Medical adherence and its predictors in Diabetes Mellitus patients attending government hospitals in the Indian Capital, Delhi, 2013: a cross sectional study

Abstract

India has the second highest Diabetes Mellitus burden globally which represents a major public health challenge. Poor adherence to medication and other treatment recommendations in diabetes patients is associated with poor glycemic control which may lead to early onset of complications with high cost of management. We assessed medical adherence and their predictors in type 2 diabetes patients attending Government Hospitals in Delhi. We conducted a cross sectional study among 385 Type 2 DM patients. We assessed medication adherence with the eight item Morisky Medication Adherence Scale. Dietary and exercise adherence were also assessed. Data was analyzed using SPSS Version 17. Prevalence of good medication adherence was 74.5 %, adherence to dietary recommendations was 70 % and adherence to exercise recommendations was 48 % in the study population. On adjusted analysis, lower socio-economic status, oral hypoglycemic agent treatment alone and reporting non-replenishment on exhaustion of drug stocks was associated with higher likelihood of poor medication adherence. Barriers against dietary adherence were differing familial dietary choices, inflation, beliefs that occasional transgression was benign and cultural factors like dining together at same time. Clinical pathology especially knee joint pain was reported as most frequent barrier to exercise adherence. The medication adherence rates found in this study were higher than most other studies conducted in India. Provision of free anti hyperglycemic medication at government hospitals by reducing patient out of pocket expenses facilitates maintenance of a high level of medication adherence. Furthermore, higher dietary and exercise adherence may reflect the improved self efficacy in patients.