CC BY-NC-ND 4.0 · Journal of Social Health and Diabetes 2021; 9(01): e8-e14
DOI: 10.1055/s-0041-1732783
Original Article

Poor Adherence to Common Recommendations and Associated Factors among Outpatients with Type 2 Diabetes Mellitus in a Police Hospital of Ethiopia

Tariku Shimels
1   Research Directorate, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
,
Melesse Abebaw
2   Pharmacy Department, Ethiopian Federal Police Referral Hospital, Addis Ababa, Ethiopia
,
Gebremedhin Beedemariam Gebretekle
3   Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Canada.
› Author Affiliations

Abstract

Introduction Poor adherence to medication and healthy lifestyle managements, such as diet and regular exercise, remains to be a challenge for patients with type 2 diabetes mellitus. The objective of this study was to assess the pattern of adherence to common recommendations, reasons, and factors associated with poor overall adherence among outpatients with type 2 diabetes mellitus in a police hospital of Ethiopia.

Method A facility-based cross-sectional study was done between 15 October 2016 and 15 January 2017. Systematic random sampling method was applied to recruit participants. A semistructured interview guide with an observation checklist was used to collect data. SPSS v.20.0 was used in the analysis.

Results Out of 361 participants, over half (56.5%) participants were male and 235 (65.1%) participants were military. Nearly half (49%) of the participants were on oral combination therapy. Only 194 (53.7%) of the patients showed good adherence for diet. Half (50.1%) of the respondents had poor adherence to all recommendations. Reasons for poor adherence included lack of adequate knowledge (68.9%) for diet, carelessness (37.8%) for exercise, and lack of adequate knowledge (34.8%) followed by carelessness (28.3%) and forgetfulness (19.6%) for medication. Intake of herbal medicines doubled the likelihood of good adherence.

Conclusion Adherence of patients to diet was found to be suboptimal. Lack of adequate knowledge, carelessness, and forgetfulness were among the reasons mentioned. Only use of herbal medicine showed statistical significance with adherence. Patient education on dietary practice is required in the study setting.



