Patients' perception vital to medication adherence for type-2 diabetes

Tackling risks from non-communicable diseases (NCD), particularly diabetes, in a resource-poor setting like Bangladesh is a daunting challenge. The International Diabetic Federation (IDF) estimates that by 2030, Bangladesh would emerge as one of the countries with largest number of people with type 2 diabetes.

Type 2 diabetes and pre-diabetes are increasing globally and often remain undiagnosed long after onset in low-income settings. Bangladesh has been shown to perform poorly in efforts to reduce NCDs, according to a newly developed NCD scorecard. This rise is due to an increase in sedentary lifestyles, rapid urbanization and (most importantly) non–adherence to medication.

Keeping this at the forefront of combating NCDs, Principal Investigator, Dr Shariful Islam,Senior Research Investigator from the non-communicable diseases division at icddr,b and colleagues embarked on a study to explore patients’ perspective on medication adherence to diabetes type 2 in Bangladesh.

Patients with diabetes have shown poor understanding of diabetes medications. Photo: GMB Akash / icddr,b

The study used  in-depth interviews with type 2 diabetes patients at a Dhaka based hospital in Bangladesh. This methodological approach allowed a more flexible exploration of respondents’ experience and attitudes.

Dr Islam says, ‘Diabetes is a major public health problem in Bangladesh and causes significant costs and healthcare burden for the patients, society and nation. It is imperative to understand patients’ perspective on diabetes and its importance to adherence to medications for glycemic control in order to promote optimum diabetes care.’

The participants were asked about their knowledge and perception of diabetes, including its causes, long-term impact and how diabetes may be controlled. Results revealed that despite receiving treatment in a specialized diabetes center, participants often had misconceptions about medication use. These misconceptions causedelayin seeking treatment, resulting in long term ill health and negatively impacting the individual, the family and society at large. Moreover, adherence to medically recommended dietary plans and exercise regimens was poor among the majority of participants. The study also showed that dietary restrictions might create psychological stress on  patients which, subsequently, might lead to depression.

A previous study among patients with diabetes in Bangladesh and among migrant Bangladeshis in the UK also identified poor understanding among patients on the connection between diabetes and healthy lifestyle.

Dr Islam acknowledges the limitations of this study. It is a qualitative study that only examines a small number of patients visiting the capital city, where they had ready access to specialised physicians and dietitians. Future studies should try and capture a larger, more representative population sample. Furthermore, the current study did not collect perspectives from healthcare providers on medication adherence - something that could be addressed in future studies to build a more holistic perspective.

Overall the study finds that patient knowledge and perception are key factors that influence medication adherence. This suggests that proper diabetes management requires greater efforts to educate diabetics about the disease and to ensure that patients carry out proper self-management.

Prof Anwar Islam co author of this paper says, ‘This study identified a number of key themes that could be useful in designing interventions aimed at further enhancing diabetes knowledge, self-management and medication adherence among patients with type 2 diabetes in Bangladesh. Healthcare providers should explore to better understand patients’ perspective on diabetes, medication beliefs, identify psychological stress and provide more effective health education interventions to enhance medication adherence.’

Innovations using information technology (including novel methods such as mobile phone interventions) offer a potentially revolutionary and a possible efficient and cost-effective paradigm for prevention and management of diabetes and other NCDsin Bangladesh.The results highlighted here will be vital to the proper design and implementation of these novel behavioral modification paradigms for public health and NCDs management.

This study was funded by Center for International Health, University of Munich, Germany.