Mroueh Lara, Ayoub Dana, El-Hajj Maya, Awada Sanaa, Rachidi Samar, Zein Salam, Al-Hajje Amal
Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
Pharm Pract (Granada). 2018 Oct-Dec;16(4):1291. doi: 10.18549/PharmPract.2018.04.1291. Epub 2018 Dec 4.
Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications.
The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence.
A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20.
Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively).
Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence.
2型糖尿病被视为主要的公共卫生问题之一。治疗依从性差会导致治疗效果不佳、血糖控制不良以及发生糖尿病并发症的风险增加。
本研究旨在评估黎巴嫩2型糖尿病患者口服抗糖尿病药物的依从性，并评估导致低依从性的因素。
在黎巴嫩贝鲁特的两家医院和四家私人诊所的门诊内分泌科进行了一项横断面研究。由经过培训的药剂师使用结构完善的问卷收集数据。依从性水平通过黎巴嫩药物依从性量表（LMAS - 14）进行测量。使用SPSS 20版进行双变量和多变量分析。
总体而言，245名患者纳入研究，其中大多数为女性（54.3%）且肥胖（47.8%）。只有29%的参与者血糖得到控制（糖化血红蛋白<7%），31.8%的受试者药物依从性高，相比之下68.2%的受试者依从性低。每天工作时间增加与口服抗糖尿病药物依从性降低相关（比值比=0.31；95%置信区间0.11:0.88；p = 0.029）。与治疗依从性降低显著相关的其他因素包括健忘、药物成本高、治疗方案复杂、出现副作用以及认为治疗无效。推迟看医生也会降低口服抗糖尿病药物的依从概率（比值比=0.36；95%置信区间0.15:0.86；p = 0.022）。低血糖/高血糖时漏服或加倍服药剂量以及治疗负担感也会降低药物依从性（分别为比值比=0.09；95%置信区间0.02:0.34；p = 0.001，以及比值比=0.04；95%置信区间0.01:0.13；p<0.001）。
黎巴嫩患者口服抗糖尿病药物的依从性较低，这导致血糖控制不佳并增加糖尿病并发症。包括患者教育策略在内的干预项目对于提高药物依从性至关重要。