Publication History

Article published online:
31 December 2021

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  • References

  • 1 American Diabetes Association. Standards of Medical Care in Diabetes-2014. Diabetes Care 2014; 17 (S1) s14-s79
  • 2 International Diabetes Federation [webpage on the Internet]. IDF Diabetes Atlas, Sixth Edition; 2014. Available from: www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf. Accessed June 27, 2021
  • 3 Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and its Burden in the United States; 2014. Available from: https://www.cdc.gov/diabetes/.../statsreport14/national-diabetes-report-web.pdf. Accessed June 27, 2021
  • 4 Cheng YJ, Imperatore G, Geiss LS. et al. Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010. Diabetes Care 2013; 36 (09) 2690-2696
  • 5 Selvin E, Parrinello CM, Sacks DB, Coresh J. Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Ann Intern Med 2014; 160 (08) 517-525
  • 6 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 (05) 417-421
  • 7 Tesfaye T, Shikur B, Shimels T, Firdu N. Prevalence and factors associated with diabetes mellitus and impaired fasting glucose level among members of federal police commission residing in Addis Ababa, Ethiopia. BMC Endocr Disord 2016; 16 (01) 68
  • 8 Lester FT, Tsega E. The pattern of adult medical admissions in Addis Ababa, Ethiopia. East Afr Med J 1976; 53 (11) 620-634
  • 9 International Diabetes Federation. IDF Diabetes Atlas. 6th edition. Brussels, Belgium: International Diabetes Fede-ration, 2014.http://www.idf.org/diabetesatlas/update-2014. Accessed June 27, 2021
  • 10 Ethiopian Diabetes Association. Adama, Ethiopia. 2009. http://www.diabetesethiopia.org.et/. Accessed June 27, 2021
  • 11 Kang AY, Park SK, Park SY. et al. Therapeutic target achievement in type 2 diabetic patients after hyperglycemia, hypertension, dyslipidemia management. Diabetes Metab J 2011; 35 (03) 264-272
  • 12 American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care 2016; 39 (Suppl. 01) S1-S106
  • 13 Nasseh K, Frazee SG, Visaria J, Vlahiotis A, Tian Y. Cost of medication nonadherence associated with diabetes, hypertension, and dyslipidemia. Am J Pharm Benefits 2012; 4 (02) e41-e47
  • 14 Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Aff (Millwood 2011; 30 (01) 91-99
  • 15 Jha AK, Aubert RE, Yao J, Teagarden JR, Epstein RS. Greater adherence to diabetes drugs is linked to less hospital use and could save nearly $5 billion annually. Health Aff (Millwood 2012; 31 (08) 1836-1846
  • 16 Teklay G, Hussein T, Tesfaye D. Non adherence and associated factors among type 2 diabetes patients at Jimma University Specialized Hospital, Southwest Ethiopia. J med Sci 2013; 13 (07) 578-584
  • 17 Abebaw M, Messle A, Hailu M, Zewdu F. Adherence and associated factors towards anti diabetic medication among type 2 diabetic patients on follow up at University of Gondar Hospital, Northwest Ethiopia. Adv Nurs 2016; ••• DOI: 10.1155/2016/8579157.
  • 18 Kassahun A, Gashe F, Mulisa E, Rike WA. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia. J Pharm Bioallied Sci 2016; 8 (02) 124-129
  • 19 Abebe SM, Berhane Y, Worku A. Barriers to diabetes medication adherence in North West Ethiopia. Springerplus 2014; 3: 195 DOI: 10.1186/2193-1801-3-195.
  • 20 Ali M, Alemu T, Sada O. Medication adherence and its associated factors among diabetic patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. BMC Res Notes 2017; 10: 676
  • 21 Cramer J, Rosenheck R, Kirk G, Krol W, Krystal J. VA Naltrexone Study Group 425. Medication compliance feedback and monitoring in a clinical trial: predictors and outcomes. Value Health 2003; 6 (05) 566-573
  • 22 Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23 (08) 1296-1310
  • 23 Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353 (05) 487-497
  • 24 Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24 (01) 67-74
  • 25 Ruddy K, Mayer E, Partridge A. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 2009; 59 (01) 56-66
  • 26 Jasti S, Siega-Riz AM, Cogswell ME, Hartzema AG. Correction for errors in measuring adherence to prenatal multivitamin/mineral supplement use among low-income women. J Nutr 2006; 136 (02) 479-483
  • 27 Berenson, ML, Levine DM, and Szabat K. Estimation and Sample Size Determination for Finite Populations. Basic Business Statistics: Global Edition. 2013. Available on: https://www.alnap.org/help-library/estimation-and-sample-size-determination-for-finite-populations-basic-business. Accessed June 27, 2021
  • 28 Ganiyu AB, Mabuza LH, Malete NH, Govender I, Ogunbanjo GA. Non-adherence to diet and exercise recommendations amongst patients with type 2 diabetes mellitus attending Extension II Clinic in Botswana. Afr J Prim Health Care Fam Med 2013; 5 (01) 457 DOI: 10.4102/ phcfm.v5i1.457.
  • 29 Rwegerera GM, Moshomo T, Gaenamong M. et al. Antidiabetic medication adherence and associated factors among patients in Botswana; implications for the future. Alex J Med 2018; 54: 103-109
  • 30 Rwegerera GM. Adherence to anti-diabetic drugs among patients with Type 2 diabetes mellitus at Muhimbili National Hospital, Dar es Salaam, Tanzania- A cross-sectional study. Pan Afr Med J 2014; 17: 252 DOI: 10.11604/pamj.2014.17.252.2972.
  • 31 Polonsky WH, Henry RR, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016; 10: 1299-1307
  • 32 Worku A, Mekonnen Abebe S, Wassie MM. Dietary practice and associated factors among type 2 diabetic patients: a cross sectional hospital based study, Addis Ababa, Ethiopia. Springerplus 2015; 4: 15 DOI: 10.1186/s40064-015-0785-1.
  • 33 Zullig LL, Gellad WF, Moaddeb J. et al. Improving diabetes medication adherence: successful, scalable interventions. Patient Prefer Adherence 2015; 9: 139-149
  • 34 Roy NT, Sajith M, Bansode MP. Assessment of factors associated with low adherence to pharmacotherapy in elderly patients. J Young Pharm 2017; 9 (02) 272-276
  • 35 Aikens JE, Piette JD. Longitudinal association between medication adherence and glycaemic control in type 2 diabetes. Diabet Med 2013; 30 (03) 338-344
  • 36 Bagonza J, Rutebemberwa E, Bazeyo W. Adherence to anti diabetic medication among patients with diabetes in eastern Uganda; a cross sectional study. BMC Health Serv Res 2015; 15: 168 DOI: 10.1186/s12913-015-0820-5.