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Medical adherence and its predictors in Diabetes Mellitus patients attending government hospitals in the Indian Capital, Delhi, 2013: a cross sectional study

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Abstract

India has the second highest Diabetes Mellitus burden globally which represents a major public health challenge. Poor adherence to medication and other treatment recommendations in diabetes patients is associated with poor glycemic control which may lead to early onset of complications with high cost of management. We assessed medical adherence and their predictors in type 2 diabetes patients attending Government Hospitals in Delhi. We conducted a cross sectional study among 385 Type 2 DM patients. We assessed medication adherence with the eight item Morisky Medication Adherence Scale. Dietary and exercise adherence were also assessed. Data was analyzed using SPSS Version 17. Prevalence of good medication adherence was 74.5 %, adherence to dietary recommendations was 70 % and adherence to exercise recommendations was 48 % in the study population. On adjusted analysis, lower socio-economic status, oral hypoglycemic agent treatment alone and reporting non-replenishment on exhaustion of drug stocks was associated with higher likelihood of poor medication adherence. Barriers against dietary adherence were differing familial dietary choices, inflation, beliefs that occasional transgression was benign and cultural factors like dining together at same time. Clinical pathology especially knee joint pain was reported as most frequent barrier to exercise adherence. The medication adherence rates found in this study were higher than most other studies conducted in India. Provision of free anti hyperglycemic medication at government hospitals by reducing patient out of pocket expenses facilitates maintenance of a high level of medication adherence. Furthermore, higher dietary and exercise adherence may reflect the improved self efficacy in patients.

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References

  1. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization; 1999 (WHO/NCD/NCS/99.2).

  2. International Diabetes Federation. IDF diabetes atlas. 6th ed. Brussels: International Diabetes Federation; 2013.

    Google Scholar 

  3. Jayawardena R, Ranasinghe P, Byrne NM, Soares MJ, Katulanda P, Hills AP. Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis. BMC Public Health. 2012;12:380.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249–57.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Shetty PS. Nutrition transition in India. Public Health Nutr. 2002;5:175–82.

    Article  PubMed  Google Scholar 

  6. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.

    Article  PubMed  Google Scholar 

  7. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008;26(2):77–82.

    Article  Google Scholar 

  8. Zhang P, Zhang X, Brown J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:293–301.

    Article  PubMed  Google Scholar 

  9. Skyler JS. Effects of glycemic control on diabetes complications and on the prevention of diabetes. Clin Diabetes. 2004;22(4):162–6.

    Article  Google Scholar 

  10. Krapek K, King K, Warrien SS, et al. Medication adherence and associated hemoglobin AIC in type 2 diabetes. Ann Pharmacother. 2004;38:1357–62.

    Article  CAS  PubMed  Google Scholar 

  11. Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM, et al. Patient adherence improves glycemic control. Diabetes Educ. 2005;31(2):240–50.

    Article  PubMed  Google Scholar 

  12. Sabatâe E. Adherence to long-term therapies: evidence for action. 1st ed. Geneva: World Health Organization; 2003.

    Google Scholar 

  13. Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V, et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India. Diabetes Care. 2007;30:252–6.

    Article  PubMed  Google Scholar 

  14. Rao KD, Bhatnagar A, Murphy A. Socio-economic inequalities in the financing of cardiovascular & diabetes inpatient treatment in India. Indian J Med Res. 2011;133:57–63.

    PubMed Central  PubMed  Google Scholar 

  15. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.

    Article  CAS  PubMed  Google Scholar 

  16. Sultana G, Kapur P, Aqil M, Alam MS, Pillai KK. Drug utilization of oral hypoglycemic agents in a university teaching hospital in India. J Clin Pharm Ther. 2010;35(3):267–77.

    Article  CAS  PubMed  Google Scholar 

  17. Mukherjee S, Sharmasarkar B, Das KK. Compliance to anti-diabetic drugs: observations from the Diabetic Clinic of a Medical College in Kolkata, India. J Clin Diagn Res. 2013;7:661–5.

