Association between Depressive Disorders and Medication Adherence among Adults with Type 2 Diabetes Mellitus in a Teaching Hospital in Sokoto, Northern Nigeria

Background Patients with diabetes mellitus have an increased risk of developing dyslipidemia, predisposing them to macro- and microvascular consequences such as coronary heart disease. Aim The aim of this study was to assess the prevalence of dyslipidemia, drug therapy problems (DTPs), and medication adherence in type 2 diabetes mellitus (T2DM) patients in a tertiary hospital in North Central Nigeria. Method This study was a cross-sectional convenient sampling of eligible patients conducted in the General Outpatient Department of General Hospital, Ilorin, from March to May 2022. A validated questionnaire was administered to obtain all relevant information on sociodemographic information, and blood samples were collected in a medium plain heparinized tube and sent to the laboratory where fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) values were calculated as appropriate. Morisky's Medication Adherence Scale 8 (MMAS-8) was used to capture patient's adherence level, and DTP was assessed using the Pharmaceutical Care Network Europe (PCNE) Criteria version 7. Ethical approval was obtained from the Ministry of Health, Ilorin. Statistical Package for Social Sciences was used to analyze the data collected for descriptive and inferential statistics. Results The mean age of the respondents was 60 ± 0.7 years. Of the 60 respondents, 25 (41.67%) were males and 35 (58.33%) were females. All the respondents had dyslipidemia, 30% respondents were identified with a DTP of nonadherence, 16.7% needed additional drug/monitoring, dosage was too low in 11.7%, and 11.6% could not afford their medication due to high cost. In all, 45 (75%) respondents had poor sugar control and 33 (55%) had poor blood pressure control. Using MMAS-8, the majority (41, [68.30%]) of the respondents were found to have poor adherence to their diabetic medications. Conclusion High prevalence of dyslipidemia, poor medication adherence, and DTPs were found in the T2DM patients in this study.

Background: Diet adherence (DA) is one of the most critical factors that determine the effectiveness of therapy among patients with type 2 diabetes mellitus (T2DM). Concomitant depressive disorder (DD) may affect treatment adherence. Aim of the study: This review aimed to synthesize the results of research published between 2010–2020 on medication adherence and DA among patients with co-occurring T2DM and DD. Potential factors related to DA are also discussed. Material and methods: This scoping review was conducted on studies published between January 2010 to November 2020. The literature review was carried out using the PubMed (MEDLINE®) medical database. The following inclusion criteria were applied: (1) written in English, (2) published in the last ten years (between 2010 and 2020), (3) applied to patients with diagnosed T2DM and DD, (4) analyzed DA, and (5) original or review studies. Results: Twenty-six studies were included in the final review. Three main areas were analyzed in the context of DD and effectiveness of T2DM therapy: (1) general medication adherence, (2) glycemic control, and (3) DA. Only 16 of the 26 included studies examined the effects of DD on DA, and 14 of those 16 studies reported a negative impact of DD symptoms on DA. Conclusions: A higher intensity of DD symptoms was associated with poorer medication adherence and DA. These data suggest that it is critical to develop proper therapeutic interventions that can strengthen personality dispositions (e.g., self-efficacy) and/or improve social support.

Objective : To assess the extent of medication adherence in patients suffering from type 2 diabetes mellitus. Methodology : The study protocol was approved by the hospital human ethical committee. The patients (in-patients and out-patients) suffering from Type-2 DM of either sex who were aged 35 years and above and patient diagnosed with Type 2 DM for more than one year who were either on parenteral or oral anti diabetic medication treatment were prospectively enrolled for six months. The patient, clinical, medication and socioeconomic data were collected into specialized patient profile form. Different levels education considered were: Post-gradates, graduates, schooling and illiterate. The patient medication adherence was assessed using Morisky Medication adherence scale. Each answer was dichotomously scored. Accordingly, each correct answer is awarded a score of zero while every incorrect or unsure answer was awarded a score of one. The scores were totalled and categorized as: Score 0 = High adherence, Score 1-3 = Moderate adherence and Score > 3 = Poor adherence. Result and Discussion : Totally 450 patients (Males 61%, Females 39%) suffering from Type-2 DM were enrolled. Mean age of the patients was 61years. Majority of the enrolled patients were graduates (198) 50% followed by the patients with basic level of school education( 116) 29% , and (69) 17% were illiterate and least number of patients were post graduates (17) 4 %. Among the patients who were assessed for their medication adherence, majority (219) (54.75%) had poor adherence followed by 31.5% patients who had moderate adherence. However, (13.75%) patients had high adherence. This indicates that majority of patients were not adherent to their medications. Research has shown that patients with diabetes mellitus have one of the lowest medication adherence rates at 65% to 85%.Factors that could influence the patients adherence were assessed and were able to find with four clear causes included forgetfulness (64.25%),feeling better (75%),feeling worse(79.25%) and inconvenience (61.75%). Conclusion: Majority of the patients suffering from Type-2 diabetes mellitus have poor medication adherence.

