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Adherence to antidiabetic treatment in primary health care in individuals with type 2 diabetes. A survey including socio-demographic, patient related and clinical factors

  • Author Footnotes
    1 https://orcid.org/0000-0002-9716-5068.
    Ruben Silva-Tinoco
    Footnotes
    1 https://orcid.org/0000-0002-9716-5068.
    Affiliations
    Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
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  • Author Footnotes
    2 https://orcid.org/0000-0002-4399-0214
    Teresa Cuatecontzi-Xochitiotzi
    Footnotes
    2 https://orcid.org/0000-0002-4399-0214
    Affiliations
    Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
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  • Author Footnotes
    3 https://orcid.org/0000-0002-9771-9796.
    Fernanda Bernal-Ceballos
    Footnotes
    3 https://orcid.org/0000-0002-9771-9796.
    Affiliations
    Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico
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  • Author Footnotes
    4 https://orcid.org/0000-0001-6309-8373.
    Viridiana de la Torre-Saldaña
    Footnotes
    4 https://orcid.org/0000-0001-6309-8373.
    Affiliations
    Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
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  • Author Footnotes
    5 https://orcid.org/0000-0003-0039-3927
    Ana Galindez-Fuentes
    Footnotes
    5 https://orcid.org/0000-0003-0039-3927
    Affiliations
    Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
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  • Author Footnotes
    6 https://orcid.org/0000-0001-9425-923X
    Lilia Castillo-Martínez
    Correspondence
    Correspondence to: Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, Mexico.
    Footnotes
    6 https://orcid.org/0000-0001-9425-923X
    Affiliations
    Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México

    Facultad de Medicina, Universidad Nacional Autónoma de México, México
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  • Author Footnotes
    1 https://orcid.org/0000-0002-9716-5068.
    2 https://orcid.org/0000-0002-4399-0214
    3 https://orcid.org/0000-0002-9771-9796.
    4 https://orcid.org/0000-0001-6309-8373.
    5 https://orcid.org/0000-0003-0039-3927
    6 https://orcid.org/0000-0001-9425-923X
Published:September 17, 2022DOI:https://doi.org/10.1016/j.pcd.2022.09.002

      Highlights

      • Adherence to treatment is a major challenge in patients with type 2 diabetes.
      • Around one half of patients with type 2 diabetes are not adherent to antidiabetic treatment.
      • Better interaction of patients with health professionals to resolve doubts/questions might improve adherence.
      • Access to diabetes self-management education programs increase patients´ adherence.

      Abstract

      Background

      Adherence to medications is a critical element in diabetes management.

      Objective

      To investigate patient-related factors associated with adherence to antidiabetic treatment in patients with type 2 diabetes in primary health-care units.

      Methods

      A cross-sectional study among patients receiving diabetes care in 18 primary care units in Mexico City was conducted. Data were collected from medical records and medical interviews. Adherence to antidiabetic therapy and patient-related factors associated with adherence were evaluated through a self-administered questionnaire. Socio-demographic, clinical, behavioral (self-care activities including a healthy diet, exercise or physical activity, self-monitoring of blood glucose testing, and foot care), and patients-adherence-related factors (health-care provider-patient communication; daily and social activities, and support network; alternative treatment beliefs; comorbidity, diabetes symptoms, and treatment; side effects and treatment access) were compared between the adherent and non-adherent group.

      Results

      Of 319 outpatients, 48.3% were adherent to their antidiabetic therapy. In the adjusted analysis, patient-related factors associated to adherence were exercise and physical activity self-care behavior (OR=1.26; 95%CI 1.09–1.46), treatment interference with daily activities (OR=0.27; 95%CI 0.14–0.52), not satisfied with resolution of questions by the physician (OR=0.42; 95%CI 0.19–0.94), independently to increased cardiovascular risk and insulin treatment.

      Conclusion

      A low proportion of outpatients with T2D with regular primary care were adherent to diabetes treatment and this was associated with patient-related factors like answering patients’ treatment-related questions by the physician. This information may be useful to identify patients at risk for low adherence, and to guide the design of quality-of-care strategies, like diabetes education programs to address suboptimal adherence in patients, and health-care professional communication skills training, particularly in primary care health systems.

      Keywords

      Abbreviations:

      DIABEMPIC (DIABetes EMPowerment and Improvement of Care), LMICs (Low-and middle-income countires), T2D (Type 2 diabetes)
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