    PubMed Central  CAS  PubMed  Google Scholar 

  18. Morisky DE, Ang A, Krousel-Wood M, et al. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10:348–54.

    Article  Google Scholar 

  19. Al-Qazaz HK, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky DE. The eight-item Morisky Medication Adherence Scale MMAS: translation and validation of the Malaysian version. Diabetes Res Clin Pract. 2010;90(2):216–21.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943–50.

    Article  CAS  PubMed  Google Scholar 

  21. Shobhana R, Rama Rao P, Paul S. Psychosocial aspects of dietary non adherence in diabetes. Int J Diabetes Dev Ctries. 1998;18:75–7.

    Google Scholar 

  22. American Diabetes Association. Diagnosis and classification of DM. Diabetes Care. 2012;35 Suppl 1:S64–71.

    Article  PubMed Central  Google Scholar 

  23. Bairwa M, Rajput M, Sachdeva S. Modified kuppuswamy’s socioeconomic scale: social researcher should include updated income criteria, 2012. Indian J Community Med. 2013;38:185–6.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Johnson SB. Methodological issues in diabetes research: measuring adherence. Diabetes Care. 1992;15:1658–67.

    Article  CAS  PubMed  Google Scholar 

  25. Sasi ST, Kodali M, Burra KC, Muppala BS, Gutta P, Bethanbhatla MK. Self care activities, diabetic distress and other factors which affected the glycaemic control in a tertiary care teaching hospital in South India. J Clin Diagn Res. 2013;7(5):857–60.

    PubMed Central  PubMed  Google Scholar 

  26. Sankar UV, Lipska K, Mini GK, Sarma PS, Thankappan KR. The adherence to medications in diabetic patients in rural Kerala, India. Asia Pac J Public Health Asia Pac Acad Consortium Public Health. 2013.

  27. Khan AR, Al-Abdul Lateef ZN, et al. Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia. J Fam Community Med. 2012;19(1):26–32.

    Article  Google Scholar 

  28. Jamous RM, Sweileh WM, Abu-Taha AS, Sawalha AF, Zyoud SH, Morisky DE. Adherence and satisfaction with oral hypoglycemic medications: a pilot study in Palestine. Int J Clin Pharm. 2011;33(6):942–8.

    Article  PubMed  Google Scholar 

  29. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complicat. 2010;24(2):84–9.

    Article  PubMed  Google Scholar 

  30. Howteerakul N, Suwannapong N, Rittichu C, Rawdaree P. Adherence to regimens and glycemic control of patients with type 2 diabetes attending a tertiary hospital clinic. Asia Pac J Public Health. 2007;19(1):43–9.

    Article  CAS  PubMed  Google Scholar 

  31. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–24.

    Article  PubMed  Google Scholar 

  32. Dutton GR, Johnson J, Whitehead D, Bodenlos JS, Brantley PJ. Barriers to physical activity among predominantly low-income African-American patients with type 2 diabetes. Diabetes Care. 2005;28(5):1209–10.

    Article  PubMed  Google Scholar 

  33. Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence: response to authors. J Clin Epidemiol. 2011;64(3):255–7. discussion 258–63.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Odegard PS, Gray SL. Barriers to medication adherence in poorly controlled DM. Diabetes Educ. 2008;34:692–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. National Centre for Disease Control (NCDC), 22 Sham, Nath Marg, Delhi, 110054, India

    Saurav Basu, Megha Khobragade & Anil Kumar

  2. Department of Community Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, Room No. 421 (4th Floor), New Delhi, 110029, India

    D. K. Raut

Authors
  1. Saurav Basu
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  2. Megha Khobragade
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  3. Anil Kumar
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  4. D. K. Raut
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Correspondence to Saurav Basu.

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Basu, S., Khobragade, M., Kumar, A. et al. Medical adherence and its predictors in Diabetes Mellitus patients attending government hospitals in the Indian Capital, Delhi, 2013: a cross sectional study. Int J Diabetes Dev Ctries 35 (Suppl 2), 95–101 (2015). https://doi.org/10.1007/s13410-014-0232-9

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  • DOI: https://doi.org/10.1007/s13410-014-0232-9

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