Background: Diabetes mellitus poses a growing global health challenge, with approximately 463 million adults (9.3%) aged 20–79 affected worldwide. Without effective intervention, this figure is projected to rise to 578 million (10.2%) by 2030. One of the major barriers to effective management of type 2 diabetes mellitus (T2DM) is poor medication adherence, which directly impacts glycemic control and increases the risk of complications. Objective: To assess the effectiveness of pharmacist-led interventions in improving medication adherence and glycemic outcomes among patients with T2DM in South Asian countries. Methods: This narrative review analyzed 21 studies published within the last two decades across five South Asian countries: Bangladesh (n=1), Sri Lanka (n=1), Nepal (n=3), Pakistan (n=8), and India (n=8). Studies included randomized controlled trials, interventional and longitudinal studies that evaluated pharmacist-led educational or counseling interventions. Eligible participants were adult T2DM patients receiving either oral hypoglycemic agents or insulin. Data collection methods included validated instruments such as the Diabetes Knowledge Questionnaire (DKQ), Diabetes Self-Management Questionnaire (DSMQ), and Morisky Medication Adherence Scale (MMAS), as well as laboratory parameters like HbA1c and fasting blood glucose levels. Statistical analyses in the primary studies included pre-post comparisons, multivariate models, and paired t-tests to measure intervention impact. Results: Across the reviewed studies, pharmacist-led interventions led to significant reductions in HbA1c (mean decrease: 0.8% to 1.2%) and fasting blood glucose (average reduction: 15–30 mg/dL). Medication adherence improved by 25–60% in intervention groups compared to controls. Improvements were also seen in patient knowledge, self-care behaviors, and health-related quality of life. Interventions were effective across diverse settings, including hospitals, community pharmacies, and rural clinics. Conclusion: Pharmacist-led interventions significantly enhance medication adherence, glycemic control, and patient education in T2DM management. Integrating pharmacists into multidisciplinary care models can optimize diabetes care and reduce the long-term burden of complications, particularly in resource-limited South Asian settings.

Type 2 diabetes mellitus (T2DM) is a chronic, lifelong disease that can negatively affect patients’ mental health and quality of life (QoL). A notable proportion of patients with T2DM worldwide have experienced stigma through instances of discrimination, unfair social treatment and lack of promotion opportunities. Stigma refers to the negative emotional experience of people with illness, often mixed with self-stigmatization. Stigma remains an obstacle to patients’ self-management, its association with patients with T2DM on medication adherence and QoL in China are unknown. Therefore, the objective of the study was to analyze the status of stigma in patients with T2DM and its association with medication adherence and QoL in China. A cross-sectional, observational study among 346 inpatients with T2DM in 2 tertiary-level hospitals in Chengdu, China, was conducted using a general data questionnaire, Chinese version type 2 diabetes stigma scale (DSAS-2), Morisky medication adherence scale (MMAS-8) and diabetic QoL specificity scale by convenient sampling method from January to August 2020. The total score and scores for the 3 dimensions of stigma, treated differently, blame and judgment, and self-stigma, were 54.30 ± 12.22, 16.57 ± 4.06, 20.92 ± 4.42, 16.82 ± 4.78, respectively. The scores for medication adherence and QoL were 5.43 ± 1.8 and 73.24 ± 9.38. Pearson correlation analysis showed that the total score of stigma and the scores of each dimension were negatively weak-correlated with the score of medication adherence (r = −0.158 to −0.121, P < .05), and positively moderate-correlated with the score of QoL (R = 0.073 to 0.614, P < .05). Stigma of patients with T2DM was negatively associated with medication adherence, and negatively associated with QoL, namely, the stronger the stigma, the worse the medication adherence and QoL. The results of the hierarchical regression analysis revealed that stigma independently explained 8.8% of the variation in medication adherence and 9.4% to 38.8% of the variation in QoL. The stigma of patients with T2DM was at a moderate degree and negatively correlated with medication adherence and QoL, it is necessary to pay more attention to relieve stigma and negative emotions timely, in order to improve patients’ mental health and QoL.

