Adherence to treatment in type 2 diabetes mellitus patients receiving multiple drug therapy

ABSTRACT

Background: objective of the study was to evaluate adherence to therapy and factors associated with non-adherence in type 2 diabetes mellitus patients on multiple drug therapy.Methods: A prospective, cross-sectional, questionnaire based study conducted on 100 type 2 DM patients in a tertiary teaching hospital. They were interviewed using self-designed, semi-structured questionnaire to assess adherence to medication and diet/exercise schedule. Morisky medication adherence questionnaire was used to calculate overall adherence.Results: 71%patients had some co-morbidity and were on multiple medications. Average daily modifications taken by patients was 4.1±2.23 (mean+SD). Only 47% patients were found adherent. Illiteracy (11%), Language (10%), complicated dosages (8%), adverse drug events (6%), heavy outpatient load (6%), psychological illness (6%), and financial (4%) were common reasons for non-adherence. Surprisingly, total number of medicines prescribed did not interfere with adherence.58% patients were aware of the importance of medication, diet and exercise but 42% patients were not aware of the consequences of non-adherence. 65% patients adhered to diet control and 43% patients followed exercise schedule.Conclusions: 53% of type 2 DM patients on multi-drug therapy were not adhering to prescribed medication making it a major hurdle to its management. The most important cause of non adherence were not comprehending instructions due to various reasons like illiteracy, language issues, complicated schedules and less doctor-patient interaction due to heavy OPDs. Also 42% of the patients were not aware of the consequences of non adherence to therapy, diet and exercise. Hence, a multidimensional approach with adequate medication and emphasis on adherence to prescribed medication, diet and exercise schedule requires implemented. Health professionals can play a major role in improving adherence by increasing interaction with patients.