Presented By: Dr Nithin Kumar Associate Professor Department of Community Medicine Kasturba Medical College Mangalore[Manipal University]
Effect of Distress on Adherence to Anti diabetic Medications among Type 2 Diabetic Patients
Attending Tertiary Care Hospitals in Mangalore
INTRODUCTION
• WHO defines adherence as “the extent to which a person's behaviour taking medication, following a diet , and /or executing lifestyle changes corresponds with agreed recommendations from a health care provider”.
• According to WHO there are 5 factors influencing patient adherence:
1. Socioeconomic factors 2. Health system and health care team related 3. Therapy related for patient 4. Condition or disease related and 5. Patient related
• Poor adherence is generally associated with bad outcomes of the disease
• Diabetes Distress, Depression, and Subclinical Depression are
all psychologic disorders which are known to affect patients with
diabetes
• Very limited studies are trying to find out association of distress with
adherence to anti-diabetic medication
OBJECTIVES
• To assess the level of adherence towards anti diabetic medication among patients with type 2 diabetes mellitus
• To assess the level of distress and its effect on adherence among diabetic patients
• To study the influence of patient related factors, medication related factors and health system related factors to adherence to anti-diabetic medications
MATERIALS AND METHODS
Study setting: - Kasturba Medical College Hospital, Attavar, and
- Peripheral outreach clinics belonging to the Department of
Community Medicine, Kasturba Medical College Mangalore.
Study design: Cross-sectional study
Study type: Analytical study
Study duration: 1st January 2015 to 31st January 2015
Study subjects: All type 2 diabetic patients on anti-diabetic therapy for
more than 6 months
• Sample size: 124
• Sample size calculation:
The sample size was calculated taking level of adherence to anti diabetic
medication as 47% based on previous study. Taking 20% relative precision
and 95% confidence interval, the sample size was calculated to be 113.
Adding 10% as non-response error, the final sample size is 124.
Data Collection Methodology:
Institutional ethics committee approval was obtained.
• Study tool: Pretested semi structured questionnaire consisting of
the following sections
Section A - Socio demographic information of
the patients
Section B - Diagnosis treatment details and
advice given
Section C - Factors related to health
Section D- Diabetes Distress Scale
Section E - Morisky 8-Item Medication
Adherence Questionnaire
DATA ANALYSIS:
• The collected data was analysed using SPSS ver 11.5.
• Descriptive statistics (Mean, Standard Deviation) and proportions.
• We undertook both unadjusted and adjusted logistic regression to assess the various ( Patient related, Medication related and Health system related) factors favoring adherence to anti-diabetic medication among patients.
• Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) are reported.
TABLE 1: Baseline characteristics of the participants Variables n(%)
Age group (yrs)<45 14(11.3)46-55 33(26.6)56-65 39(31.5)>65 38(30.6)GenderMale 68(54.8)Female 56(45.2)
Marital statusMarried 107(86.
3)Widow 012(09.
7)Unmarried 004(03.
2)Divorced 001(0.8)
N=124
Median age =
60(50-68)yrs
Variables n(%)
Lower socioeconomic status 100 (80.6)
Family History of diabetes 43 (34.7)
Presence of comorbidities 72 (58.1)
Presence of diabetic complications 51 (41.1)
Smoker 25 (20.2)
Alcohol consumption 16 (12.9)
Experience of side effects 48 (38.7)
Table 1 continued:N=124
Table 2: Univariate analysis showing the Patient related factors associated with adherence to anti-diabetic medication [N=124]
Variables Adherence UnadjustedOR (95%C.I)
P value
Good (n=70)
Poor(n=54)
Distance from hospital (km)
≤2 28(62.2) 17(37.8)0.7(0.3-1.5)
0.329
>2 42(53.2) 37(46.8)
Cost of drugs Free 36(63.2) 21(36.8)
0.6(0.3-1.2) 0.166Paid 34(50.7) 33(49.3)
Frequency of blood glucose monitoring
Regular 58(61.7) 36(38.3)0.4(0.2-0.9) 0.040
Occasional 12(40.0) 18(60.0)
Means of conveyance
Walking 22(71.0) 9(29.0)0.4(0.2-1.0) 0.063
Use Transport 48(51.6) 45(48.4)
Table 3:Univariate analysis showing the Health system related associated with adherence to anti-diabetic medication [N=124]
VariablesAdherence
UnadjustedOR (95%C.I)
P value
Good (n=70)
Poor(n=54)
Number of anti diabetic medications taken
≤2 39(52.0) 36(48.0) 0.6(0.3-1.3) 0.217
>2 31(63.3) 18(36.7)
Side effects experienced
Yes 21(43.8) 27(56.2) 0.4(0.2-0.8) 0.025
No 49(64.5) 27(35.5)
Insulin injection taken
Yes 20(57.1) 15(42.9) 0.9(0.4-2.1) 0.922
No 50(56.2) 39(43.8)
Table 4: Univariate analysis showing Medication related factors associated with adherence to anti diabetic medication [N=124]
Variables AdherenceUnadjusted
OR (95%C.I)
P value
Good (n=70)
Poor(n=54)
Duration of diabetes (yrs)
<5 25(54.3) 21(45.7) 0.6 (0.3-1.3)
0.217>5 45(57.7) 33(42.3)
Diabetic complications
Yes 27(52.9) 24(47.1) 0.8 (0.4-1.6)
0.510
No 43(58.9) 30(41.1)
Fasting Blood Glucose Level
≤126 56(80.0) 06(11.1) 0.5 (0.2-1.4)
0.188
>126 14 (20.0) 48(88.9)
Variables Adherence UnadjustedOR (95%C.I)
P Value
Good (n=70)
Poor(n=54)
Diabetic distress
Low 67 (95.7) 41 (75.9)0.1 (0.0-0.5) 0.004
High 03 (04.3) 13 (24.1)
Emotional Burden
Low 49 (70.0) 25 (46.3)0.4 (0.2-0.8) 0.008
High 21 (30.0) 29 (53.7)
Regimen distress
Low 69 (98.6) 35 (64.8)0.0 (0.0-0.2) 0.001
High 01 (01.4) 19 (35.2)Interpersonal
Low 60 (85.7) 41 (75.9)0.5 (0.2-1.3) 0.168
High 10 (14.2) 13 (24.1)
Table 5: Univariate analysis showing association between diabetic distress and adherence to anti-diabetic medication [N=124]
FactorsUNADJUSTE
DOR (95%
CI)
P value
ADJUSTEDOR (95% CI)
Pvalue
Absence of Side effects
0.4 (0.2-0.9) 0.025 0.4 (0.2-1.0)
0.06
Regular blood monitoring
0.4 (0.2-0.9) 0.040 0.7 (0.3-2.1)
0.570
Low Diabetic distress
0.1 (0.0-0.5) 0.004 0.6 (0.0-5.9) 0.620
Low Emotional burden
0.4 (0.2-0.8) 0.008 0.7 (0.3-1.7) 0.442
Low Regimen distress
0.0 (0.0-0.2) 0.001 0.0 (0.0-0.3) 0.006
Table 6:Factors associated with adherence to antidiabetic medication [N=124]
CONCLUSION AND RECOMMENDATIONS
• In our study , experiencing any side-effects , non-monitoring of blood
glucose and diabetic distress were found to be significantly associated with
good adherence behaviour Not one factor can be solely held responsible for
influencing non-adherence among patients
• The regimen distress could be minimized by prescribing fixed-dose or
combined preparations.
Health education and awareness about regular monitoring of blood glucose levels must be promoted.
Uninterrupted Government supply of anti diabetic drugs will benefit the patients
Top Related