Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2018; 9(5): 72-79
Published online May 15, 2018. doi: 10.4239/wjd.v9.i5.72
Adherence to self-care practices, glycemic status and influencing factors in diabetes patients in a tertiary care hospital in Delhi
Saurav Basu, Suneela Garg, Nandini Sharma, M Meghachandra Singh, Sandeep Garg
Saurav Basu, Suneela Garg, Nandini Sharma, M Meghachandra Singh, Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
Sandeep Garg, Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India
Author contributions: All authors contributed to study conception, design and approval of the final manuscript; Basu S contributed to data acquisition, data analysis, interpretation and writing of article; Garg S, Sharma N and Singh MM contributed to data analysis, interpretation, editing, reviewing; Garg S contributed to interpretation, editing, reviewing.
Institutional review board statement: Institutional ethical clearance was granted by the Institutional Ethics Committee of the hospital.
Informed consent statement: Written and informed consent was taken from all the subjects prior to enrolment in the study.
Conflict-of-interest statement: Dr. Basu has nothing to disclose.
STROBE statement: STROBE statement guidelines have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Saurav Basu, MBBS, Doctor, Department of Community Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, India. saurav.basu.mph@gmail.com
Telephone: +91-84-47527452
Received: March 6, 2018
Peer-review started: March 7, 2018
First decision: April 2, 2018
Revised: April 7, 2018
Accepted: April 15, 2018
Article in press: April 15, 2018
Published online: May 15, 2018
Processing time: 100 Days and 8.8 Hours
Abstract
AIM

To assess the adherence to self-care practices, glycemic status and influencing factors in diabetes patients.

METHODS

This was a cross-sectional observational analysis of baseline data from a quasi-experimental study conducted among 375 diabetic patients aged between 18 to 65 years at a major public tertiary care centre in New Delhi, India during February-September’ 2016. The Summary of Diabetes Self-care activities measure was used to assess medical adherence in diabetic patients. Open ended questions were used to identify facilitators and inhibitors of medical adherence.

RESULTS

Mean age of the study subjects was 49.7 ± 10.2 years. A total of 201 men and 174 women were enrolled in the study. Three hundred nine (82.4%) subjects were adherent to their intake of anti-diabetic medication. On binary logistic regression, education level below primary school completion and absence of hypertension comorbidity were found to be independent predictors of medication non-adherence. Sociocultural resistance was an important factor impeding outdoor exercise among younger women. Knowledge of diabetes in the study subjects was low with mean score of 3.1 ± 2 (maximum score = 10). Suboptimal glycemic control was found in 259 (69%) subjects which was significantly more likely in patients on Insulin therapy compared to those on Oral Hypoglycemic agents alone (P < 0.006).

DISCUSSION

Our study found a large gap existed between self-reported medication adherence and glycemic control. This suggests the need for enhanced physician focus for diabetic patient management.

Keywords: Diabetes; Adherence; Glycemic control; Insulin; India

Core tip: A cross sectional analysis was conducted in 375 adult diabetic patients in the outpatient settings of a major tertiary care government hospital in Delhi (2016). A total of 309 (82.4%) subjects reported are adherent to their prescribed anti-diabetic medication. However, optimal glycemic control was achieved by only 116 (31%) subjects. These findings suggest the presence of a high burden of clinical inertia. Furthermore, patients on insulin therapy despite reporting higher medication adherence comprised a significantly higher proportion with suboptimal glycemic control compared to those are not on insulin therapy indicating the need to effectively validate patient administration of insulin.