Assessment of Medication Adherence Among Patients with Diabetes Mellitus in Saarathi Hospital, Anand

Abstract

Medication adherence is crucial for the effective management of diabetes mellitus (DM). Non-adherence to diabetes medications can lead to poor glycemic control, increased risk of complications, and higher healthcare costs. This review article examines a study conducted at Saarathi Hospital in Anand, Gujarat, assessing medication adherence among diabetes patients. The study identified factors affecting adherence and analyzed the usage patterns of anti-diabetic drugs. This review provides insights into the common barriers to adherence and suggests strategies to improve patient outcomes through enhanced adherence practices.

Keywords

Introduction

Diabetes Mellitus (DM) is a chronic condition that requires lifelong management. Effective management of DM involves strict adherence to prescribed medications to maintain blood glucose levels within the target range. Poor medication adherence, however, remains a significant challenge in diabetes care, contributing to suboptimal health outcomes, including long-term complications such as cardiovascular diseases, renal failure, neuropathy, and retinopathy. This review examines the findings from a study conducted at Saarathi Hospital, Anand, which explored medication adherence patterns in diabetic patients. The study aimed to understand the factors influencing adherence and to evaluate the impact of different anti-diabetic treatments.

Study Overview

The study at Saarathi Hospital involved 269 diabetic patients with a mean age of 56 years, consisting of 141 males (52.45%) and 128 females (47.55%). The study participants were primarily overweight (81.25%), followed by those in the normal weight category (33.45%) and obese (26.02%). A significant portion (69.51%) did not have a family history of diabetes mellitus.

The most commonly used medications included Pioglitazone, Vildagliptin, and Sitagliptin, with a majority of patients using monotherapy (53.5%), followed by combination therapy (40%) and insulin therapy (29%).

Medication adherence was assessed using the Morisky Medication Adherence Scale, which classifies adherence as high, medium, or low. The results indicated that 26.7% of patients had low adherence, 65% had medium adherence, and only 8.17% had high adherence.

Factors Affecting Medication Adherence

Several factors contribute to medication non-adherence in diabetes patients. These factors can be categorized into patient-related, treatment-related, and systemic factors:

1. Regimen Complexity

Diabetes treatment regimens often involve multiple medications with varying doses and times of administration. The complexity of these regimens can create confusion and increase the likelihood of non-adherence, particularly when patients struggle to manage multiple medications.

2. Forgetfulness

Forgetting to take medications, particularly when away from home or during busy periods, was a significant reason for non-adherence in the study population. This is especially common among patients who take medications multiple times a day.

3. Perceived Control Over Health

A common issue among patients was the belief that they no longer needed medication once their blood sugar levels were under control. Many patients discontinued medication because they felt their health was stable, despite the ongoing need for medication to manage the chronic condition.

4. Side Effects

Some patients stopped taking their medications due to adverse effects like gastrointestinal issues, dizziness, or fatigue. These side effects can discourage patients from continuing with treatment, particularly if the side effects are perceived as more bothersome than the benefits of the medication.

5. Cost of Medications

The financial burden associated with purchasing diabetes medications can be a major barrier to adherence. In the context of low-income settings, the cost of medications often leads to patients skipping doses or discontinuing their medication regimens altogether.

6. Patient Beliefs and Attitudes

Negative beliefs about the efficacy of medications or concerns about side effects can also contribute to non-adherence. Some patients may not fully understand the importance of consistent medication use for preventing long-term complications.

7. Social and Emotional Support

A lack of support from family, friends, or healthcare providers can hinder adherence. Support systems are crucial in helping patients remember to take their medications and in providing encouragement to continue with treatment.

8. Healthcare Access

Limited access to healthcare services and pharmacies, especially in rural or underserved areas, can make it difficult for patients to obtain medications regularly, leading to gaps in adherence.

9. Mental Health Conditions

Conditions such as depression or cognitive impairments can interfere with a patient's ability to adhere to prescribed regimens. Mental health issues often go unnoticed in diabetes care but are essential to consider when addressing adherence.

Medication Adherence Levels

The Morisky Medication Adherence Scale provided insights into the adherence levels of the patients in the study. The findings revealed the following:

• 26.7% of patients exhibited low adherence.
• 65% of patients demonstrated medium adherence.
• 8.17% maintained high adherence.

The study highlighted that most patients (71.7%) were not adhering to their medication regimens optimally, with the majority falling into the "medium" or "low" adherence categories.

