on oral combination therapy. Only 194 (53.7%) of the patients showed good adherence for diet. Half (50.1%) of the respondents had poor adherence to all recommendations. Reasons for poor adherence included lack of adequate knowledge (68.9%) for diet, carelessness (37.8%) for exercise, and lack of adequate knowledge (34.8%) followed by carelessness (28.3%) and forgetfulness (19.6%) for medication. Intake of herbal medicines doubled the likelihood of good adherence. Conclusion Adherence of patients to diet was found to be suboptimal. Lack of adequate knowledge, carelessness, and forgetfulness were among the reasons mentioned. Only use of herbal medicine showed statistical significance with adherence. Patient education on dietary practice is required in the study setting.

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Adherence to medication among Tunisian adults with type 2 diabetes

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1151 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Amara ◽

R Ghammem ◽

N Zammit ◽

S BenFredj ◽

J Maatoug ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

University Hospital ◽

Health Concern ◽

Eligibility Criteria ◽

Cross Sectional ◽

Adherence To Medication

Abstract Introduction Diabetes mellitus is a growing public health concern. Despite compelling evidence about the effectiveness of medications, studies have indicated that less than 50% of patients achieved therapeutic targets. The aim of this study was to assess the adherence to type 2 diabetes mellitus treatment and its determinants. Methods A cross-sectional study was conducted between April and June 2017 in the Endocrinology and internal medicine departments of Farhat Hached University Hospital in Sousse, Tunisia. A convenient sample of patients who fulfilled the eligibility criteria was recruited. A pre-tested questionnaire was used to gather information. This was followed by assessing patients' adherence to diabetes medications using the eight-item Morisky Medication Adherence Scale (MMAS-8). Results A total of 330 patients with Type 2 Diabetes Mellitus participated in this study. The mean ±SD age of patients was 58.96±10.3 with female predominance (60.3%). More than half of participants were with high cardiovascular risk. In most cases (70.6 %), participants were moderate adherent. Results showed that patients become non-adherent as the disease gets older (p = 0.001). In addition patients with health insurance were significantly more adherent comparing to those who did not have it (p = 0.01). Regarding self-care practices and other metabolic risk factors' effects, our data revealed that exercising 30 minutes below than 5 times in week and poor self-management of diet were associated with low adherence (p < 10-3). On the other hand, patients who have started insulin therapy were less adherent than those who had not yet (0.01). Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent, with respective percentage of 39.1% and 37.5%. Conclusions This study provides insights into the determinants of non-adherence, ultimately guiding the effective interventions through development of structured long-term policies not yet implemented. Key messages In most cases (70.6 %), participants were moderate adherent. Patients with diabetic retinopathy or maculopathy were significantly more prone to be non- adherent.

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Oral antidiabetic medication adherence and glycaemic control among patients with type 2 diabetes mellitus: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia

BMJ Open ◽

10.1136/bmjopen-2019-029280 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029280 ◽

Cited By ~ 2

Author(s):

Bander Balkhi ◽

Monira Alwhaibi ◽

Nasser Alqahtani ◽

Tariq Alhawassi ◽

Thamir M Alshammari ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Saudi Arabia ◽

Glycaemic Control ◽

Tertiary Hospital ◽

Good Adherence ◽

Cross Sectional ◽

Oral Antidiabetic

ObjectivesThe purpose of this study is to measure the adherence rates of oral antidiabetic drugs (OADs) in patients with type 2 diabetes mellitus (T2DM) and assess the relationship of glycaemic control and adherence to OADs after controlling for other associated factors.DesignCross-sectional retrospective study.SettingLarge tertiary hospital in the central region of Saudi Arabia.Participants5457patients aged 18 years and older diagnosed with T2DM during the period from 1 January 2016 to 31 December 2016.Primary and secondary outcome measuresThe modified medication possession ratio (mMPR) was calculated as a proxy measure for adherence of OADs. The factors associated with OADs non-adherence and medication oversupply were assessed using multinomial logistic regression models. The secondary outcomes were to measure the association between OADs adherence and glycaemic control.ResultsMajority of patients with T2DM were females (n=3400, 62.3%). The average glycated haemoglobin was 8.2±1.67. Among the study population, 48.6% had good adherence (mMPR >0.8) and 8.6% had a medication oversupply (mMPR >1.2). Good adherence was highest among those using repaglinide (71.0%) followed by pioglitazone (65.0%) and sitagliptin (59.0%). In the multivariate analysis, women with T2DM were more likely to have poor adherence (adjusted OR (AOR)=0.76, 95% CI=0.67, 0.86) compared with men. Also, medication oversupply was more likely among patients with hyperpolypharmacy (AOR=1.88, 95% CI=1.36, 2.63), comorbid osteoarthritis (AOR=1.72, 95% CI=1.20, 02.45) and non-Saudi patients (AOR=1.53, 95% CI=1.16, 2.01). However, no association was found between glycaemic control and adherence to OADs.ConclusionThe study findings support the growing concern of non-adherence to OADs among patients with T2DM in Saudi Arabia. Decision makers have to invest in behavioural interventions that will boost medication adherence rates. This is particularly important in patients with polypharmacy and high burden of comorbid conditions.

