Evaluation of the Beliefs About Medication, Adherence and Self-Care Knowledge Among Type 2 Diabetic Patients in a Nigerian Teaching Hospital

Evaluation of the Beliefs About Medication, Adherence and Self-Care Knowledge Among Type 2 Diabetic Patients in a Nigerian Teaching Hospital.

ABSTRACT

This study was carried to evaluate the beliefs about medicines, adherence and self care management knowledge among type 2 diabetes mellitus patients in a teaching hospital in south eastern Nigeria.

A questionnaire consisting of standardized survey instruments (DSCK–30, MMAS, BMQ and factors affecting knowledge acquisition and barriers to adherence) were used for this study.

The questionnaire was interviewer assisted and administered to a cross section of 480 randomly selected ambulatory adult patients (18 years and above) who were attending the endocrinology clinic in the teaching hospital used for this study.

Data was presented in frequency tables. Bivariate analysis was used to test the correlations among variables. Chi – square test was used to test for independence of variables.

413 participated in the study. The bivariate analysis showed a correlation between patients knowledge of diabetes and adherence (0.776, P = 0.000). Chi Square tests showed an association between occupation and monthly income with the categorical adherence of the patients.

No association was found between age, gender, family history, duration of diabetes with categorical adherence for this study.

The overall adherence of the patients on the Morisky Medication Adherence Scale (MMAS) was 6.2. Most of the respondents reported side effects (75.3%), forgetfulness (79%), cost of medications (84%), polypharmacy/pillburden (72.4%) and depression 77.0% as major barriers to adherence to their medications.

Most of the respondents reported lack of time on the part of the patients, lack of time on the part of the health care professionals and access to health care as major barriers to acquiring diabetes care knowledge.

There are many factors that lead to medication non- adherence and acquisition of diabetes self care knowledge. Cost of medications, forgetfulness, polypharmacy, depression and side effects were the major factors reported in this study. A lot of work should be done in this area to improve patients’ adherence to medications for better prognostic outcomes.

INTRODUCTION

Diabetes is a group of metabolic diseases¹ in which a person has high blood sugar, either because the body does not produce enough insulin, or cells do not respond to the insulin that is produced.² This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydyspsia (increased thirst) and polyphagia (increased hunger).

There are three main types of diabetes mellitus (DM): Type 1 DM results from the body’s failure to produce insulin and presently requires the person to inject insulin or wear an insulin pump. This form  was previously referred to as “insulin-dependent diabetes mellitus” (IDDM) or “Juvenile diabetes”.

Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.

This form was previously referred to as non-insulin dependent diabetes mellitus (NIDDM) or “adult onset diabetes”. The third main form, gestational diabetes occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 Diabetes mellitus.

All forms of diabetes are treatable since the discovery of insulin in 1921, and type 2 diabetes may be controlled with oral medications. Both types 1 and 2 are chronic conditions that cannot be cured but can be adequately managed as to allow the patients lead normal lives.

Pancreas transplants have been tried with limited success in types 1 DM; gastric bye pass surgery has been performed in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery. Diabetes without proper treatments can cause  many complications.

Acute complications include hyperglycemia, diabetic ketoacidosis, or non-ketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and diabetic retinopathy (retinal damage).

Adequate treatment of diabetes is thus important, as well as blood pressure control and life style modifications such as smoking cessation and maintaining a healthy body weight.

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