Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria
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Objective To describe the pattern of anti-diabetic drug prescribing; ascertain the level of glycemic control, adherence with prescribed anti-diabetic medications, and diabetes self management practices among patients with type-2 diabetes in a tertiary care setting in Nigeria. Setting University College Hospital (UCH); a 900 bed teaching hospital with medical residents located in Ibadan, southwestern Nigeria. Method The study consisted of two phases. A cross-sectional review of randomly selected 200 case notes of type 2 diabetic patients that attended the Endocrinology clinic over 3 month; and crosssectional interviews, with a pre-tested Adherence and Self-Management Monitoring Tool (ASMMT), of 200 consecutive patients that presented their drug prescriptions at the satellite pharmacy unit over a 4 week period at a 900-bed teaching hospital located in Ibadan, South-Western Nigeria. Results Oral Hypoglycemic Agents (OHA) were prescribed for 86% (171) of cohorts while insulin and OHA was prescribed in 14% (29). About 70.8% (121) of patients on OHA were on combination therapy. The most frequently prescribed OHA combination was glibenclamide and metformin (95.8%). Glibenclamide was prescribed as twice daily regimen in 69% of cohorts. The most frequently documented side effect was hypoglycemia (60.3%). Only 44% (88) of cohorts had adequate glycemic control; of these, 93% (82) were adjudged adherent with prescribed anti-diabetic drugs. Interviews with the structured ASMMT revealed that 59% of patients were non-adherent with the previous anti-diabetic drugs due to lack of finance (51.7%); side effects (34.5%); perceived inefficacy of prescribed anti-diabetic drugs leading to self-medication with local herbs (13.8%). Only 20% of non-adherent patients claimed disclosure to physicians during consultation. The identified factors for non-disclosure were lack of privacy during consultation (58%); and short consultation time (42%). The knowledge and practice of critical components of diabetes self-management behaviours were generally low among the cohort studied. However, it was significantly higher among patient judged adherent with their prescribed anti-diabetic medications (P < 0.05). Conclusion Majority of patients with type 2 diabetes in an ambulatory tertiary care setting in Nigeria are managed with OHA combinations, mainly glibenclamide and metformin. While the current prescribing strategy achieved glycemic control in about one third of patients, majority are still not meeting the recommended blood glucose targets due to poor adherence with prescribed drug regimen, and poor knowledge and practice of successful self-management.
KeywordsAdherence Anti-glycemic drugs Blood glucose Diabetes mellitus type 2 Nigeria Prescribing Self-management
We acknowledge the guidance and support of Prof. Fola Tayo, Department of Clinical Pharmacy & Biopharmacy, Faculty of Pharmacy, University of Lagos, Lagos, Nigeria.
Conflicts of Interest
- 2.World Health Organisation. Diabetes mellitus fact sheet, Number 238. 2002. http://www.who.int/diabetes. Cited 13 Aug 2006.
- 13.Turner RC, Cull CA, Fright V, Holman RR, for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic control with diet, sulfonylurea, metformin or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies. JAMA. 1999;281:2005–12.Google Scholar
- 15.Chuang LM, Tsai ST, Huang BY, Tai TY; Diabcare-Asia 1998 Study Group. The status of diabetes control in Asia- a cross-sectional survey of 24,317 patients with diabetes mellitus in 1998. Diabetes Med. 2002;19:978–85.Google Scholar
- 19.Ndububa DA, Erhabor GE. Diabetic mortalities in Ilesa, Nigeria: a retrospective study. Cent Afr J Med. 1994;40(10):28–9.Google Scholar
- 28.British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary, March 2005. London: BMJ Publishing Group and Royal Pharmaceutical Society of Great Britain; 2005.Google Scholar
- 29.American Society of Health-System Pharmacists/American Hospital Formulary Services (ASHP/AHFS). AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2002.Google Scholar
- 34.Kolawole BA, Adegbenro C, Ayoola ZO, Opebiyi B. Diabetes mellitus related treatment goals: awareness and attainment in the Ife-Ijesha zone of south-western Nigeria. Afr J Med Med Sci. 2005;34(4):389–94.Google Scholar
- 35.United Nation Development Programme (UNDP). Eye of the needle—Nigeria 2000. New York, USA: Human Development Reports; 2000.Google Scholar
- 37.Talabi OA. A questionnaire survey of senior house officers/registrars response to their training at University College Hospital, Ibadan. West Afr J Med. 2003;22(2):108–11.Google Scholar
- 38.Ndom RJE, Makanjuola AB. Perceived stress factors among resident doctors in a Nigerian teaching hospital. West Afr J Med. 2004;23(3):78–81.Google Scholar
- 42.Campbell RK. Role of the pharmacists in diabetes management. Am J Health Syst Pharm. 2002;59(9):18–21.Google Scholar
- 43.Acheampong JW, Boateng KA, Eghan BA, Story P, Parry EHO, Tomlinson S. The impact of diabetes nurses in the Komfo Anokye Teaching Hospital, Ghana. Diabetes Int. 2000;10:81–3.Google Scholar
- 44.Berthoet N, Favrat B, Fallab-Stubi CL, Brunner HR, Burnier M. Why objective monitoring of compliance is important in management of hypertension. J Clin Hypertens. 2000;2:210–4.Google Scholar
- 45.Fodor GJ, Kotrec M, BacsKai K, et al. Is interview a reliable method to verify compliance with antihypertensive therapy? An international central-European study. J Hum Hypertens. 2005;23:1261–6.Google Scholar