Adherence to anti diabetic medication among patients with diabetes in eastern Uganda; a cross sectional study

James Bagonza, Elizeus Rutebemberwa, William Bazeyo, James Bagonza, Elizeus Rutebemberwa, William Bazeyo

Abstract

Background: Lack of adherence to anti diabetic medication causes suboptimal blood sugar control among patients with diabetes and can lead to treatment failures, accelerated development of complications and increased mortality. This study assessed factors associated with adherence to anti diabetic medication in rural eastern Uganda.

Methods: A cross sectional study was conducted among 521 patients with diabetes in Iganga and Bugiri hospitals between October 2012 and January 2013. Respondents were patients who were18 years and above and had been on diabetic treatment for not less than a month. Pretested questionnaires were used. Variables that were collected included socio-demographic characteristics, possible barriers to adherence, and self management efforts. Adherence was assessed using self reports. Descriptive and inferential statistics were done to determine adherence to anti diabetic medication and the associated factors.

Results: The level of adherence to anti diabetic medication was 83.3% and factors that were independently associated with adherence were; having been on anti diabetic drugs for at least three years (OR = 1.89, 95% CI = 1.11 - 3.22), availability of diabetic drugs (OR = 2.59, 95% CI = 1.54 - 3.70), and having ever had diabetic health education (OR = 4.24, 95% CI =1.15 - 15.60).

Conclusion: About four in five patients adhere to anti-diabetic treatment. Strategies aimed at improving anti diabetic drug availability and providing health education could improve adherence.