DISCUSSION

The findings from Saarathi Hospital reflect a broader trend in diabetes care, where adherence to prescribed medication is often suboptimal. The study identifies several modifiable factors—such as forgetfulness, perceived health control, and regimen complexity—that contribute to non-adherence.

• Regimen complexity and forgetfulness were significant barriers. Simplifying treatment regimens and employing reminder systems could improve adherence.
• Social support emerged as an important factor, with patients who had stronger family or peer support more likely to adhere to their treatment regimens.
• Psychosocial factors such as mental health conditions and patient beliefs about medications play a crucial role. Addressing these issues through patient-centered care and mental health support could improve adherence.

Strategies to Improve Medication Adherence

Based on the findings of the study, several strategies can be employed to improve medication adherence in diabetes patients:

1. Patient Education

Providing education about the importance of medication adherence and its role in preventing complications can help patients understand the need for continuous treatment. Educational interventions should be tailored to the patient's level of health literacy.

2. Simplifying Treatment Regimens

Using combination therapies or longer-acting medications can simplify the treatment regimen, making it easier for patients to adhere to their medications.

3. Technology Integration

Mobile applications, pillboxes, and automated reminder systems can help patients keep track of their medications and ensure timely intake.

4. Regular Follow-ups

Routine follow-up visits or phone calls to monitor adherence and address any concerns can significantly improve medication adherence.

5. Addressing Financial Barriers

Making medications more affordable through subsidized pricing, insurance coverage, or generic alternatives can reduce the financial burden on patients and improve adherence.

6. Mental Health Support

Screening for mental health conditions such as depression or anxiety can help identify patients who may need additional support. Integrating mental health care into diabetes management can improve adherence.

7. Social Support Systems

Encouraging family involvement and peer support groups can reinforce the importance of adherence and provide emotional support to patients.

CONCLUSION

Medication adherence is a critical component in the management of diabetes mellitus. The study conducted at Saarathi Hospital demonstrated that a significant proportion of diabetic patients have medium to low adherence to prescribed medications. Factors such as regimen complexity, forgetfulness, perceived health control, and side effects were identified as key barriers to adherence. Addressing these factors through patient education, simplifying treatment regimens, and providing mental health and social support could improve adherence rates and patient outcomes. To enhance adherence, healthcare providers should prioritize individualized care, incorporate technology into treatment plans, and collaborate with patients to overcome personal and systemic barriers. Improving medication adherence is essential not only for better disease management but also for reducing the long-term complications and associated healthcare costs of diabetes mellitus.

Future Research Directions

1. Longitudinal Studies: To assess the long-term sustainability of adherence interventions and their impact on patient health outcomes.
2. Multicenter Studies: Collaborating with other healthcare institutions to enhance the generalizability of findings and better understand adherence across different populations.
3. Technology-Driven Interventions: Evaluating the effectiveness of mobile apps, smart pillboxes, and telemedicine in improving adherence rates.
4. Psychosocial Support: Investigating the role of psychological counseling, social support groups, and mental health screenings in enhancing medication adherence in diabetes patients.

By addressing the barriers to adherence and integrating personalized care approaches, the management of diabetes mellitus can be significantly improved, leading to better health outcomes for patients and reduced healthcare costs.

