Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study

Abstract

Medication adherence (MA) in adults with type 2 diabetes mellitus (T2D) is associated with improved disease control (glycated hemoglobin, blood pressure, and lipid profile), lower rates of death and diabetes-related complications, increased quality of life, and decreased health care resource utilization. However, there is a paucity of data on the effect of diabetes-related distress, depression, and health-related quality of life on MA. This study examined factors associated with MA in adults with T2D at the primary care level. This was a cross-sectional study conducted in three Malaysian public health clinics, where adults with T2D were recruited consecutively in 2013. We used the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess MA as the main dependent variable. In addition to sociodemographic data, we included diabetes-related distress, depressive symptoms, and health-related quality of life as independent variables. Independent association between the MMAS-8 score and its determinants was done using generalized linear models with a gamma distribution and log link function. The participant response rate was 93.1% (700/752). The majority were female (52.8%), Malay (52.9%), and married (79.1%). About 43% of patients were classified as showing low MA (MMAS-8 score <6). Higher income (adjusted odds ratio 0.90) and depressive symptoms (adjusted odds ratio 0.99) were significant independent determinants of medication non-adherence in young adults with T2D. Low MA in adults with T2D is a prevalent problem. Thus, primary health care providers in public health clinics should focus on MA counselling for adult T2D patients who are younger, have a higher income, and symptoms of depression.

Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes

“…In the present study, there was a reduction in adherence to medication as the age of participants increased. This finding was in line with research in Malaysia, which showed that reduction of 1 year in the age of participants increased the probability of non-adherence to medication by 3.4% [27,28]; however, another study did not find any relationship between age and adherence to medication [29]. These differences can be explained in part by the different socioeconomic status of the studied population.…”

“…This finding was in line with the SHIELD study [30]. It is notable that one of the potential confounding factors might be the high prevalence of depression amongst obese people, which could lead to decrease in medication adherence [28,31]. Moreover, our findings indicated that the relationship between gender and adherence to medication was not significant.…”

Psychological predictors of adherence to oral hypoglycaemic agents: an application of the ProMAS questionnaire

“…While DiMatteo (DiMatteo, 2004) and Kirkman and colleagues (Kirkman et al, 2015) associated higher levels of education with medication adherence, a recent study by Chew and colleagues (Chew, Hassan, & Sherina, 2015) indicated that higher education was associated with poor diabetes medication adherence. Another review by Jin and colleagues (Jin, Sklar, Min Sen Oh, & Li, 2008) reported inconsistent findings.…”

Negative Affectivity Predicts Lower Quality of Life and Metabolic Control in Type 2 Diabetes Patients: A Structural Equation Modeling Approach

“…Indeed, a large body of studies found that the above reported psychological factors are associated with sub-optimal glycemic control (Lustman et al, 2000), DM complications (de Groot et al, 2001), and decreasing levels of QoL (Chew et al, 2015). The combination of DM with negative mental health aspects, mainly depression and anxiety, is associated with an impaired QoL, as well as with a greater difficulty in patients to self-monitor their blood glucose levels (Lewko et al, 2012).…”