Understanding factors influencing medication adherence in Type 2 diabetes guided by the COM-B behaviour change model and assessed using the Morisky scale: A systematic review.

ObjectiveWe determined the prevalence of poor glycemic control and associations with sociodemographics, comorbid conditions, and medication adherence among patients with type 2 diabetes mellitus (T2DM) at a tertiary hospital in southwestern Nigeria.MethodsWe conducted a retrospective observational study among 300 patients with T2DM using systematic random sampling. We used a semi-structured questionnaire to collect information on respondents’ sociodemographic profile, lifestyle, comorbid conditions, and antidiabetic medications. Adherence was determined using the Morisky Medication Adherence Scale. Fasting blood samples were tested using a glycated hemoglobin marker. Multivariate logistic regression was used to identify factors associated with poor glycemic control.ResultsRespondents’ mean age was 61.9 ± 11.8 years. The prevalence of poor glycemic control was 40.0% (95% confidence interval [CI]: 34.4%–45.8%). The adjusted odds ratio (95% CI) for factors associated with poor glycemic control was 2.522 (1.402–4.647) for older age, 1.882 (1.021–3.467) for low income, 1.734 (1.013–3.401) for obesity, 2.014 (1.269–5.336) for non-initiation of insulin therapy, and 1.830 (1.045–3.206) for poor medication adherence.ConclusionOlder age, lower income, obesity, non-initiation of insulin, and poor medication adherence were associated with poor glycemic control. These variables may help clinicians identify patients at high risk of poor glycemic control.

Although drug formulary restrictions may reduce use of prescription medication and pharmacy costs, the effect of patient cost sharing on medication adherence and health care utilization and cost is unclear. To evaluate the relationship between patient cost sharing for novel type 2 diabetes mellitus (T2DM) medications and medication adherence, persistence, and health care utilization and cost. This retrospective study used medical and pharmacy claims linked to pharmacy benefit plan design data. Patients with T2DM were identified via ICD-9-CM codes (medical claims), outpatient prescription fills (pharmacy claims), and pharmacy benefit design information. Patients with T2DM treated with novel T2DM medications (DPP4 or GLP-1) were enrolled in plans with fixed or coinsurance medication copayment structures and followed for 12-48 months. Endpoints included medication persistence and adherence and total all-cause health care cost. Multivariable regression analysis estimated the effect of benefit design parameters, adjusting for baseline patient characteristics. The integrated database included 36,475 patients with T2DM. The majority (83.1%) had fixed copayment plans, and 3-tier plans were common (93.1%). Higher third-tier copayment was associated with poorer medication adherence and persistence but not total health care cost during follow-up. A $10 higher third-tier copayment was associated with 11% greater risk of novel T2DM medication discontinuation and 3% lower adherence. A comparison of patients with fixed versus coinsurance plans found that fixed plans were associated with higher adjusted persistence and total all-cause health care costs. Higher medication copayment amounts were associated with lower patient medication adherence and persistence in T2DM but not total health care costs, as health plan costs decreased while patient out-of-pocket costs increased. We observed higher total all-cause health care costs among T2DM patients with a fixed copay (vs. coinsurance) pharmacy benefit. Additional research incorporating plan design information is needed to further examine this finding. This study was funded by Janssen Scientific Affairs, which was involved in study design, interpretation of data, editing manuscript content, and had final approval of the manuscript before submission. Lopez and Bookhart are employed by Janssen Scientific Affairs. At the time of this study, Henk was employed by Optum HEOR, which was contracted by Janssen to conduct this study. Portions of this study were presented at the 21st Annual International Meeting, ISPOR; May 21-25, 2016; in Washington, DC.