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The Effect ofTinospora crispaon Serum Glucose and Insulin Levels in Patients with Type 2 Diabetes Mellitus

Journal of Biomedicine and Biotechnology ◽

10.1155/2012/808762 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Theerawut Klangjareonchai ◽

Chulaporn Roongpisuthipong

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Healthy Subjects ◽

Statistical Significance ◽

Area Under The Curve ◽

Serum Glucose ◽

Dry Powder ◽

Insulin Levels

Objective. To determine the effects ofTinospora crispaon serum glucose and insulin levels in healthy subjects and patients with type 2 diabetes mellitus.Method. Serum from 10 healthy subjects and 10 diabetic participants, who had fasted overnight, were obtained every 30–60 minutes during the 3 hours of continued fasting and during the 3 hours after ingestion of 75 g of glucose with or without ingestion of 125 or 250 g ofTinospora crispadry powder capsule. Glucose and Insulin levels were analyzed and the areas under the curve for mean serum glucose and insulin levels were calculated.Result. The areas under the curve of mean serum glucose and insulin levels in both healthy and diabetic participants were not significantly different between with or withoutTinospora crispadry powder capsule. In diabetic participants the area under the curve of glucose was slightly lesser when 250 mg ofTinospora crispawas ingested, but not reaching statistical significance (478 and 444 mg min/ml, resp.,P=0.57).Conclusion. The results suggest thatTinospora crispaingestion cannot affect serum glucose and insulin levels in healthy subjects or patients with type 2 diabetes mellitus.

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C-REACTIVE PROTEIN IN DIABETIC PATIENTS BEFORE GASTRIC BYPASS AS A POSSIBLE MARKER FOR POSTOPERATIVE COMPLICATION

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-6720201500s100005 ◽

2015 ◽

Vol 28 (suppl 1) ◽

pp. 11-14 ◽

Cited By ~ 3

Author(s):

Daniel C. LINS ◽

Josemberg M. CAMPOS ◽

Patrícia S. de PAULA ◽

Manoel GALVÃO-NETO ◽

Eduardo PACHU ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Gastric Bypass ◽

Type 2 Diabetes Mellitus ◽

Postoperative Complications ◽

Statistical Significance ◽

C Reactive Protein ◽

Reactive Protein ◽

Inflammatory State

Background : Obesity and type 2 diabetes mellitus are associated to inflammatory state, which can be set off by the adipose tissue, once it is a metabolically active organ that can cause a chronic mild inflammatory state. Aim : To evaluate the correlation between preoperative C-reactive protein and postoperative complications risk in obese patients (grades II and III) after Roux-en-Y gastric bypass, with and without type 2 diabetes mellitus. Methods : Between 2008 and 2013 were analysed 209 patients (107 with diabetes), presenting body mass index >40 kg/m2or >35 kg/m2with comorbidities. During the postoperative period, two groups were evaluated: with and without complications. Preoperative ultra-sensitive C-reactive protein was measured by immunonephelometry method. Results : Complications occurred in seven patients (pulmonary thromboembolism, fistula, two cases of suture leak, pancreatitis, evisceration and upper digestive hemorrhage). No statistical significance was found regarding lipid profile and C-reactive protein between patients with and without type 2 diabetes mellitus. When compared to each other, both groups (with and without complications) presented with statistical significance regarding C-reactive protein level (7,2 mg/dl vs 3,7 mg/dl, p=0,016) and had similar weight loss percentage after 3, 6 and 12 months follow-up. Conclusions : Preoperative C-reactive protein serum level was higher in the group which presented complications after Roux-en-Y gastric bypass when compared to the group without postoperative complications.

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The Association of Uric Acid Calculi with Obesity, Prediabetes, Type 2 Diabetes Mellitus, and Hypertension

BioMed Research International ◽

10.1155/2017/7523960 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Fang-Yeh Chu ◽

Chih-Chun Chang ◽

Pin-Hao Huang ◽

Yi-Ning Lin ◽

Po-Wen Ku ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Urinary Tract Infection ◽