References

    1. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14(Suppl 5):S1–85.
    1. Hjelm K, Mufunda E, Nambozi G, Kemp J. Preparing nurses to face the pandemic of diabetes mellitus: a literature review. J Adv Nurs. 2003;41(5):424–34. doi: 10.1046/j.1365-2648.2003.02548.x.
    1. World Health Organization . The World Health Report 1997: Conquering Suffering, Enriching Humanity. Geneva: World Health Organization; 1997.
    1. Perry M. Early detection of type 2 diabetes: the role of the community nurse. Br J Community Nurs. 2001;6(4):176–9. doi: 10.12968/bjcn.2001.6.4.7090.
    1. Government of Uganda . National Health Policy. Kampala: Ministry of Health; 1999.
    1. Government of Uganda . Health Sector Strategic Plan II 2005/06 - 2009/2010. Kampala: Ministry of Health; 2005.
    1. Lasky D, Becerra E, Boto W, Otim M, Ntambi J. Obesity and gender differences in the risk of type 2 diabetes mellitus in Uganda. Nutrition. 2002;18(5):417–21. doi: 10.1016/S0899-9007(01)00726-2.
    1. WHO . Adherence to long term therapies, time for action. Geneva: World Health Organization. 221; 2003.
    1. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–24. doi: 10.2337/diacare.27.5.1218.
    1. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43(6):521–30. doi: 10.1097/.
    1. Lee WC, Balu S, Cobden D, Joshi AV, Pashos CL. Prevalence and economic consequences of medication adherence in diabetes: a systematic literature review. Manag Care Interface. 2006;19(7):31–41.
    1. Hutchins V, Zhang B, Fleurence RL, Krishnarajah G, Graham J. A systematic review of adherence, treatment satisfaction and costs, in fixed-dose combination regimens in type 2 diabetes. Curr Med Res Opin. 2011;27(6):1157–68. doi: 10.1185/03007995.2011.570745.
    1. Pollack MF, Purayidathil FW, Bolge SC, Williams SA. Patient-reported tolerability issues with oral antidiabetic agents: Associations with adherence; treatment satisfaction and health-related quality of life. Diabetes Res Clin Pract. 2010;87(2):204–10. doi: 10.1016/j.diabres.2009.11.023.
    1. Lee WC, Balu S, Cobden D, Joshi AV, Pashos CL. Medication adherence and the associated health-economic impact among patients with type 2 diabetes mellitus converting to insulin pen therapy: An analysis of third-party managed care claims data. Clin Ther. 2006;28(10):1712–25. doi: 10.1016/j.clinthera.2006.10.004.
    1. van Bruggen R, Gorter K, Stolk RP, Zuithoff P, Klungel OH, Rutten GE. Refill adherence and polypharmacy among patients with type 2 diabetes in general practice. Pharmacoepidemiol Drug Saf. 2009;18(11):983–91. doi: 10.1002/pds.1810.
    1. Jin J, Sklar GE, Min Sen OV, Chuen Li S. Factors affecting therapeutic compliance: A review from the patients perspective. Ther Clin Risk Manag. 2008;4(1):269–86.
    1. Wong MCS, Kong APS, So W-Y, Jiang JY, Chan JCN, Griffiths SM. Adherence to Oral Hypoglycemic Agents in 26 782 Chinese Patients: A Cohort Study. J Clin Pharmacol. 2011;51(10):1474–82. doi: 10.1177/0091270010382911.
    1. Park KA, Kim JG, Kim BW, Kam S, Kim KY, Ha SW, et al. Factors that Affect Medication Adherence in Elderly Patients with Diabetes Mellitus. Korean Diabetes J. 2010;34(1):55–65. doi: 10.4093/kdj.2010.34.1.55.
    1. 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. Curr Med Res Opin. 2014;30(6):1071–85. doi: 10.1185/03007995.2014.884491.
    1. DiMatteo MR. Variations in patients adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200–9. doi: 10.1097/01.mlr.0000114908.90348.f9.
    1. Walker EA, Molitch M, Kramer MK, Kahn S, Ma Y, Edelstein S, et al. Adherence to preventive medications: predictors and outcomes in the Diabetes Prevention Program. Diabetes Care. 2006;29(9):1997–2002. doi: 10.2337/dc06-0454.
    1. Chao J, Nau DP, Aikens JE. Patient-reported perceptions of side effects of antihyperglycemic medication and adherence to medication regimens in persons with diabetes mellitus. Clin Ther. 2007;29(1):177–80. doi: 10.1016/j.clinthera.2007.01.014.
    1. Kalyango JN, Owino E, Nambuya AP. Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. Afr Health Sci. 2008;8(2):67–73.
    1. Travis T. Patient perceptions of factors that affect adherence to dietary regimens for diabetes mellitus. Diabetes Educ. 1997;23(2):152–6. doi: 10.1177/014572179702300205.
    1. Reeve PA, Falkner MJ. Disease patterns in a rural black population. S Afr Med J. 1986;69(9):551–2.
    1. Rutebemberwa E, Lubega M, Katureebe SK, Oundo A, Kiweewa F, Mukanga D. Use of traditional medicine for the treatment of diabetes in Eastern Uganda: a qualitative exploration of reasons for choice. BMC Int Health Hum Rights. 2013;13:1. doi: 10.1186/1472-698X-13-1.
    1. Khan AR, Al-Abdul Lateef ZN, Al Aithan MA, Bu-Khamseen MA, Al Ibrahim I, Khan SA. Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia. J Family Community Med. 2012;19(1):26–32. doi: 10.4103/2230-8229.94008.
