Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study

Abstract

ObjectivesThe disease burden of type 2 diabetes mellitus (T2DM) is rising due to suboptimal glycaemic control leading to vascular complications. Medication adherence (MA) directly influences glycaemic control and clinical consequences. This study aimed to assess the MA of patients with T2DM and identify associated factors.DesignAnalysis of data from a cross-sectional survey and electronic medical records.SettingPrimary care outpatient clinic in Singapore.ParticipantsAdult patients with T2DM.Main outcome measuresMA to each prescribed oral hypoglycaemic agent (OHA) was measured using the five-question Medication Adherence Report Scale (MARS-5). Low MA is defined as a MARS-R score of <25. Demographic data, clinical characteristics and investigation results were collected to identify factors that are associated with low MA.ResultsThe study population comprised 382 patients with a slight female predominance (53.4%) and a mean±SD age of 62.0±10.4 years. 57.1% of the patients had low MA to at least one OHA. Univariate analysis showed that patients who were younger, of Chinese ethnicity, married or widowed, self-administering their medications or taking fewer (four or less) daily medications tended to have low MA to OHA. Logistic regression revealed that younger age (OR 0.97; 95% CI 0.95 to0.99), Chinese ethnicity (OR 2.80; 95% CI 1.53 to5.15) and poorer glycaemic control (HbA1c level) (OR 1.27; 95% CI 1.06 to1.51) were associated with low MA to OHA.ConclusionsYounger patients with T2DM and of Chinese ethnicity were susceptible to low MA to OHA, which was associated with poorer glycaemic control. Polytherapy was not associated with low MA.

Evaluation of antidiabetic medication adherence in the Lebanese population: development of the Lebanese Diabetes Medication Adherence Scale

“…The presence of diabetes complications or comorbidities was not associated with medication adherence. This is in line with results obtained in a study in Singapore . Patients who did not have medical insurance or enough money were also less adherent treatment, highlighting the need for better social security programmes.…”

“…Longer working hours was associated with decreased adherence since these patients may have difficulty attending to treatment, similar to a study done in Singapore . No relationship between cigarette smoking or alcohol consumption and medication adherence was found.…”

The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

“…Participants responded to five items (e.g., I forget to take my medicines) on a 5-point scale from "always" to "never," and a total score of 25 and more indicated better adherence to medications [38]. The MARS has been previously used for patients with T2DM in Singapore [39]. In this study, Cronbach's alpha was 0.6967.…”

Modifiable Factors Associated with Non-adherence to Antihypertensive or Antihyperlipidemic Drugs Are Dissimilar: a Multicenter Study Among Patients with Diabetes in Indonesia

“…32 In studies elsewhere, similar and lower non-adherence rates have been found, also using the MARS questionnaire. 26,33 Therefore, a minimum sample size of 180 patients per therapeutic drug group was required based on the formula for prediction models with a binary outcome, 34 when including maximum of 9 possible independent variables in the multivariate analysis and assuming a proportion of non-adherence of 50%. With an expected distribution of 2:1 between patients receiving antihypertensive drugs and antihyperlipidemic drugs, 540 patients need to be recruited in the most conservative scenario of no overlap in the use of both therapeutic groups.…”