BackgroundType D personality and medication nonadherence have been shown to be associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease, myocardial infarction, and heart failure. However, the relationship between type D personality and medication adherence in patients with Type 2 Diabetes Mellitus (T2DM) remains unknown. This study aims to examine whether type D personality was associated with medication adherence in patients with T2DM.Design and SettingsA follow-up study was conducted in general hospital of the People's Liberation Army in Beijing.Methods412 T2DM patients (205 females), who were recruited by circular systematic random sampling, provided demographic and baseline data about medical information and completed measures of Type D personality. Then, 330 patients went on to complete a self-report measure of medication adherence at the sixth month after baseline data collection. Chi-square test, t tests, and hierarchical multiple regression analyses were conducted, as needed.ResultsPatients with type D personality were significantly more likely to have poor medication adherence (p<0.001). Type D personality predicts poor medication adherence before and after controlling for covariates when it was analyzed as a categorical variable. However, the dimensional construct of type D personality was not associated with medication adherence when analyzed as a continuous variable.ConclusionAlthough, as a dimensional construct, type D personality may not reflect the components of the personality associated with poor medication adherence in patients with T2DM, screening for type D personality may help to identify those who are at higher risk of poor medication adherence. Interventions, aiming to improve medication adherence, should be launched for these high-risk patients.

Medication Adherence and Diabetes Self-Care Activities Among Patients With Type 2 Diabetes Mellitus

The treatment of Type 2 Diabetes Mellitus (T2DM) is a protracted and arduous process. Medication, being a universally crucial therapeutic measure, underscores the significance of medication adherence in managing the disease effectively. Medication beliefs have emerged as a significant predictor of adherence, attracting considerable scholarly attention in recent years. However, there remains a paucity of research utilizing individual-centered approaches to explore medication beliefs among the T2DM population during the hospital-home transition, leaving the relationship between these beliefs and medication adherence unclear. To investigate latent categories of medication beliefs among patients with T2DM during the transition from hospital to home, and to analyze variations in medication adherence across these categories of patients. Between August 2022 and September 2023, this study selected 304 patients with a pre-discharge diagnosis of T2DM as study subjects from a tertiary hospital in Dongguan City. The patients' profiles were assessed comprehensively via the Sociodemographic and Clinical Characteristics Questionnaire, alongside the Chinese version of Beliefs about Medicines Questionnaire-Specific and Morisky Medication Adherence Scale-8. The present study conducted latent profile analysis using Mplus 7.4 software and analyzed the influencing factors of different medication belief categories and their differences in medication adherence using SPSS 26.0 software. The medication beliefs of 304 patients were rated at 3.36±5.24 points, while medication adherence scored 6.23±1.56 points. The medication beliefs were classified into four categories: moderate necessity - low to moderate concern group (40.13%), high necessity - low concern group (9.54%), moderate necessity - moderate to high concern group (19.08%), and moderate necessity - high concern group (31.25%). Age, monthly per capita household income, and place of residence emerged as influential factors for the four categories. Moreover, the disparity in medication adherence among these categories demonstrated statistical significance (P < 0.001). The medication beliefs of patients were classified into four distinct categories, and variations in medication adherence were evident across these categories. The high necessity - low concern group demonstrated the highest medication adherence scores, while the moderate necessity - high concern group exhibited the lowest scores. Healthcare providers are advised to tailor personalized medication belief enhancement programs based on patients' homogeneous beliefs, addressing specific issues encountered by each category. This approach aims to ensure optimal medication adherence across diverse medical and social environments, effectively improving patient prognosis and enhancing quality of life.

Regimen-related emotional distress in patients with type 2 diabetes mellitus (T2DM) is associated with poor glycemic control, but the mediators of this relationship are not well described. This cross-sectional study at baseline examines these relationships, including the specific role of medication adherence in rural African American women. At baseline in the EMPOWER randomized trial, the investigators collected the following data: Regimen-Related Distress (RRD; subscale of the validated Diabetes Distress Scale), diabetes medications, medication adherence using the Morisky Medication Adherence Scale, and hemoglobin A1C (A1C). The study enrolled 189 rural African American women with T2DM (mean age = 53 ± 11 years, A1C = 9.1% ± 1.8%, body mass index = 37.7% ± 8.2%; 61% on insulin); 56% reported elevated RRD (mean ≥ 3.0), and this was associated with significantly lower medication adherence (4.4 vs 6.4, P < 0.001) and significantly higher A1C (9.5% vs 8.6%, P < 0.001). In multivariate modeling, both elevated RRD (exp β = 2.1; 95% CI = 1.1-4.2; P < 0.05) and lower medication adherence (exp β = 3.3; 95% CI = 1.1-9.6; P < 0.05) were independently associated with higher A1C values. In mediation analysis, medication adherence was a significant mediator of the effects of RRD on A1C. Among rural African American women with T2DM, elevated levels of RRD were common and were associated with higher A1C values, in part via effects on medication adherence. Complex treatment regimens accompanied by psychological distress may be associated with poorer glycemic control.

