Non-adherence to Diabetic Drug Therapy and Associated Factors among Type 2 Diabetic Patients at the Diabetic Clinic of Jimma University Specialized Hospital, Southwest Ethiopia

Abstract

Treatment non-adherence for chronic illnesses such as diabetes is a common problem. Multiple factors related to the patient, disease, therapeutic regimen, and health-care system may contribute for medication non-adherence. Non-adherence leads to poor glycemic control and increases the risk of diabetes related complications. The prevalence and factors associated with non-adherence in this resource limited settings has not been determined before. Objective: The study was conducted to assess the pattern of non-adherence to diabetic drug therapy and associated factors among type 2 diabetic patients. Methods: A cross sectional study was conducted from February 15 – March 16, 2011, at the diabetic clinic of Jimma University Specialized Hospital. All patients attending the diabetic clinic during the study period who fulfilled the inclusion criteria were enrolled as study subjects. Data on patient socio-demography, non-adherence to medication, and factors related to nonadherence was collected using a pre-tested structured questionnaire through interview and from patient medical records. Data were entered into SPSS for windows version 16. Chi-square test and binary logistic regression was used to analyze the association between non-adherence and tested factors. P-value of less than 0.05 was considered as statistically significant. Results: A total of 267 type 2 diabetic patients were enrolled in the study. About 179 (67%) of the participants were in the age group 31-59 while 77 (28.8%) were in the age ≥60. The mean age was 52.4  11.9 years. Non-adherence was observed in 65 patients accounting for 24.3%. The most common reasons for non-adherence were forgetting to take medication 42(64.6%) followed by feeling healthy 19(29.2%). Factors independently associated with non-adherence were presence of depressive symptoms (AOR= 2.404, 95% CI = 1.323-4.366, P =0.004); side effects (AOR =1.868, 95% CI =1.012-3.446, P =0.046); and complex regimen (AOR = 3.413, 95% CI =1.652-7.050, P =0.001. Non-adherence was also found to be associated with diabetes related hospitalization (COR =2.966, 95% CI =1.540-5.712, P =0.001); diabetes complications (COR =2.609, 95% CI = 1.250-5.445, P =0.011) and uncontrolled fasting blood glucose (COR =2.115, 95% CI =1.111-4.027, P =0.023). Conclusion: The prevalence of non-adherence in the current study was 24%. Factors related to the disease (depression), therapeutic regimen (side effect and complexity of regimen) and poor diabetic outcomes were significantly associated with non-adherence. Recommendation: Health care providers should strengthen diabetes education and design strategies to improve adherence to those patients at higher odds of medication non-adherence, as this could substantially improve clinical outcomes.