Factors Associated with Adherence to Oral Antidiabetic Drugs among Patients with type 2 Diabetes Mellitus attending Diabetic Clinic at Jinja Regional Referral Hospital Jinja District
Tendai Mahomedi
Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.
ABSTRACT
Diabetes Mellitus (DM) is a metabolic illness that causes excessive blood sugar levels as a result of either impaired pancreatic insulin production, insulin resistance, or both. People with diabetes mellitus die prematurely, and DM is a global burden. Adherence to drug regimens is essential in the management of diabetes mellitus, in addition to lifestyle changes. However, patients with diabetes are more likely not to take their medications as prescribed, and poor medication compliance jeopardizes patient safety and treatment efficacy, increasing mortality and morbidity. This study aimed to determine oral diabetes medication adherence and its associated factors among type two diabetes patients (T2DM) at Jinja Regional Referral Hospital. An institutional-based cross-sectional study of 136 T2DM patients was undertaken at Jinja Regional Referral Hospital in Jinja district. A convenience sampling technique was used to recruit participants, and the research was carried out from April 2022 to October 2022. The Morisky Medication Adherence Scale was used to assess medication adherence. STATA version 15.1 was used to analyze the data. To discover independent determinants of T2DM adherence, logistic regressions were used. To declare statistical significance, a P-value of less than 0.05 was employed. This study enrolled 136 type 2 diabetes patients, with a response rate of 100%. Overall, 58.33% of T2DM patients showed good medication adherence. T2DM patients who took both oral and injectable anti-diabetic medications (AOR = 1.98, 95% CI: 1.16-3.39), received the prescribed anti-diabetic medication from the hospital (AOR = 0.51, 95% CI: 0.32-0.80), had their own glucometer at home (AOR = 0.30, 95% CI: 0.16-0.54), and had good diabetes-related knowledge were found to be more adherent to oral antidiabetic medication. At Jinja Regional Referral Hospital, there is a low prevalence of oral anti-diabetic drug adherence among patients with T2DM. Significant independent predictors of anti-diabetic treatment adherence included the type of medication that T2DM patients were taking, the ability of patients to receive their prescriptions from the hospital, having a glucometer at home for glucose monitoring, and having sound knowledge of diabetes. Patients should therefore receive more education on the importance of medication adherence, and as well be encouraged to purchase personal glucometers.
Keywords: Diabetes Mellitus, Blood sugar levels, Insulin, Medication adherence, Oral anti-diabetic.
INTRODUCTION
Diabetes Mellitus (DM) is a metabolic illness that causes excessive blood sugar levels as a result of either impaired pancreatic insulin production, insulin resistance, or both. DM is more prevalent in low-income and middle-income countries [1, 2]. Common risk factors to DM include obesity and overweight, poor nutrition, lack of exercise, and a sedentary lifestyle [3].
DM can be basically divided into three: Types 1, 2, and gestational. Type 1 (Insulin Dependent Diabetes Mellitus (IDDM) or juvenile-onset diabetes), accounts for 5–10% of DM. It affects people of all ages but is most common in children or young adults. It is hereditary in nature. Type 2 (Noninsulin Dependent Diabetes Mellitus) makes up for 90–95% of all DM. Gestational Diabetes Mellitus (GDM) is commonly diagnosed during pregnancy. GDM is a risk factor for type 2 diabetes in women [4]. 387 million people worldwide, including over 22 million in Africa, have diabetes, according to the International Diabetes Federation (IDF). This number will nearly double by 2035 [4]. Metabolic syndromes like obesity, insulin resistance, and dyslipidemia contribute to type 2 diabetes [5, 6]. There have been several drugs used in the management of DM such as Exenatide, sulfonylureas, Liraglutide; insulin injections; dipeptidyl peptidase-4 (DPP-4) inhibitors like sitagliptin, metformin [7-9]. Despite these numerous drugs, the incidence of DM is still high as patients sometimes do not adhere to taking these drugs citing adverse effects and economic burden as reasons. Some patients even resort to the use of alternative treatments mainly herbs and plant products [10]. The use of herbal medications in the management of diseases is an age-long globally acceptable practice and its use is approved by the World Health Organization [11, 12]. The phytoconstituents of these herbs and plants are responsible for their various therapeutic effects and also serve as precursors of conventional drugs [13, 14]. Notably, some herbs and plant products have been scientifically proven to possess anti-diabetic properties like Allium sativum [15], Pterocarpus santalinoides [16], Moringa oleifera [17], Ageratum conyzoides [18], Bucholzia coriacea [19], Sphenocentrum jollyanum [20], and Datura stramonium [21].
