Mohammed Adel Gassab, Yaseen Nassar Taha, AlWaeli Dheyaa K
Department of Medicine, Endocrine and Metabolism Division, University of Thi-Qar, College of Medicine, Thi-Qar Specialized Diabetes, Endocrine, and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq.
Faiha Specialized Diabetes, Endocrine and Metabolism Center, University of Basrah, Basrah, Iraq.
J Diabetes Res. 2025 May 16;2025:6659722. doi: 10.1155/jdr/6659722. eCollection 2025.
This research investigates the adherence levels to diabetes treatment among patients and explores the factors influencing adherence, glycemic control, and the occurrence of diabetes-related complications. A cross-sectional study involving 296 diabetes patients was conducted to evaluate their demographic and clinical profiles, treatment strategies, and adherence levels using the eight-item Morisky Medication Adherence Scale (MMAS-8). Statistical analyses identified variables affecting adherence and their relationships with glycemic control and complications. The study population comprised 56% men, with an average age of 49.4 years. Obesity was observed in 24.3% of participants, while the median disease duration was 5 years. The average HbA1c level was 8.4%. Microvascular complications were present in 48.6% of patients, and 18.2% experienced macrovascular complications. Most patients were prescribed oral antidiabetic medications (OAD), with 25% receiving insulin therapy. Adherence rates were suboptimal, with only 3.4% achieving good adherence, 30.4% moderate adherence, and 66.2% poor adherence. Men had higher rates of poor adherence compared to women (72.3% vs. 58.5%). Interestingly, adherence was better in patients with a longer disease duration and a higher body mass index (BMI). The study further examined adherence's impact on glycemic outcomes, finding that poor adherence strongly correlated with elevated HbA1c levels. Among individuals with HbA1c ≥ 7%, 70.5% exhibited poor adherence, whereas 40% of patients with good adherence still had suboptimal glycemic control. Conversely, among those with HbA1c < 7%, 24.5% demonstrated poor adherence compared to 40% with good adherence. Random blood sugar (RBS) levels were significantly higher in poorly adherent patients (237 mg/dL) versus those with good adherence (141 mg/dL). Although adherence was not statistically linked to complication prevalence, patients with reported adherence challenges were more prone to both microvascular and macrovascular complications. Different treatment regimens were also analyzed, revealing that sulfonylureas (SUs) were associated with poor adherence (85%), while sodium-glucose cotransporter 2 inhibitors (SGLT2i) showed better adherence rates (16.7%). Missed doses were strongly linked to poor glycemic outcomes but had a lesser impact on complication development. These findings underscore the need for individualized strategies to enhance adherence and optimize glycemic control, ultimately reducing diabetes-related complications.
本研究调查了患者对糖尿病治疗的依从性水平，并探讨了影响依从性、血糖控制以及糖尿病相关并发症发生的因素。开展了一项涉及296名糖尿病患者的横断面研究，以使用八项Morisky药物依从性量表（MMAS-8）评估他们的人口统计学和临床特征、治疗策略及依从性水平。统计分析确定了影响依从性的变量及其与血糖控制和并发症的关系。研究人群中男性占56%，平均年龄为49.4岁。24.3%的参与者存在肥胖，疾病持续时间中位数为5年。平均糖化血红蛋白（HbA1c）水平为8.4%。48.6%的患者存在微血管并发症，18.2%的患者发生大血管并发症。大多数患者被开具口服降糖药（OAD），25%的患者接受胰岛素治疗。依从率不理想，只有3.4%的患者达到良好依从，30.4%为中等依从，66.2%为依从性差。男性的依从性差率高于女性（72.3%对58.5%）。有趣的是，疾病持续时间较长和体重指数（BMI）较高的患者依从性更好。该研究进一步考察了依从性对血糖结果的影响，发现依从性差与HbA1c水平升高密切相关。在HbA1c≥7%的个体中，70.5%表现为依从性差，而40%依从性良好的患者血糖控制仍不理想。相反，在HbA1c<7%的人群中，24.5%表现为依从性差，而依从性良好的为40%。依从性差的患者随机血糖（RBS）水平（237mg/dL）显著高于依从性好的患者（141mg/dL）。虽然依从性与并发症患病率无统计学关联，但报告有依从性问题的患者更易发生微血管和大血管并发症。还对不同治疗方案进行了分析，结果显示磺脲类药物（SUs）与依从性差相关（85%），而钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的依从率较好（16.7%）。漏服药物与血糖结果不佳密切相关，但对并发症发生的影响较小。这些发现强调了需要采取个体化策略来提高依从性并优化血糖控制，最终减少糖尿病相关并发症。
