Low adherence to prescribed medication in patients with non-communicable diseases (NCDs) increases risk of hospitalization, development of complication and premature mortality. Adherence is defined as the extent to which a person’s behaviour of taking medication, following diet, and/or executing lifestyle changes corresponds with agreed recommendations from the health care provider [1].

The management of diabetes mellitus is multi- pronged. Majority of patients with type 2 diabetes fail to control glycemia with diet and exercise and require pharmacotherapy-in general, initially monotherapy with oral hypoglycemic agents (OHA); however, owing to the progressive nature of the disease, most of the patients will eventually require combination therapy and ultimately injectable treatments as monotherapy or part of polytherapy. Glycemic control in type 2 diabetes is essential to prevent complications. Hence the holistic approach to the control of diabetes is vital. Adherence is directly related to various factors such as education, knowledge, economic status, forgetfulness, lack of will power & physician knowledge. Duration of the disease also bears a direct effect on the adherence of the patient to the treatment. The decline in adherence is most rapid after the first 6 months of therapy. Thus, the overall management of type 2 diabetes should address adherence as well as appropriate medications [2].

Assessing adherence to medications and its correlates among patients with non-communicable diseases (NCDs) can help in delivering targeted interventions. Non-adherence to medication plays an important role in increasing the all cause hospitalization, mortality, and out of pocket expenditure among patients with diabetes [3]. Poor adherence to recognized standards of care is the principal cause of development of complications in NCDs. Adherence to medication is essential in order to obtain full therapeutic benefit in diabetes. With this background, this study was undertaken among adults with diabetes mellitus in the urban field practice area of RajaRajeswari Medical College & Hospital (RRMCH), Bangalore.

1. To assess the socio-demographic profile of diabetic patients in Urban Field Practice Area of RajaRajeswari Medical College & Hospital, Bangalore

Out of 150 study subjects, it was observed that majority, 70(46.7%) belonged to the age group of 45-59 yrs. The proportion of males was higher, 82 (54.7%) as compared to females 68(45.3%). Literates were 95(63.3%).

Occupation-wise, majority, 86 (57.34%) were employed. 134(89.3%) were married. Majority, 98(65.3%) of the study subjects belonged to lower middle class according to Modified Kuppuswamy Classification (2019) of Socio-economic status.

Of the total, study subjects who had not used alcohol, 121 (80.7%) and those who had not used tobacco, 114 (76%) in the past one month constituted the majority. [Table 1]

Table-1: Socio-Demographic characteristics of diabetic adults in the urban field practice area of RRMCH (N= 150)

Disease duration more than 5 years was observed among 54(36%) of the study subjects. Co-morbidities was absent in majority, 112(74.7%) of the study subjects. Study subjects on twice daily regimen were found to be higher, 82 (58%) as compared to those on once daily and thrice daily treatment regimens.

High, moderate and low adherence to medication was found among 25 (16.67%), 91(60.67%) and 34 (22.66%) of the study subjects respectively.

Low adherence was observed to be higher among study subjects with disease duration of more than 5 years 20(58.8%) as compared to the study subjects in disease duration <1 & >5 years categories. Co-morbidity was absent in majority, 24(70.6%) of the study subjects with low adherence. The proportion of low adherence was found to be higher among study subjects on twice daily drug regimen as compared to once & thrice daily treatment regimens. Study subjects taking two or three medications daily constituted the majority 22(64.7%) in the low adherence category. [Table 4]

Diabetes mellitus has become an important public health concern which needs immediate attention of the healthcare professionals. Its optimum control is a major challenge to patients and poses a great burden on the health care system and national economy [2].

This study conducted among adults with diabetes mellitus on treatment consisted of details of socio-demographic characteristics, morbidity profile, treatment received and adherence to medication. In this study, 70(46.7%) of the diabetics belonged to the age group of 45-59 yrs. Similar findings were observed in the study by Shukla P et al [2] wherein the mean age of the participants was 57.52±12.33 years.

Substance abuse often compromises the glycemic control of patients further reducing their quality of life [2]. In this study, majority of the study subjects 121 (80.7%) and 114 (76%) had not used alcohol and tobacco in the past one month respectively. Similar findings were observed in the study by Thekkur P et al [5] wherein, 12.8% and 10.3% of the participants reported current use of alcohol and tobacco respectively.

Majority, 80(53.3%) had a disease duration of 1-5 yrs. However, in a study conducted at Patiala [2],

29% of the patients were diagnosed with diabetes between the period of 1-5 year. Thekkur P et al [5] observed that co-morbidities was absent in 93.2% of the participants similar to our study (74.7%). However in the study by Shukla P et al [2] at least one associated co-morbidity such as hypertension, asthma or osteoarthritis, etc. was present in 57% of the study population.

In this study, patients taking twice daily treatment regimen were found to be higher 82 (58%) however, in a study conducted at Puducherry [5], majority, 114 (40.6%) were consuming drugs only once in a day.

In the present study, patients on two to three medications daily constituted the majority 89 (57.3%) similar to the findings of Thekkur P et al [5] who observed that, of the total, 114 (40.6%) were consuming drugs only once in a day and around 164 (58.4%) had to consume two to three drugs per day.

In this study, high, moderate & low adherence to medication was found among 25(16.67%), 91(60.67%) & 34 (22.66%) of the study subjects respectively. In the study by Shukla P et al [2], analysis of MMAS- 8 item scores of patients showed that 52% of patients had low adherence, 29% had medium while 19% had high adherence to the treatment.

Arulmozhi et al [6] in a study at Puducherry using MMAS-8 scale reported low adherence to medication in 39% patients. However, in a community based cross-sectional study conducted in rural village of Kerala [7] it was observed that 74% of diabetic patients were less adherent to medication (according to MMAS-8).

The proportion of low adherence in our study was found to be higher i.e., 17 (50%) among patients aged more than 60 years. Similarly Shaimol T et al [8] observed that when the age of the patient increased, medication adherence decreased. However in the study by Thekkur P et al [5] low adherence was observed in 19 (12.8%) of the participants above 60 yrs.

Gender-wise, in a study conducted by Shaimol T et al [8] adherence was observed to be more among males (24%) as compared to females (20.8%), this finding is similar to our study. In the same study [8] the unmarried group (78.3%) showed higher adherence compared to married group (18.3%) this is in contrast to the present study.

The present study has shown that low adherence to medications was observed among 22.66% of the patients while high adherence was found in only 16.67% of the diabetic adults. Hence there is a need for targeted education programs for health care providers and for patients in order ensure that the patients obtain full benefit of the treatment which would help in improving the quality of life.

Relevance of the study: In view of the significant public health challenge posed by Diabetes Mellitus, this study highlights the importance of good adherence to the prescribed medications among the patients which would help in reducing the burden of the disease on the individual and the community.

Srividya V- Concept, design, data review, preparation & finalization of the manuscript and revising it for intellectual relevance. R. S. Neshant Balaje – Literature search, collection, analysis, interpretation & presentation of data.

Sample size was relatively small hence generalizability of this study to other population groups is limited.

We would like to express our gratitude to the members of the community residing at the urban field area of our institution.