Adherence to Anti-Diabetic Therapy in Women with Diabetes in Pregnancy

Abstract

Background: Hyperglycemia in pregnancy is associated with adverse pregnancy outcomes. Strict glycaemic control is necessary to promote favourable pregnancy outcomes. Objectives: To assess adherence to anti-diabetic therapy (diet, physical activity and medications) in women with diabetes in pregnancy. Methods: This study utilized a cohort of 157 pregnant women at three Central hospitals in Zimbabwe. Adherence to anti-diabetic therapy was the exposure and the outcomes of interest were maternal and perinatal outcomes. This paper focuses on adherence levels. Consecutive sampling was used to recruit women with diagnoses of gestational diabetes, type 1 and type II diabetes. Ethical approval was granted by respective ethical review boards. Participants gave informed consent. Data was collected through an interviewer administered questionnaire which had sections on demographics, adherence to diet, physical activity and medications and perinatal outcomes. An adherence level of at least 80%, measured by self-report, was high while an adherence of less than 80% was low. Data were analyzed using the statistical package for Social Sciences (SPSS) version 20. Descriptive statistics were used to analyze demographic data and adherence levels. Results: Majority participants (31.8%) were aged from 30-34 years. Regarding type of diabetes, 25.5% had type I, 43.9% type II while 30.6% had gestational diabetes mellitus. Mean adherence to anti-diabetic therapy was 79.6%. Conclusions: Adherence to anti-diabetic therapy namely diet, physical activity and medications was suboptimal. Adherence counselling and monitoring is essential in pregnancy considering the strict glycemic control that is required in diabetes in pregnancy.

Adherence to Antidiabetic Medications among Women with Gestational Diabetes

“…Although self-reported measures were the main tools for estimating medication adherence in this review [18-26, 28, 29], some studies assessed fasting blood glucose or glycated haemoglobin as a means of confirming adherence and predicting disease outcomes [18,22,28]. Generally, adherence to oral antidiabetic medications and insulin has been found to range between 36-93% and 62-64%, respectively [31,32].…”

“…The dominant medications used in the management of gestational diabetes according to the papers reviewed were insulin [18,[20][21][22][23][24] and metformin [19,21,22,25]. Besides medications, adherence to lifestyle/behaviours like self-monitoring of blood glucose levels, dietary therapy, and physical activity were considered [18,20,[22][23][24][25][26][27][28]. Self-report measures were the recorded means of estimating adherence [18-26, 28, 29].…”

Adherence to medical nutrition therapy and it's challenges among antenatal women with gestational diabetes mellitus in South India- A sequential explanatory mixed-method study

“…This is much less than the results of a hospital-based study in Zimbabwe (66.8%) on dietary adherence. [ 18 ] This difference in results may be due to the use of different study tools. This indicates that we will have to work more on the monitoring of dietary adherence among antenatal women with GDM.…”

“…Using OpenEpi version 3.01, a study conducted in Zimbabwe reported the adherence rate to diet therapy was 66.8%. [ 18 ] Assuming the same prevalence, absolute precision of 5%, and 95% confidence interval (CI), the calculated sample size was 341. Universal sampling was done to include the eligible participants.…”