Noncompliance to Diet and Medication among Patients with Type 2 Diabetes Mellitus in Selected Hospitals of Kathmandu, Nepal

Abstract

Background Diabetes is a major public health problem affecting people of all ages globally. Noncompliance compromises the effectiveness of treatment and adversely affects patients' health. The main purpose of this study was to assess and compare the proportion of noncompliance to diet and medication between patients with type 2 diabetes mellitus (T2DM) visiting public and private hospitals in Kathmandu, Nepal. Methods Descriptive cross-sectional study was conducted in T2DM patients visiting public and private hospitals. Eight item Morisky Medication Adherence Questionnaire (MMAQ) for medication adherence and Perceived Dietary Adherence Questionnaire (PDAQ) for dietary adherence were used. Epidata was used for data entry and SPSS for data analysis. Chi-square test was used as a test of significance. Odds ratio (OR) and the corresponding 95% confidence intervals (CI) were calculated. Results The study involved 182 T2DM patients. Participants' age was ≥ 17 years and they were under treatment for ≥ 6 months. Mean age of the participants was 54.67 years with standard deviation (SD) ± 11.69. Prevalence of medication noncompliance was seen in 126 (69.2%) patients, whereas prevalence of dietary noncompliance was seen in 166 (91.2%) patients. Illiterate participants were more likely to be noncompliant than literate to medication (OR 4.32, p = 0.001). Self-employed were more likely to be noncompliant to medication than job holders (OR 2.93, p = 0.008). People visiting public hospital were more likely to be noncompliant to diet than those visiting private hospital (OR 4.89, p = 0.009). Illiterate participants were more likely to be noncompliant to diet than literate (OR 10.94, p = 0.005). Conclusion The T2DM patients visiting public hospitals were more noncompliant to diet. Illiterate patients were more noncompliant to both medication and diet. Self-employed compared with job holders were more noncompliant to medication. Patient education and counseling should be aggressively addressed mainly in public hospitals. There was no significant difference in medication noncompliance between public and private hospitals (p = 0.108).

Association Between Nutritional Knowledge and Dietary Compliance among Type 2 Diabetes Mellitus Patients at the Bono Regional Hospital, Sunyani, Ghana

“…Contrary to our expectations, the majority of T2DM patients (60.7%) in our study reported poor dietary compliance despite good nutritional knowledge. This is consistent with those from similar single-site studies in Komotini, Greece (Katsaridis et al, 2020), Eastern Ethiopia (Mohammed et al, 2020, Kampala, Uganda (Davidsson & Fahlén, 2016), Kathmandu, Nepal (Kafle et al, 2018), northwest Ethiopia (Ayele et al, 2018), and Kelantan, Malaysia (Tan et al, 2011) where 58.8%, 62.5%, 53.3%, 91.2%, 74.3%, and 83.6% of T2DM patients, respectively were non-adherent to dietary recommendation provided by their dieticians. A possible explanation for the poor dietary compliance despite good nutritional knowledge is the fact that several factors other than nutritional knowledge influence individuals' food selection and dietary habits, including psychosocioeconomic factors such as work-related barriers, community-level, and organizational barriers, personal challenges, and other factors (Shamsi et al, 2013) patients' adherence to recommended dietary practices, it is important that nutritionists and dieticians adopt dietary interventions tailored to patient's readiness to change, employing relevant behavioural change communication skills such as Transtheoretical Model (Tan et al, 2011).…”

Rural/Urban Variations in Diabetes Self-Care in a Sample of Ghanaian Adults with Type II Diabetes: a Study in the East Gonja Municipality

“…In this study, more than half of the respondents were non-adherent to dietary recommendations. There seem to be similarities between the dietary adherence found in the current study and those reported in similar single-site studies in Ghana ), Greece (Katsaridis et al, 2020, and Nepal (Kafle et al, 2018). Seasonal food shortages occur in Ghana, particularly in the Northern part of the country, from March to June (Agble et al, 2009).…”

Factors Associated with Medication Adherence among Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cross-Sectional Study in Nepal

“…In a global context, diabetes medication adherence has been associated with the female gender [ 17 ], level of education [ 18 , 19 ], knowledge about diabetes [ 18 , 19 ], duration of diabetes [ 19 , 20 ], perception of disease severity [ 17 ], among other factors. In Nepal, few studies have identified factors for the adherence or non-adherence to treatment among patients with type 2 diabetes [ 21 , 22 , 23 , 24 , 25 ]. The good medication adherence measured using the eight-item Morisky medication adherence scale (MMAS-8) was 28.5% in Nepal [ 21 ].…”

“…The reasons for non-adherence were intentional discontinuation, forgetfulness, carelessness, and hypoglycemia [ 22 ]. However, these previous studies have used simple statistical methods to determine predictors of medication adherence [ 21 , 22 , 24 , 25 ]; only one used multiple logistic regression [ 23 ]. Two studies used MMAS-8 [ 21 , 25 ], two studies used MMAS-4 [ 23 , 24 ], one study did not use standardized questions to measure medication adherence and failed to identify its associated factors scientifically [ 22 ].…”