Determinants and patterns of medication adherence among individuals with type 2 diabetes mellitus

Jakia Sultana; M. Mamun Khan; M. Nawshed Ali; Nur A. Samira; Ummat Safwat Sristy; Motasim Billah; Aqib Hossain Khan

doi:10.18203/2394-6040.ijcmph20263587

Authors

Jakia Sultana Department of Pharmacy, North South University, Dhaka, Bangladesh
M. Mamun Khan Department of Community Medicine, Sir Salimullah Medical College, Dhaka, Bangladesh
M. Nawshed Ali Department of Pharmacy, State University of Bangladesh, Narayanganj, Bangladesh
Nur A. Samira Department of Public Health, University of Southern Denmark, Denmark
Ummat Safwat Sristy Department of Epidemiology and Biostatistics, University at Albany, New York, United States of America
Motasim Billah Department of Pharmacy, Jagannath University, Dhaka, Bangladesh
Aqib Hossain Khan Department of Pharmacy, Jahangirnagar University, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263587

Keywords:

MMAS-8, Bangladesh, Polypharmacy, Healthcare access, Medication adherence, Type 2 diabetes mellitus

Abstract

Background: Medication adherence is a key determinant in the effective management of type 2 diabetes mellitus (T2DM). Poor adherence contributes to inadequate glycemic control, increased complications, and higher healthcare costs. This study aimed to assess patterns of medication adherence and associated factors among patients with T2DM in Bangladesh.

Methods: A facility-based cross-sectional study was conducted among 412 adult patients with T2DM attending selected hospitals in Gazipur and Manikganj districts from September 2024 to March 2025. Participants were selected using simple random sampling. Data were collected through face-to-face interviews using a structured questionnaire, including the validated 8-item Morisky Medication Adherence Scale (MMAS-8). Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were performed using SPSS version 26.

Results: Overall, 31.6% of participants demonstrated high adherence, 38.8% medium adherence, and 29.6% low adherence. Higher adherence was significantly associated with secondary or higher education (AOR: 2.14; 95% CI: 1.32-3.46), shorter duration of diabetes (<5 years) (AOR: 1.78; 95% CI: 1.10-2.89), good healthcare access (AOR: 2.67; 95% CI: 1.59-4.49), and living with family. Polypharmacy (AOR: 0.56; 95% CI: 0.34-0.91) and comorbidities (AOR: 0.63; 95% CI: 0.40-0.98) were negatively associated. Common barriers included forgetfulness (48.2%), financial constraints (33.5%), and lack of awareness (27.9%).

Conclusions: Medication adherence among patients with T2DM was moderate and influenced by multiple factors. Interventions focusing on patient education, improved healthcare access, and family support are essential to enhance adherence and improve outcomes in Bangladesh.

Metrics

Metrics Loading ...

References

Goyal R, Singhal M, Jialal I. Type 2 diabetes. In: StatPearls. StatPearls Publishing, Treasure Island; 2025.

Chen S, Cao Z, Chen W, Zhao J, Jiao L, Prettner K, et al. The global macroeconomic burden of diabetes mellitus. Nat Med. 2026;32(1):126-38. DOI: https://doi.org/10.1038/s41591-025-04027-5

Sugandh F, Chandio M, Raveena F, Kumar L, Karishma F, Khuwaja S, et al. Advances in the management of diabetes mellitus: a focus on personalized medicine. Cureus. 2023;15(8):e43697. DOI: https://doi.org/10.7759/cureus.43697

Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97. DOI: https://doi.org/10.1056/NEJMra050100

Pednekar P, Heller DA, Peterson AM. Association of medication adherence with hospital utilization and costs among elderly with diabetes enrolled in a state pharmaceutical assistance program. J Manag Care Spec Pharm. 2020;26(9):1099-108. DOI: https://doi.org/10.18553/jmcp.2020.26.9.1099

Kennedy-Martin T, Boye KS, Peng X. Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review. Patient Prefer Adherence. 2017;11:1103-17. DOI: https://doi.org/10.2147/PPA.S136639

Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy. 2014;7:35-44. DOI: https://doi.org/10.2147/RMHP.S19801

Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-9. DOI: https://doi.org/10.5001/omj.2011.38

Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag. 2008;4(1):269-86. DOI: https://doi.org/10.2147/TCRM.S1458

Sadeghi D. Improving adherence to treatment in patients with diabetes: Practical strategies. Endocrinol Diabetes Metab. 2024;7(4):e00512. DOI: https://doi.org/10.1002/edm2.512

Huang YM, Shiyanbola OO, Chan HY, Smith PD. Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic. Postgrad Med. 2020;132(4):328-36. DOI: https://doi.org/10.1080/00325481.2020.1749499

Schillinger D, Machtinger EL, Wang F, Palacios J, Rodriguez M, Bindman A. Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment. J Health Commun. 2006;11(7):651-64. DOI: https://doi.org/10.1080/10810730600934500

Esfanjani AT, Zare M, Mardi A, Haghighian-Roudsari A, Rafraf M, Iranparvar-Alamdari M, et al. Effect of a medication adherence education intervention on clinical outcomes in adults with type 2 diabetes mellitus: a randomized controlled trial study. Endocr Metab Immune Disord Drug Targets. 2025;25. DOI: https://doi.org/10.2174/0118715303335172241216102015

Bashir M, Ijaz S, Farooq U. Diabetes educator-led education intervention to improve medication adherence and quality of life in type 2 diabetes patients: a pre- and post-analysis. Romanian J Diabetes Nutr Metab Diseases. 2025;32(2):119-27.

Majeed A, Rehman M, Hussain I, Imran I, Saleem MU, Saeed H, et al. The impact of treatment adherence on quality of life among type 2 diabetes mellitus patients- findings from a cross-sectional study. Patient Prefer Adher. 2021;15:475-81. DOI: https://doi.org/10.2147/PPA.S295012

Diabetes Atlas. 2024. IDF Diabetes Atlas. Available from: https://www.diabetesatlas.org. Accessed on 3 June 2026.

Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adher. 2016;10:1299-307. DOI: https://doi.org/10.2147/PPA.S106821

Capoccia K, Odegard PS, Letassy N. Medication adherence with diabetes medication: a systematic review of the literature. Diabetes Educ. 2016;42(1):34-71. DOI: https://doi.org/10.1177/0145721715619038

Sharma T, Kalra J, Dhasmana DC, Basera H. Poor adherence to treatment: a major challenge in diabetes. J Immunol Clin Microbiol. 2014;15:26-9.

Kassaw AT, Tarekegn TB, Derbie A, Ashagrie G, Girmaw F, Mengesha A. Non-adherence to antidiabetic medications and associated factors among adult type 2 diabetes mellitus patients in Northeast Ethiopia: institutional based cross-sectional study. BMJ Open. 2025;15(4):e093413. DOI: https://doi.org/10.1136/bmjopen-2024-093413

Alqarni AM, Alrahbeni T, Qarni AA, Qarni HMA. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia - a cross-sectional survey. Patient Prefer Adher. 2019;13:63-71. DOI: https://doi.org/10.2147/PPA.S176355

Kassahun T, Gesesew H, Mwanri L, Eshetie T. Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey. BMC Endocr Disord. 2016;16(1):28. DOI: https://doi.org/10.1186/s12902-016-0114-x

Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119(23):3028-35. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.768986

Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008;31(3):213-24. DOI: https://doi.org/10.1007/s10865-007-9147-y

Mayberry LS, Osborn CY. Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Diabetes Care. 2012;35(6):1239-45. DOI: https://doi.org/10.2337/dc11-2103

Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93(1):1-9. DOI: https://doi.org/10.1016/j.diabres.2011.02.002

Kassahun T, Eshetie T, Gesesew H. Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: a cross-sectional survey in Ethiopia. BMC Res Notes. 2016;9(1):78. DOI: https://doi.org/10.1186/s13104-016-1896-7