Adherence to recommended treatment among type 2 diabetes mellitus patients in East Delhi, India : a clinic based cross-sectional survey

Abstract

Background: Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia due to lack of insulin or its ineffective utilization by body. Diabetes is considered as a leading cause of premature death and disability and most of this is due to type 2 DM. It is also considered as one of the four priority non communicable diseases. It leads to many micro and macro-vascular complications. India is known as the “diabetic capital of the world.” DM is a chronic illness demanding lifelong therapy. Evidence suggests that adherence to long term therapies is very low in low and middle income countries. Good adherence to the antidiabetic treatment like dietary modification, physical activity, routine ophthalmic screenings and foot care leads to improved quality of life with effective decrease in complications and disability due to DM. Aim: This study aimed to assess the level of adherence to the recommended regime and medication, its determinants and perceived barriers to adherence to the treatment among type 2 diabetes mellitus patients in East Delhi, India Methods: Cross sectional survey was conducted by using a self-administered questionnaire in a primary health care clinic among type 2 DM patients (aged 18 years and more) living in East Delhi, India. Convenience sampling was used and the sample size was 180. A validated tool (Medication Adherence Questionnaire) was used to measure adherence to the medication. All the study variables were analyzed descriptively and compared between two outcome groups: adherent and non-adherent. Chi2 tests and t tests were run, univariate and multivariate logistic regression analysis was done to get the final predictor model and the model fit was checked by Hosmer and Lemeshow test. Result: Only 36.6% of the study participants were adherent to the medication and the mean percent score for adherence to recommended regime was 59.6 (SD 24.7). Predictors for the adherence to recommended regime were adequate knowledge about DM (1.28 OR and CI 1.02-1.61), high level of income (OR 9.11 and CI 2.97-27.91), receiving advice from doctor (OR 5.22 and CI 1.34 - 20.32), current smoking (OR 6.54 and CI: 2.17-19.74) and being obese (OR 3.24 and CI: 1.161- 9.49). The predictors for adherence to the medication only were adequate knowledge about DM (OR 2.26 and CI: 1.01-5.10), high income (OR 2.43 and CI: 1.06-5.55), receiving advice from doctor (OR 5.40 and CI: 1.04-28.03), age over 40 years (OR 0.29 and CI: 0.12-0.68) and being obese (OR 3.17 and CI: 1.32-7.61). Conclusion: The level of adherence to the antidiabetic treatment was not optimal among population. Educational program should be implemented for diabetic patients to improve their DM-related knowledge, which further can improve their level of adherence. Some policies should be implemented to provide antidiabetic medicines free of charge to the patients or make them affordable for patients. Training programs for the physicians should be implemented to train the physicians to build trustful patient provider relationship.