ABSTRACTIntroduction:Advanced stages of change (SOC) are usually associated with lower glycated hemoglobin (HbA1c) scores in patients with type 2 diabetes mellitus (T2DM). Additionally, these patients’ adherence to antidiabetic medications is crucial to achieve controlled HbA1c scores. The purpose of this study was to determine the relationship between SOC and HbA1c as well as between medication adherence and HbA1c in patients with T2DM in a primary health-care setting in Qatar.Materials and Methods:A cross-sectional observational study was conducted in patients with T2DM at the noncommunicable diseases clinics at Mesaimeer Healthcare Center and West Bay Health Care Center. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8), whereas a two-item SOC questionnaire was used to measure the SOC. HbA1c values were obtained from the electronic database at the clinic. Spearman rank correlations were performed, with the significance level set at α < 0.05.Results:A total of 387 patients were included in the analysis. More than 75% of them reported that they were in the maintenance stage, and 35.4% of them had a controlled diabetes status. There was no significant correlation between SOC and HbA1c or between medication adherence and HbA1c.Conclusions:There was no relationship between SOC and HbA1c or between medication adherence and HbA1c in patients with T2DM, indicating that in this study, self-reported measures are not associated with the HbA1c scores of patients.

This study aimed to assess the level of illness perception and medication adherence among adult patients with type 2 diabetes mellitus (T2DM) in Jeddah, Saudi Arabia, with a specific focus on understanding how these two factors may be related. This descriptive correlation study included all adult patients with T2DM attending the Jeddah Care Centre for Diabetes and Hypertension at King Abdulaziz Hospital between January and April 2022. Data were collected using a questionnaire that elicited sociodemographic and clinical information, and the Arabic versions of the Brief Illness Perception Questionnaire and the Morisky Medication Adherence Scale. Descriptive statistics and Pearson's correlation analysis were used for data analysis. A total of 365 patients were included (mean age: 50.9 ± 15.9 years), with the majority being female (53.4%). Overall, the level of medication adherence was moderate (mean score: 5.36 ± 1.73). Patients with lower medication adherence perceived the consequences of T2DM as more severe, had a stronger association with the illness identity, and experienced more intense emotional responses (for all, P < 0.001). Conversely, patients with higher adherence had a greater sense of personal control, a stronger belief in treatment effectiveness, and a better understanding of the illness (for all, P < 0.001). The study found a correlation between illness perception and medication adherence in patients with T2DM. Addressing patients' perceptions may enhance their ability to manage the condition more effectively.

Despite the availability of a wide selection of antidiabetic treatments, many patients with type 2 diabetes mellitus (T2DM) still do not have controlled glucose levels. This study aimed to assess illness perception, medication adherence, and glycemic control among primary care attendees with T2DM. A cross-sectional study was conducted between July 2019 and November 2020. A random sample of 265 Egyptian T2DM patients were enrolled from primary health-care settings in Port Said, Egypt. Data on socio-demographic characteristics, lifestyle habits, and diabetic medical history were collected using a semi-structured questionnaire. The Brief Illness Perception Questionnaire (B-IPQ) was used to assess diabetes perception, whereas the 8-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate medication adherence. There was a significant difference in B-IPQ scores between different groups of the patients in terms of diabetic medications, complications, and glycemic control (p < 0.05). There was a significant difference in MMAS-8 score found between different groups of the patients in terms of disease duration, family history of T2DM, and glycemic control (p < 0.05). Further, there was a significant difference in HbA1c score found between different groups of patients in terms of disease duration, medications, complications, and family history of T2DM (p < 0.05). Higher BMI, a positive family history of T2DM, patients who take insulin, high illness perception, and poor medication adherence were the factors associated with higher HbA1c level. Higher HbA1c levels were linked to a higher BMI, a positive family history of T2DM, insulin users, high illness perception, and poor medication adherence.