REFERENCES

1. Lumen Learning. The Endocrine Pancreas | Anatomy and Physiology II [Internet].  courses.lumenlearning.com. 2023. Available from: https://courses.lumenlearning.com/suny-ap2/chapter/the-endocrine-pancreas/
2. Basma D. Gestational Diabetes: A Silent Danger during pregnancy and 6 ideas to manage it. [Internet]. Only Pharmacist. 2023 [cited 2024 Apr 5]. Available from: https://onlypharmacist.com/gestational-diabetes-and-6-ideas-to-manage-it/
3. Cleveland Clinic. Diabetes [Internet]. Cleveland Clinic. Cleveland Clinic; 2023. Available from: https://my.clevelandclinic.org/health/diseases/7104-diabetes
4. NIH. Diabetes Diet, Eating, and Physical Activity | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. 2019. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating
5. Diabetic Meal Plans for American Cuisine Based on Calories [Internet]. Diabetic Gourmet Magazine. 2017 [cited 2024 Apr 5]. Available from: https://diabeticgourmet.com/articles/diabetic-meal-plans-american-cooking 
6. Cleveland Clinic. Diabetes [Internet]. Cleveland Clinic. Cleveland Clinic; 2023. Available from: https://my.clevelandclinic.org/health/diseases/7104-diabetes
7. Coursehero.com. 2024 [cited 2024 Apr 5]. Available from: https://www.coursehero.com/file/192750866/Diabetic-drugspng/
8. Dinkova R, Marinov L, Doneva M, Kamusheva M. Medication Adherence among Patients with Diabetes Mellitus and Its Related Factors—A Real-World Pilot Study in Bulgaria. Medicina [Internet]. 2023 Jul 1;59(7):1205. Available from: https://www.mdpi.com/1648-9144/59/7/1205
9. T M. Self Care and Medication Adherence among Type 2 Diabetics in Puducherry, Southern India: A Hospital Based Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2014; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064856/
10.  Jannoo Z, Mamode Khan N. Medication Adherence and Diabetes Self-Care Activities among Patients with Type 2 Diabetes Mellitus. Value in Health Regional Issues [Internet]. 2019 May; 18:30–5. Available from: https://www.sciencedirect.com/science/article/pii/S2212109918301122 
11.  Paraidathathu T, Azuana, Islahudin F, Ahmad. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Preference and Adherence. 2013 Jun;525. Available from: https://pubmed.ncbi.nlm.nih.gov/23814461/ 
12. Capoccia K, Odegard PS, Letassy N. Medication Adherence With Diabetes Medication. The Diabetes Educator. 2015 Dec 4;42(1):34–71. Available from: https://journals.sagepub.com/doi/10.1177/0145721715619038 
13. Olickal JJ, Chinnakali P, Suryanarayana BS, Saya GK, Ganapathy K, Subrahmanyam DKS. Medication adherence and glycemic control status among people with diabetes seeking care from a tertiary care teaching hospital, south India. Clinical Epidemiology and Global Health. 2021 Jul;11:100742. Available from:https://www.sciencedirect.com/science/article/pii/S2213398421000464 
14. Prathyusha Rani T, Prashanthi B, Ayesha Amreen Fathima, Ayesha Firdose, Sara Naser, Najma Begum. Medication adherence in patients with type 2 diabetes mellitus- a cross-sectional study. Asian Journal of pharmaceutical and clinical; research. Available from:  https://www.researchgate.net/publication/346208124
15. Udupa H, Viswanath A, Shenoy PU, Antao KJ, Das R, Udupa DH, et al. Medication Adherence in Elderly Diabetic Patients: A Cross-Sectional Study From Dakshina Kannada, India. Cureus [Internet]. 2023 Aug 7 [cited 2023 Sep 10];15(8). Available from:https://www.cureus.com/articles/160737 
16. Sahoo J, Mohanty S, Kundu A, Epari V. Medication Adherence Among Patients of Type II Diabetes Mellitus and Its Associated Risk Factors: A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India. Cureus. 2022 Dec 29;14(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883658/ 
17. Kishor Khotkar, Sameer Chaudhari, Pradeep Jadhav, Yeshwant Deshmukh. Assessment of medication adherence in type 2 diabetic patients: A cross-sectional study. Available from: https://www.researchgate.net/publication/319935518 
18. Mishra R, Sharma SK, Verma R, Kangra P, Dahiya P, Kumari P, et al. Medication adherence and quality of life among type-2 diabetes mellitus patients in India. World Journal of Diabetes. 2021 Oct 15;12(10):1740–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554374/ 
19.  Mishra A, Pradhan S, Bimal Kumar Sahoo, Das A, Arvind Kumar Singh, Swayam Pragyan Parida. Assessment of Medication Adherence and Associated Factors Among Patients With Diabetes Attending a Non-communicable Disease Clinic in a Community Health Centre in Eastern India. Cureus [Internet]. 2023 Aug 20; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507421/ 
