Glycemic control and its association with medication adherence among type 2 diabetes mellitus patients in Nepal

Pushpanjali Shakya 1,2, Bård Eirik Kulseng 1, Biraj Man Karmacharya 2, Archana Shrestha 2

 1. Norwegian University of Science and Technology, Trondheim, Norway   2. Dhulikhel Hospital/Kathmandu University Hospital, Dhulikhel, Nepal

Background
WHO reports that diabetes is steadily increasing around the world resulting in 1.5 million deaths in 2012. The high mortality rate is due to a number of life-threatening health problems caused by uncontrolled glycaemia. Medication adherence contributes significantly to good glycemic control and therefore, to reduce diabetes-related complications and death. 

Aims
(i) To determine status of glycemic control
(ii) To determine status of medication adherence
(iii)To assess association between glycemic control and medication adherence. 

Method
Study design : Hospital-based cross-sectional study 

Sample size : 343, Consécutive sampling technique

Study site & duration: Dhulikhel Hospital, September to December 2016

Inclusion Criteria:
(i) Adult (≥18 years) type-2 diabetes patients 
(ii) Under diabetes medicines for at least past 3 months

Data Collection tools: 
	(i) Face-to-face individual interview based questionnaire
	-8-item Morisky Medication Adherence Scale *(MMAS-8) © 2007
	(ii) Anthropometric measurements
	(iii)Fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) reports

Statistical Tools: 
(i) Descriptive analysis 
-Mean (Standard Deviation) and Median (IQR) for continuous data
-Percentage (frequency) for categorical data

(ii) Analytical Tools
- Model 1: Bivariate analysis
- Model 2: Multivariate linear regression adjusted for socio-demographic characteristics (age, education, occupation and annual household per capita income)
- Model 3: Multivariate linear regression adjusted for socio-demographic characteristics  and clinical characteristics (logarithm of medicine intake duration, attendance of diabetes counseling, types of diabetes medicines)

Results
Mean age of respondents was 55.8 years, 54.2% were male and 49% belonged to the Newar ethnicity. Average FBS was 147.9 (SD: 57.3) mg/dl [8.2 (SD: 3.2) mmol/L] and average HbA1c among 198 participants was 7.8 (SD: 1.8) %. The mean MMAS score of 7.4 (SD: 1) with 61% high adherence, 32% moderate and 7% low adherence. Compared to moderate and low adherence, high medicine adherence was associated with lower FBS level after adjusting for age, education, occupation, annual household per capita income, medicine intake duration, attendance of diabetes counseling and types of diabetes medicines (beta coef: -14.3; 95% CI: -28.5, -0.16; p-value: 0.047). HbA1c% was 0.33% lower for high adherence group compared to moderate and low adherence. However, the association was not statistically significant (beta coef: -0.33; 95% CI: -0.88, 0.23); p-value: 0.17).

Conclusion
The study concluded that emphasizing on medication adherence among type 2 diabetes patients may result in good blood sugar control.


*Use of the ©MMAS is protected by US copyright laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, 
MMAS Research LLC, 16636 159th Place SE, Renton WA 98058;  dmorisky@gmail.com.