    1. Sankar UV, Lipska K, Mini GK, Sarma PS, Thankappan KR. The Adherence to Medications in Diabetic Patients in Rural Kerala. India: Asia-Pacific Journal of Public Health; 2013.
    1. Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence. 2013;7:525–30.
    1. Karter AJ, Parker MM, Moffet HH, Ahmed AT, Schmittdiel JA, Selby JV. New prescription medication gaps: a comprehensive measure of adherence to new prescriptions. Health Serv Res. 2009;44(5 Pt 1):1640–61. doi: 10.1111/j.1475-6773.2009.00989.x.
    1. Yusuff K, Obe O, Joseph B. Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria. Pharm World Sci. 2008;30(6):876–83. doi: 10.1007/s11096-008-9243-2.
    1. Wabe NT, Angamo MT, Hussein S. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. N Am J Med Sci. 2011;3(9):418–23. doi: 10.4297/najms.2011.3418.
    1. Bezie Y, Molina M, Hernandez N, Batista R, Niang S, Huet D. Therapeutic compliance: a prospective analysis of various factors involved in the adherence rate in type 2 diabetes. Diabetes Metab. 2006;32(6):611–6. doi: 10.1016/S1262-3636(07)70316-6.
    1. Gill G. Diabetes in Africa - Puzzles and challenges. Indian J Endocrinol Metab. 2014;18(3):249–51. doi: 10.4103/2230-8210.131111.
    1. Beran D, Yudkin JS. Diabetes care in sub-Saharan Africa. Lancet. 2006;368(9548):1689–95. doi: 10.1016/S0140-6736(06)69704-3.
    1. Hogerzeil HV, Liberman J, Wirtz VJ, Kishore SP, Selvaraj S, Kiddell-Monroe R, et al. Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. Lancet. 2013;381(9867):680–9. doi: 10.1016/S0140-6736(12)62128-X.
    1. Goudge J, Gilson L, Russell S, Gumede T, Mills A. Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa. BMC Health Serv Res. 2009;9:75. doi: 10.1186/1472-6963-9-75.
    1. Aikins A-G. Healer shopping in Africa: new evidence from rural–urban qualitative study of Ghanaian diabetes experiences. BMJ. 2005;331(7519):737. doi: 10.1136/bmj.331.7519.737.
    1. Matheka DM, Demaio AR. Complementary and alternative medicine use among diabetic patients in Africa: a Kenyan perspective. Pan Afr Med J. 2013;15:110. doi: 10.11604/pamj.2013.15.110.2925.
    1. Bailey GR, Barner JC, Weems JK, Leckbee G, Solis R, Montemayor D, et al. Assessing Barriers to Medication Adherence in Underserved Patients With Diabetes in Texas. Diabetes Educ. 2012;38(2):271–9. doi: 10.1177/0145721711436134.
    1. Lorenzi GM, LaRue SM, Collins SE. Effects of a Patient Education Support Program on Pramlintide Adherence. Clinical Diabetes. 2011;29(1):17–24. doi: 10.2337/diaclin.29.1.17.
    1. Rothschild SK, Martin MA, Swider SM, Tumialán Lynas CM, Janssen I, Avery EF, et al. Mexican American Trial of Community Health Workers: A Randomized Controlled Trial of a Community Health Worker Intervention for Mexican Americans With Type 2 Diabetes Mellitus. Am J Public Health. 2014;104(8):1540–8. doi: 10.2105/AJPH.2013.301439.
    1. Rodondi N, Peng T, Karter AJ, Bauer DC, Vittinghoff E, Tang S, et al. Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Ann Intern Med. 2006;144(7):475–84. doi: 10.7326/0003-4819-144-7-200604040-00006.
    1. AmericanDiabetesAssociation Standards of Medical Care in Diabetes—2009. Diabetes Care. 2009;32(Supplement 1):S13–61. doi: 10.2337/dc09-S013.
    1. Mensing C, Boucher J, Cypress M, Weinger K, Mulcahy K, Barta P, et al. National Standards for Diabetes Self-Management Education. Diabetes Care. 2002;25(suppl 1):s140–7. doi: 10.2337/diacare.25.2007.S140.
    1. Schoenthaler AM, Schwartz BS, Wood C, Stewart WF. Patient and Physician Factors Associated With Adherence to Diabetes Medications. Diabetes Educ. 2012;38(3):397–408. doi: 10.1177/0145721712440333.
    1. Nicolucci A, Rossi MC. Incretin-based therapies: a new potential treatment approach to overcome clinical inertia in type 2 diabetes. Acta Biomed. 2008;79(3):184–91.
    1. Hays RD, Kravitz RL, Mazel RM, Sherbourne CD, DiMatteo MR, Rogers WH, et al. The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study. J Behav Med. 1994;17(4):347–60. doi: 10.1007/BF01858007.
    1. Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB. The Concordance of Self-Report With Other Measures of Medication Adherence: A Summary of the Literature. Med Care. 2004;42(7):649–52. doi: 10.1097/01.mlr.0000129496.05898.02.
    1. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. J Clin Hypertens. 2008;10(5):348–54. doi: 10.1111/j.1751-7176.2008.07572.x.
    1. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100(2):258–68. doi: 10.7326/0003-4819-100-2-258.
    1. Kravitz RL, Hays RD, Sherbourne CD, DiMatteo MR, Rogers WH, Ordway L, et al. REcall of recommendations and adherence to advice among patients with chronic medical conditions. Arch Intern Med. 1993;153(16):1869–78. doi: 10.1001/archinte.1993.00410160029002.

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