Compliance to Pharmacotherapy and Lifestyle Modification Among Diabetic Patients at Gatundu Level 5 Hospital, Kiambu County, Kenya

Abstract

Background: Diabetes Mellitus together with its complications is becoming more prevalent globally. Complications of diabetes result  from poor glycemic control which can be due to non-compliance to medication and lifestyle modification.

Objectives: To determine the  types pharmacotherapies used by patients with diabetes at Gatundu L5H, to assess their level of adherence to drugs and lifestyle  modification as well as to evaluate the reasons for nonadherence to pharmacotherapy.

Methodology: This was a cross-sectional survey  conducted between October 2022 and December, 2022. Systematically sampled diabetic patients (n=310) were interviewed using a  structured questionnaire. A validated Morisky Green Levine Medication Adherence Scale (MGLS) and a two-point adherence scale were  used to determine adherence to medication and lifestyle modification respectively. Descriptive reporting was done and quantitative data  analyzed using chisquare test (p <0.05).

Results: The adherence level was high with 70% of the patients scoring an MGLS score of zero (0)  and only 15% scoring poorly at a MGLS score of 3-4. Seventy-eight percent spent between Kshs.1000- 5000 (US$7 – 36) monthly on  medications. Poor adherence to medication was directly associated with poor-adherence to recommended lifestyle modification. Those  with poor adherence were likely to be on insulin therapy or a high-dosing frequency of OHAs.

Conclusion: Biguanides and sulphonyureas were the most prescribed medications. The adherence level to pharmacotherapy was high but low for lifestyle modification. There was a positive correlation between non-adherence to pharmacotherapy and lifestyle interventions. Insulin therapy and pill-burden were  independently linked to poor adherence to pharmacotherapy.

Recommendations: We recommend the following; (i) Patient education on  adherence and ways to improve it, (ii) Aggressive follow up of patients on insulin therapy via phone calls or engaging Community  Health Promoters (CHP), (iii) Encourage use of Fixed Drug Combinations (FDC) to reduce the pill burden, (iv) Health education regarding  lifestyle modifications and footwear, (v) Healthcare providers at the hospital to be educated on foot care examination.