20. Shenglan Ding, Shuyuan Xiong Zhipig Liu.Medication adherence and associated factor in patients with type 2 diabetes: structural equation model. Available from: https://www.researchgate.net/publication/355906805
21. Mishra R, Sharma SK, Verma R, Kangra P, Dahiya P, Kumari P, et al. Medication adherence and quality of life among type-2 diabetes mellitus patients in India. World Journal of Diabetes. 2021 Oct 15;12(10):1740–9. Available from: https://pubmed.ncbi.nlm.nih.gov/34754375/ 
22. Omer Reveng Abdullah Abdulkareem, Lawan AL-mufti, Nojdar Kamal, Siber Qasim, Rahama Sagvan, Zaynab Hinir. Mediation adherence among Diabetic Patients in Developing Countries : Review of studies. Available from; https://www.researchgate.net/publication/344304843
23. Ravi Kuma Medi, Uday Venkat Mateli, Krishna Reddy Kanduri, Shiv Sagar Konda. Medication adherence and determinants of non-adherence among south Indian diabetes patients. Available from: https://www.researchgate.net/publication/266141610
24.  H C N, Gali A, Muraraiah S. Assessment of Factors Influencing Adherence to Antidiabetic Drugs among Patients with Type 2 Diabetes Mellitus at a Tertiary Care Hospital in India. Pharmacology and Clinical Pharmacy Research. 2020 Apr 1;5(1):7. Available from: https://jurnal.unpad.ac.id/pcpr/article/view/26507#:~:text=The%20mean%20age%20was%2054,adherence%20to%20anti%2Ddiabetic%20medication
25. Mende Sorato M, Tesfahun C, Lamessa D. Levels and predicators of adherence to self-care behaviour among adult Type 2 Diabetics at Arba Minch General hospital, southern Ethiopia. Available from: https://www.researchgate.net/publication/305078282
26. Adeladlew Kassie Netere, Asmamaw Emagn Kasahun, Eyayaw Ashete Belachew Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. ProQuest [Internet]. 2022 Sep 1;e0274971. Available from: https://www.proquest.com/docview/2716502229/DAB57AC443B74B7APQ/2
27. Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The Patient-Provider Relationship: Attachment Theory and Adherence to Treatment in Diabetes. American Journal of Psychiatry. 2001 Jan;158(1):29–35. Available from : https://pubmed.ncbi.nlm.nih.gov/11136630/
28. Thinley Dorji, Pempa Lhamo, Tshering Tsheting, Lungten Zangamo, Kencho Choden, Deki Chodene Kesang Namgyal. Glycemic control, medication adherence, and injection practices among diabetic patients treated in the 3 tertiary referral hospitals in Bhutan. Available from: https://www.researchgate.net/publication/330247694 
29.  Waari G, Mutai J, Gikunju J. Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. Pan African Medical Journal. 2018;29. Available from: https://pubmed.ncbi.nlm.nih.gov/29875963/
30. Mahacita Andanalusia, Umi Athiyah, Yunita Nita. Medication adherence in diabetes mellitus patients at Tanjung Karang Primary Health Care Center, Mataram. Available from: https://www.researchgate.net/publication/338022556
31. Clifford S, Perez-Nieves M, Skalicky AM, Reaney M, Coyne KS. A systematic literature review of methodologies used to assess medication adherence in patients with diabetes. Current Medical Research and Opinion. 2014 Feb 11;30(6):1071–85. Available from: https://www.tandfonline.com/doi/full/10.1185/03007995.2014.88449
32. Teng CL, Chan CW, Wong PS. Medication Adherence of Persons with Type 2 Diabetes in Malaysia : A Scoping Review and Meta-Analysis. Journal of the ASEAN Federation of Endocrine Societies [Internet]. 2022 Apr 26;37(1):75–82. Available from: https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/1247 
33.  Lee WY, Ahn J, Kim JH, Hong YP, Hong SK, Kim YT, et al. Reliability and validity of a self-reported measure of medication adherence in patients with type 2 diabetes. Journal of International Medical Research. 2013 Jul 16;41(4):1098–110. Available from:  https://pubmed.ncbi.nlm.nih.gov/23860015 
34.  Aloudah NM, Scott NW, Aljadhey HS, Araujo-Soares V, Alrubeaan KA, Watson MC. Medication adherence among patients with Type 2 diabetes: A mixed methods study. PLoS ONE [Internet]. 2018 Dec 11 [cited 2020 Mar 5];13(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289442/
35. Shakya P, Shrestha A, Biraj Man Karmacharya, Morisky DE, Bård Eirik Kulseng. Factors Associated with Medication Adherence among Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cross-Sectional Study in Nepal. International Journal of Environmental Research and Public Health [Internet]. 2023 Jan 14 [cited 2023 Apr 27];20(2):1537–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9866714/  
36. Research C for DE and. FDA Drug Safety Podcast: Updated FDA review concludes that use of pioglitazone may be linked to an increased risk of bladder cancer. FDA [Internet]. 2022 Jan 20; Available from: https://www.fda.gov/drugs/fda-drug-safety-podcasts/.