Analysis of Non-Adherence to Medication in Patients with Type 2 Dm.

ABSTRACT

BACKGROUND: Non-adherence to medication in chronic diseases, like diabetes, is a serious problem which is associated with poor outcomes. Material and Objectives: Primary Objective: To study the proportion of non-adherence to treatment in patients with type 2 DM and factors responsible for it. SECONDARY OBJECTIVE: To correlate the degree of glycemic control, presence of target organ damage and metabolic derangements with non-adherence to medication. METHODS: A cross-sectional analytical study was conducted on 100 patients of Type 2 diabetes mellitus. Proportion of drug coverage (PDC) over the last 1 month was used to assess adherence. A questionnaire was used to collect information for variable factors responsible for non-adherence. The percentage of non-adherence and factors contributing were analyzed. OBSERVATION AND RESULTS: Out of 100 patients with T2 DM (MF 3565); 56 patients had good (>80%) adherence, 13 patients had moderate (50-80%) adherence and 31 patients had poor (<50%) adherence to medication. Following factors were assessed for non-adherence;

1. Amongst Drug-related factors; cost (43%;p<0.001), non-availability of drugs (39%;p<0.001) and long-term use of drugs (3%;p=0.017) were significantly associated with non-adherence to medication.
2. None of the Insulin-related factors i.e. phobia (13.04%;p=0.441), negative impact (13.04%;p=0.441), less flexibility (60.86%;p=0.595), don't know the way of taking insulin (52.17%;p=0.983) and others (17.39%,p=0.67) were significantly associated with non-adherence.
3. Amongst social factors- Function(12%;p=0.881), no support (27%;p=0.005), patient not well (23%;p=0.004), travelling (42%,p=0.158) and illness in family (5%;p=0.658). No support from family and patient not well were significantly associated with non-adherence.
4. None of the disease-related (duration, poor perception & unawareness) and psychological factors (forgetfulness & willful default) were significantly associated with non-adherence.
5. Miscellaneous factors- Frequency of visits (20%,p=0.034), lack of communication (53%,p<0.001) and SMBG related issues (74%,p=0.029) were significantly associated with non-adherence. Others factors like distance, covid-related and alternate therapy were not significantly associated with non-adherence.

Patients with good adherence had significantly lower HbA1c (p=0.044).Patients with good adherence had lesser prevalence of target organ damage but it was not significantly associated with non-adherence except nephropathy (66%;p=0.039). Also, association of medication adherence with metabolic complications was found to be insignificant. CONCLUSION: Non-adherence to medication in patients with Type 2 DM is significantly associated with cost of medication, non-availability of medication, long-term use, no support from family, patient not well, frequency of visits, lack of communication and SMBG related issues. Non-adherence impairs glycemic control and effects target organ damage to some extent.