Original Data

Evaluation of Adherence to Oral Hypoglycemic Agent Prescription in Patients with Type 2 Diabetes

Mahtab Irani¹, Mohammad Sarafraz Yazdi², Meisam Irani³, Sina Naghibi Sistani⁴, Sahar Ghareh⁵

Manuscript submitted September 13, 2020; resubmitted September 23, 2020; accepted September 30, 2020.

Keywords: medication adherence, hypoglycemic drugs, type 2 diabetes

Abstract

BACKGROUND: Diabetes is a global health problem that has affected more than 400 million people worldwide. Adherence to treatment is considered to be one of the most important and deterministic factors in the treatment of diabetes. This study investigates medication adherence and factors affecting it in patients with type 2 diabetes. METHODS: This cross-sectional study investigated 136 patients with type 2 diabetes in 2018-2019. Data collection was done using a checklist that included information on personal characteristics, medication, and healthcare. The collected data were analyzed by statistical tests in SPSS 25 software. RESULTS: 79.4% of the patients adhered to prescribed medication. Medication adherence had no significant relationship with taking other drugs, fasting blood sugar (FBS), and the daily number of hypoglycemic tablets (p ˃ 0.05). However, adherence to medication was significantly associated with age, gender, income, hemoglobin A1c, medication period, and hypoglycemia (p ˂ 0.05). CONCLUSIONS: Higher levels of adherence were observed among females aged below 60 years, with higher income, a hemoglobin A1c level below 7%, a medication period of less than 10 years, and among patients without hypoglycemia. Regarding drug type, adherence levels were lower in people taking glibenclamide.

1. Introduction

Diabetes is one of the most critical epidemic diseases all over the world [1]. Type 2 diabetes (T2D) is highly prevalent, and is considered a metabolic chronic disease with consequences affecting public health and healthcare cost [2]. In 2017, more than 400 million people were diagnosed with T2D worldwide [3]. Diabetes can be controlled by a healthy lifestyle and on-time medication. Uncontrolled diabetes may cause microvascular and macrovascular complications [4]. Vascular complications may be prevented by controlling blood glucose levels in patients with T2D [5, 6]. Increased prevalence rates of diabetes impose individual, familial, and health-related challenges on people and the global systems, and are accompanied by increased mortality and morbidity [7]. Beside using hypoglycemic drugs, changes in lifestyle and diet may help to improve glycemic control and to achieve target blood glucose levels in patients before starting insulin therapy [8]. Effective treatment of T2D comprises an integrated treatment of lifestyle modification and medication intervention. Important factors in achieving optimal glycemic control are treatment by hypoglycemic drugs and medication adherence [9, 10].

Medication adherence is decisive in controlling T2D [11]. Various factors determine medication adherence of diabetic patients in their daily life, including degree of disease complications, kind of treatment, age, gender, existence of stress and depression, and number of drugs included in the therapy [12]. Poor adherence is accompanied by the risk of hospitalization and the development of diabetes complications such as kidney diseases [13]. If used properly, orally ingested hypoglycemic drugs are highly effective in controlling T2D [14]. In general, high rates of adherence to hypoglycemic drugs lead to lower numbers of drugs being used [15].

T2D is usually diagnosed with a high level of hemoglobin A1c, and drug therapy is applied based on hypoglycemic effects, patients' priorities, and drug side effects [16]. Oral treatment with metformin, sulphonylurea, thiazolidinediones (TZD), and dipeptidyl peptidase-4 inhibitor (DPP4) does not result in definite cure, but rather improved glycemic control, prevention of disease complications, and mitigation of symptoms [17].

T2D causes a wide range of microvascular and macrovascular complications, including cardiovascular, kidney, and eye diseases, blindness, neuropathy, amputation, and also nonvascular complications; all these complications impose a lot of pain and discomfort on patients [18]. Adherence to hypoglycemic drugs has been proven to be an effective and cost-efficient means to reduce diabetes complications and hospitalization times and thus to reduce the cost of short- and long-term complications [19]. Since various studies have investigated patients’ adherence to oral hypoglycemic drugs, we aimed to investigate the factors involved in adherence to or noncompliance with medication prescriptions and the ratio of the number of days for which the patient takes the drug to the number of days in 6 months.