Type 2 Diabetes Mellitus ◽

Uric Acid ◽

Surgical Management ◽

Surgical Intervention ◽

Statistical Significance ◽

Urinary Calculi

Objectives.To disclose the link between the composition of urolithiasis, especially that of uric acid calculi, and obesity, prediabetes, type 2 diabetes mellitus, and hypertension.Materials and Methods.Patients who had urinary calculi and underwent surgical treatment were registered in the study. The composition of urinary calculi was analyzed and correlated with clinical features and biomedical profiles of the patients before surgical intervention.Results.A total of 666 patients with urolithiasis who underwent surgical management were registered and analyzed. In those who had uric acid calculi, there was a significant association with prediabetic (OR: 20.11, 95% CI: 7.40–54.63,P<0.001) and diabetic states (OR: 11.55, 95% CI: 4.41–29.97,P<0.001). It also seemed that uric acid calculi were related to obesity but there was no statistical significance (OR: 2.45, 95% CI: 0.91–6.62,P=0.078). There was no association of uric acid calculi with hypertension (OR: 1.08, 95% CI: 0.54–2.17,P=0.822) and concurrent urinary tract infection (OR: 0.93, 95% CI: 0.44–1.96,P=0.841).Conclusion.There was a remarkable association of uric acid calculi with prediabetic and diabetic states. The uric acid calculi were also seemingly associated with obesity in patients with urolithiasis undergoing surgical management.

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Non-adherence to diet and exercise recommendations amongst patients with type 2 diabetes mellitus attending Extension II Clinic in Botswana

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v5i1.457 ◽

2013 ◽

Vol 5 (1) ◽

Cited By ~ 23

Author(s):

Adewale B. Ganiyu ◽

Langalibalele H. Mabuza ◽

Nomsa H. Malete ◽

Indiran Govender ◽

Gboyega A. Ogunbanjo

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Poor Adherence ◽

High Rate ◽

Adherence To Diet ◽

Lack Of Information ◽

Diet And Exercise ◽

Lifestyle Recommendations

Background: Patients diagnosed with type 2 diabetes mellitus in Extension II Clinic in Botswana have difficulty in adhering to the lifestyle modifications recommended by healthcare practitioners. Poor adherence to lifestyle recommendations leads to poor control of the condition and consequently to complications.Objectives: The aim of the study was to determine reasons for poor adherence to lifestyle recommendations amongst the patients. The objectives were to determine: reasons for pooradherence to dietary requirements, exercise recommendations, the support they had in adhering to the recommendations, and their understanding of the role of dietary and exercise requirements in the management of their condition.Method: This was a cross-sectional descriptive study. The sample comprised of 105 participants. Data on participants’ baseline characteristics and adherence to dietary and exercise habits were analysed using the SPSS 14.0 version.Results: The sample of 104 participants comprised of 61 (58.7%) women. The rates of nonadherence to diet and exercise were 37% and 52% respectively. The main reasons for nonadherence to diet were: poor self-discipline (63.4%); lack of information (33.3%) and thetendency to eat out (31.7%). The main reasons for non-adherence to exercise were: lack of information (65.7%); the perception that exercise exacerbated their illness (57.6%) and lack of an exercise partner (24.0%).Conclusion: There was a relatively high rate of non-adherence to both diet and exercise recommendations by patients suffering from type 2 diabetes mellitus at Extension II Clinic,Botswana, with non-adherence to exercise recommendations more common.

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Analysis of the Relationship between the Referral and Evolution of Patients with Type 2 Diabetes Mellitus

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15071534 ◽

2018 ◽

Vol 15 (7) ◽

pp. 1534 ◽

Cited By ~ 6

Author(s):

Camilo Alvarez ◽

Cecilia Saint-Pierre ◽

Valeria Herskovic ◽

Marcos Sepúlveda

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Patient Adherence ◽

Timely Manner ◽

Adherence To Medication ◽

The Relationship ◽

Positive Evolution ◽

Lower Adherence

Type 2 Diabetes Mellitus (T2DM) is a chronic disease that has risen in prominence in recent years and can cause serious complications. Several studies show that the level of adherence to different types of treatment has a direct correlation with the positive evolution of chronic diseases. While such studies relate to patient adherence to medication, those that concern adherence to medical appointments do not distinguish between the different disciplines that attend to or refer patients. This study analyses the relationship between adherence to referrals made by three distinct disciplines (doctors, nurses, and nutritionists) and the results of HbA1c tests from a sample of 2290 patients with T2DM. The aim is to determine whether a relationship exists between patient improvement and the frequency with which they attend scheduled appointments in a timely manner, having been previously referred from or to a particular discipline. Results showed that patients tended to be more adherent when their next appointment is with a doctor, and less adherent when it is with a nurse or nutritionist. Furthermore, patients that remained stable had higher rates of adherence, whereas those with lower adherence tended to be more decompensated. The results can enable healthcare professionals to monitor patients and place particular emphasis on those who do not attend their scheduled appointments in a timely manner.

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

Journal of Pharmacy ◽

10.31436/jop.v1i2.66 ◽

2021 ◽

Vol 1 (2) ◽

pp. 79-86

Author(s):

Nazmi Liana Azmi ◽

Nurul Aida Md Rosly ◽

Hock Chun Tang ◽

Anis Fariha Che Darof ◽

Nor Dini Zuki

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Medication Adherence ◽

Life Questionnaire ◽

Adherence To Medication ◽

The Mean

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.

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