Community based Study on Drug adherence among diabetic patients in a rural area of north India

Sunday, 17 August 2014
Exhibit hall (Dena'ina Center)
Puneet Misra, MD , All India Institute of Medical Sciences, New Delhi, India
Rahul Srivastava, MD , All India Institute of Medical Sciences, New Delhi, India
Shashi Kant, MD , All India Institute of Medical Sciences, New Delhi, India
Harshal Salve, MD , All India Institute of Medical Sciences, New Delhi, India
K Anand, MD , All India Institute of Medical Sciences, New Delhi, India
INTRODUCTION:  India is set to become the global capital of diabetes with the disease increasing across geographic, ethnic and administrative boundaries. Adherence is the single most important modifiable factor that compromises treatment outcome but still non-adherence to medical regimens is a global problem. The present study was conducted to assess the prevalence of adherence and its association with various socio-demographic factors. 

METHODS:  

This is a cross-sectional study conducted in a rural community of north India; Comprehensive Rural Health Services Project (CRHSP), Ballabgarh- an HDSS site. From a list of all self reported diabetics (aged ≥18 years) from HDSS, 400 were randomly selected. Trained field investigators visited the houses and interviewed them on various aspects, which consisted of; drug prescription and intake, socio-demographic factors, health seeking behaviors and disease status. Height, weight and blood pressure were recorded. Blood samples were collected to measure HbA1c levels.    

RESULTS:  A total of 371 self reported diabetic patients were interviewed for drug adherence, amongst them 113 (30.4%) patient did not take any medication since last one month. Amongst 258 (69.5%) patients, who were taking treatment, 146 (39.4, 95%CI: 34.5-44.4) were found to have 100% drug adherence rate. Tobacco (p=0.03) and alcohol (p=0.04) use were significantly associated with drug adherence on bivariate analysis. Drug adherence was highest for injectables in comparison to oral hypoglycemic.  Drug adherence rate was higher in group with HbA1c level more than 6.4gm% in comparison to group with HbA1c level less than 5.7 gm% (27.5%).

CONCLUSIONS:  

A high proportion of diabetic patients were not adhering to the treatment prescribed to them by their consulting doctors. Adhering to a treatment is a multi-factorial subject and requires a multi-pronged approach. Focus of the policy makers must emphasize towards provision of treatment and its compliance and not just screening and diagnosing diabetic cases.   

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