2. Methods

2.1 Study design

References

1. Chu WM, Ho HE, Huang KH, Tsan YT, Liou YS, Wang YH, Lee MC, Li YC. The prescribing trend of oral antidiabetic agents for type 2 diabetes in Taiwan: An 8-year population-based study. Medicine (Baltimore) 2017 96(43):e8257. [DOD] 
2. Kennedy-Martin T, Boye KS, Peng X. Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review. Patient Prefer Adherence 2017. 11:1103. [DOD] [CrossRef]
3. Jeannette AC, Esther J, Anoop, MT, et al. IDF Diabetes Atlas, 8th ed., International Diabetes Federation, Brussels, 2017. [DOD] 
4. World Health Organization. Diabetes fact sheet. Available from: http://www.who.int/mediacentre/factsheets/fs312/en/. Accessed May 11, 2017. [DOD] 
5. De Brito GM, Gois CF, Zanetti ML, Resende GG, Silva JR. Quality of life, knowledge and attitude after educational program for diabetes. Acta Paulista de Enfermagem 2016. 29(3):298-306. [DOD] [CrossRef]
6. de Araujo MF, de Jesus dos Santos Alves P, Veras VS, de Araujo TM, Zanetti ML, Damasceno MM. Drug interactions in Brazilian type 2 diabetes patients. Int J Nurs Pract 2013. 19(4):423-30. [DOD] [CrossRef]
7. Babazadeh T, Dianatinasab M, Daemi A, Nikbakht HA, Moradi F, Ghaffari-fam S. Association of self-care behaviors and quality of life among patients with type 2 diabetes mellitus: Chaldoran County, Iran. Diabetes Metab J 2017. 41(6):449-456. [DOD] [CrossRef]
8. Dawed AY, Zhou K, Pearson ER. Pharmacogenetics in type 2 diabetes: influence on response to oral hypoglycemic agents. Pharmgenomics Pers Med 2016. 9:17-29. [DOD] 
9. Awodele O, Osuolale JA. Medication adherence in type 2 diabetes patients: study of patients in Alimosho General Hospital, Igando, Lagos, Nigeria. Afr Health Sci 2015. 15(2):513-522. [DOD] [CrossRef]
10. Nau DP. Recommendations for improving adherence to type 2 diabetes mellitus therapy - focus on optimizing oral and non-insulin therapies. Am J Managed Care 2012. 18(3 Suppl):S49-S54. [DOD] 
11. Bailey C, Kodack M. Patient adherence to medication requirements for therapy of type 2 diabetes. Int J Clin Pract 2011. 65(3):314-322. [DOD] [CrossRef]
12. Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabetic Med 2015. 32(6):725-737. [DOD] [CrossRef]
13. Giorgino F, Penfornis A, Pechtner V, Gentilella R, Corcos A. Adherence to antihyperglycemic medications and glucagon-like peptide 1-receptor agonists in type 2 diabetes: clinical consequences and strategies for improvement. Patient Prefer Adherence 2018. 12:707. [DOD] [CrossRef]
14. Asif M. The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. J Educ Health Promot 2014. 3:1. [DOD] [CrossRef]
15. 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 2018. 13(12):e0207583. [DOD] [CrossRef]
16. Gordon J, McEwan P, Idris I, Evans M, Puelles J. Treatment choice, medication adherence and glycemic efficacy in people with type 2 diabetes: a UK clinical practice database study. BMJ Open Diabetes Res Care 2018. 6(1):e000512. [DOD] [CrossRef]
17. Association AD. 8. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes 2018. Diabetes Care 2018. 41(Suppl 1):S73. [DOD] [CrossRef]
18. Cersosimo E, Johnson EL, Chovanes C, Skolnik N. Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach. Diabetes Obes Metab 2018. 20(3):497-507. [DOD] [CrossRef]
19. Fadare J, Olamoyegun M, Gbadegesin B. Medication adherence and direct treatment cost among diabetes patients attending a tertiary healthcare facility in Ogbomosho, Nigeria. Malawi Med J 2015. 27(2):65-70. [DOD] [CrossRef]
20. Horii T, Momo K, Yasu T, Kabeya Y, Atsuda K. Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan. PloS One 2019. 14(10): e0223431. [DOD] [CrossRef]
21. Chew BH, Hassan NH, Sherina MS. Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study. Patient Pref Adherence 2015. 9:639. [DOD] [CrossRef]
22. Shams ME, Barakat EA. Measuring the rate of therapeutic adherence among outpatients with T2DM in Egypt. Saudi Pharmaceut J 2010. 18(4):225-232. [DOD] [CrossRef]
23. Fadheel J, Mohammed AJ. Adherence to therapy among Iraqi patients with type 2 DiabetesMellitus. J Health Med Nurs 2016. 32:75-82. [DOD] 
24. Boccuzzi SJ, Wogen J, Fox J, Sung JC, Shah AB, Kim J. Utilization of oral hypoglycemic agents in a drug-insured US population. Diabetes Care 2001. 24(8):1411-1415. [DOD] [CrossRef]
25. Jemal A, Abdela J, Sisay M. Adherence to oral antidiabetic medications among type 2 diabetic (T2DM) patients in chronic ambulatory wards of Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: a cross sectional study. J Diabetes Metab 2017. 8:721. [DOD] [CrossRef]
26. Ayele AA, Tegegn HG, Ayele TA, Ayalew MB. Medication regimen complexity and its impact on medication adherence and glycemic control among patients with type 2 diabetes mellitus in an Ethiopian general hospital. BMJ Open Diabetes Res Care 2019. 7(1):e000685. [DOD] [CrossRef]