Adherence to management plans in patients with type 2 diabetes mellitus

INTRODUCTION The aim of diabetes treatment is to keep the life quality higher and to prevent the development of complications. Researchers have focused on patient adherence to treatment in the last 10 years. Many scales have been developed for this. The most commonly used scale is eight-item Morisky Medication Adherence Scale (MMAS-8) All scales focus on adherence to drug treatments and they are not diabetes-specific. In patients with type 2 diabetes, lifestyle modification is as important as drug therapy. The aim of the study is to evaluate the patient adherence to management plans in patients with type 2 diabetes in Aydın and to identify barriers against and facilitators for adherence. METHODS The study was carried out between September 2016 and December 2017 with diabetic patients at the Endocrinology Polyclinics of Adnan Menderes University Hospital and Number 1 Family Health Center in Aydın. The sample size was calculated as 384. A questionnaire was developed to collect demographic and diabetes-related data. Morisky Medication Adherence Scale was used for treatment compliance. Three new questions have been developed to measure adherence to lifestyle changes. The survey was conducted face to face by a researcher (NT). In addition to descriptive statistics, Spearman and Kendall's Tau_B correlations were used in correlation analyses and Mann Whitney U test was used in group comparisons in the analysis of the data. Multiple logistic regression analyzes were performed to determine the associated variables. The distribution normality of continuous variables was assessed by Shapiro-Wilk test. Significance level was accepted as p<0.05. RESULTS Of the 308 diabetic patients participating in the study, 54.2% were female and the mean age was 59,1±10,6 years. Participants having diabetes mellitus for 10,7±7,5 years on average had diabetic medications of 3,8±1,6 doses per day and overall medications of 7,6±3,9 doses per day. Mean fasting blood glucose (FBG) was 162,5±68,8 mg/dl and mean HbA1c was 7,3±2,0%. Mean total MMAS score of the participants was 5,7±1,6. 58.8% of the participants (181 people) were in compliance with treatment according to the Morisky compliance measure. When we also considered blood sugar control (together with the process and output components of treatment compliance), the compliance rate fell to 34.4% (106 people). Binary analyzes showed that treatment compliance was better for those with education levels 9 years and over, regular follow-up areas, non-insulin users, those not using home medications, blood glucose control, those with macrovascular complications, dieters and those exercising. According to the created logistic regression model; blood glucose compliance was 4.3 times greater in patients under control than in controls, 6.3 times more in stimulation than those who did not observe the recommendations (p> 0.05). CONCLUSION According to the results of the study, those who comply with the recommendations are also in compliance with the treatment. Increased compliance with treatment increases glycemic control. Keywords: diabetes, adherence treatment, Morisky scale