BMC public health · 2025
Non-adherence to oral antidiabetic medications among patients with type 2 diabetes: evidence from a nationwide multicentre study in a lower-middle-income country.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Arshed Muhammad, Kiran Mehwish, Ashraf Waseela, Virk Muhammad Kashif Shahzad, Qamer Shafqat, Umer Muhammad Farooq, Umar Ahmad, Saleem Javeria, Gillani Ali Hassan, Hanif Asif, Naeem Muhammad, Arif Muhammad Maaz, Azhar Syed Hanzila
Аннотация
BACKGROUND: Non-adherence to oral antidiabetic medications is a critical, multifactorial challenge that undermines disease management nationwide. This study aimed to determine the prevalence and predictors of non-adherence among patients with type 2 diabetes (T2DM) across Pakistan. We conducted a nationwide cross-sectional study between December 2023 and March 2025 in 225 healthcare facilities across all provinces of Pakistan. A total of 41,095 participants were selected using a multistage random sampling approach. Medication adherence was evaluated with self-reported pill counts and the Self-Efficacy for Appropriate Medication Use Scale (SEAMS). Multivariable logistic regression using a generalized linear model (GLM) logit approach was employed integrated with Interaction analysis to discover predictors of non-adherence.
RESULT: Non-adherence was present in 59.9% (n=24,616) of cases (n=24,616). Factors associated with reduced adherence included being female (AOR = 0.229, 95% CI: 0.067-0.779, P = 0.02), having only primary or secondary education (AOR = 0.186, 95% CI: 0.166-0.208, P < 0.001), absence of hospitalization, taking fewer medications per day, less frequent dosing schedules, and uncontrolled HbA1c levels. In contrast, factors linked to increased adherence were being married (AOR = 4.118, 95% CI: 3.611-4.695, P < 0.001), being a non-smoker (AOR = 12.98, 95% CI: 11.53-14.62, P < 0.001), having no family history of diabetes (AOR = 1.074, 95% CI: 1.021-1.129, P = 0.005), and having more than one comorbid condition.
CONCLUSION: Non-adherence to oral antidiabetic medication is prevalent and influenced by diverse personal, socioeconomic, and health-related factors. Targeted interventions addressing modifiable risk factors could improve adherence, ultimately reduce the healthcare burden and enhancing outcomes for patients with diabetes in Pakistan.
RESULT: Non-adherence was present in 59.9% (n=24,616) of cases (n=24,616). Factors associated with reduced adherence included being female (AOR = 0.229, 95% CI: 0.067-0.779, P = 0.02), having only primary or secondary education (AOR = 0.186, 95% CI: 0.166-0.208, P < 0.001), absence of hospitalization, taking fewer medications per day, less frequent dosing schedules, and uncontrolled HbA1c levels. In contrast, factors linked to increased adherence were being married (AOR = 4.118, 95% CI: 3.611-4.695, P < 0.001), being a non-smoker (AOR = 12.98, 95% CI: 11.53-14.62, P < 0.001), having no family history of diabetes (AOR = 1.074, 95% CI: 1.021-1.129, P = 0.005), and having more than one comorbid condition.
CONCLUSION: Non-adherence to oral antidiabetic medication is prevalent and influenced by diverse personal, socioeconomic, and health-related factors. Targeted interventions addressing modifiable risk factors could improve adherence, ultimately reduce the healthcare burden and enhancing outcomes for patients with diabetes in Pakistan.