Adherence to drug regimens is essential in the management of diabetes mellitus, in addition to lifestyle changes. However, patients with diabetes are more likely not to take their medications as prescribed, and poor medication compliance jeopardizes patient safety and treatment efficacy, increasing mortality and morbidity. In the end, the healthcare system will incur high direct and indirect expenditures [22]. Additionally, it is asserted that increasing adherence to current treatments would have a greater global health impact than developing new medical interventions due to the severity and scope of non-adherence [23]. Lower morbidity, mortality, and healthcare use are all connected with effective diabetes management, which lowers the expense and burden on the government and the community. According to a study conducted in the USA, persons with diabetes who did not follow their prescribed therapy had noticeably worse clinical results than those who did [24]. Despite the focus placed on the necessity of proper pharmaceutical use, many patients have poor adherence to medications, especially those for chronic conditions like diabetes. As a result, they are unable to achieve their desired levels of health. Non-adherence is associated with factors that are patient-centered, therapy-related, or healthcare system-related [25]. The patient-centered factors can be demographic (age, gender, educational level, and marital status) and psychological (patients’ beliefs and motivation towards the therapy, negative attitude, patient-prescriber relationship, understanding of health issues, and patients’ knowledge) [26]. Therapy-related characteristics include medication route, duration of treatment, treatment complexity, medication kind, and medication adverse effects. The availability and accessibility of health care, as well as health provider-patient relationships, are issues related to the healthcare system [27]. Non-adherence is sometimes associated with medication-related adverse effects [10, 11]. The number of diabetic patients in rural areas is growing. According to a Ministry of Health (MoH) report, diabetes is on the rise in Uganda [28]. According to the IDF, diabetes affects 1.6% of adults in Uganda [4]. Similarly, in Uganda, a population-based nationwide assessment of diabetes and its associated indicated a prevalence of 1.4% among adults [29]. However, there has been little published work in the research area on the prevalence of and factors related to adherence to Oral Antidiabetic Drugs (OADs) therapy so far. As a result, there is a need to investigate factors associated with drug adherence. Furthermore, the majority of research has been conducted in industrialized nations, leaving a gap in understanding the prevalence and factors that may be linked with diabetic treatment adherence in settings such as Jinja. Thus, this study sought to determine factors associated with adherence to oral antidiabetic drugs among patients with Type 2 diabetes attending the diabetic clinic in Jinja Regional Referral Hospital (JRRH), Jinja District.
CONCLUSION
At Jinja Regional Referral Hospital, there is a low prevalence of oral anti-diabetic drug adherence among patients with diabetes mellitus type II. Significant independent predictors of anti-diabetic treatment adherence included the type of medication that T2DM patients were taking, the ability of patients to receive their prescriptions from the hospital, having a glucometer at home for glucose, monitoring, and having sound knowledge of diabetes.
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CITE AS: Tendai Mahomedi (2023). Factors Associated with Adherence to Oral Antidiabetic Drugs among Patients with type 2 Diabetes Mellitus attending Diabetic Clinic at Jinja Regional Referral Hospital Jinja District. IDOSR JOURNAL OF SCIENTIFIC RESEARCH 8(3) 99-112. https://doi.org/10.59298/IDOSR JSR /2023/00.8.6000