الفهرس 
INTRODUCTION& AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is one of the major non communicable diseases which are growing very fast in this modern era. The International Diabetes Federation (IDF) has identified Egypt as the ninth leading country in the world for the number of patients with T2D. The prevalence of T2D in Egypt was almost tripled over the past two decades.
Diabetes and its associated complications represent a major healthcare burden worldwide and a major challenge to patients, health care systems and national economies. Individuals with uncontrolled diabetes are at a greater risk of developing long-term microvascular and macrovascular complications that lead to damage of end organs such as kidney, heart, brain, and eyes and affect direct and indirect healthcare costs and overall quality of life.
The prevalence of DM is growing rapidly worldwide and is reaching epidemic proportions. It is estimated that there are currently 285 million people with diabetes worldwide and this number is set to increase to 438 million by the year 2030 . Moreover, recent data from the International Diabetes Federation (IDF) suggest that previous estimates have already been exceeded, with a prevalence of 415 million by 2015 and estimated to reach 642 million by 2040 .
Adherence to the medication imposes important therapeutic and economic implications in diabetics .Drug adherence is defined as the extent to which patient takes the medications being prescribed by his health care provider .
Adherence to antidiabetic drugs is associated with better glycaemic control, reduced risk of diabetes complications and reduced economic burden. Hence, surveying compliance on antidiabetic medications and factors affecting it, is a great issue to be studied to identify barriers that will help in adapting appropriate tools to overcome and improve medication adherence.
Non- adherence may be primary non-adherence or non-compliance during treatment. Primary non- adherence refers to those patients who receive prescription but fail to obtain medications from the beginning, its incidence has been reported to be 31% .A WHO report has shown that in developed countries, the rate of non-compliance in patients with chronic disease like DM is about 50% and it could be even higher in developing countries .There are various factors which influence non-compliance which may be patient-centered, therapy related, health care system related, social and economic factors or disease factors.
The aim of this study was to determine the magnitude of nonadherence and its contributing factors among diabetic patients attending family medicine centers at El-Balyana district ; Sohag governorate.
We assessed the patients’ responses using the 8-item Morisky adherence predictor scale, results revealed that 44.5% of the patients showed good adherence with prescribed medications, whereas 55.5% had poor adherence.
Data entry and analysis were done using SPSS version 16.0. The calculation of frequency and percent¬ages for the classified data, mean, and standard deviations were obtained. While statistical differences between the classes were done with chi-square test and fisher exact test and final binary logistic regression model was done to show the final factors affecting poor compliance. P-value at or below 0.05 was considered significant.
Our results were presented in groups of tables; generally as regard patients’ socio-demographic criteria : The majority of the studied population live at rural areas (96.5%).
Thirty percent of the studied diabetic patients are above 60 years, and slight more than double of them are between 40 and 60 years, while those who are below 40 years represent the fewer category (8.2%). Fifty six percent of the studied population are females.
Younger patients below 40 are found to be more compliant to their antidiabetic medications than older patients above 60 (66.7% versus 20.8%).
As regard the educational level, 48.5% of the studied group can read and write, 30.2% finished their primary education. Only 6.5% of the studied population finished their secondary education or joined the college, high education was found to be associated with good compliance; as the majority of illiterate patient or those who can read and write have poor compliance to their treatment (91.5% and 70.1% respectively) while only one fourth of those with 2ry education or higher have poor compliance.
In the current study we found that hypertension is the most common associated comorbid disease in the studied diabetic people (45.5%), followed by visual problems (32%) then cardiac diseases come in order (16%).
There was a significant association between compliance and having comorbid diseases. Over 90% of those with associated diseases are poor compliant patients while over 90% of those with no associated diseases are good compliant patients.
Regarding the type of antidiabetic medication, 56% of the studied population are on oral hypoglycemic drugs compared to 16% on insulin and 28% on both oral hypoglycemic and insulin and none of them uses alternative medicine to control diabetes, over 75% of them have financial issues with the price of their antidiabetic medications and found at least some of the drugs unaffordable.
The studied population are classified into two groups according to their answers to the 8 items Morisky score. Forty four and half percent of the studied population are considered to be good compliant patients to their antidiabetic medications versus 55.5% whose compliance to their antidiabetic medications is poor.
Regarding drug modality, it is found that patients on insulin have better compliance compared to those on oral hypoglycemic drugs or those on both insulin or oral hypoglycemic (53.1% vs. 50.9% vs. 26.8% respectively).
More than 3/4 of those Who suffer from treatment side effects have poor compliance to antidiabetic medications while only 12.8% of those who don’t suffer from any side effects have poor compliance.
The mean level of HA1C in the group with good compliance to their antidiabetic medications was 5.35% versus a mean of 10.54% in the group of poor compliance.
In the final regression model, it is found that male, illiterate, overweight or obese patients who work as governmental employee have more risk to be non-compliant to their treatment. Patients who have had health education in the last 6 m are more liable to be more compliant.
Conclusion
Non-adherance to medications in Type 2 DM patients is due to inadequate patient knowledge and awareness about the importance of adherence in the diabetes management. Therefore, there is a definite need to improve patient adherence by improving the health care system and health education to patients and their families.
The level of adherence to medication in diabetes mellitus patients in El-balyana district was found to be suboptimal. The findings point toward the need for better management of primary health care providers’ approaches to individual patients, by taking into account their medication adherence levels. Better identification of patients’ level of adherence remains essential for successful diabetes treatment.
An improvement with medication adherence may be achieved through continuing patient education about the disease, improvement of patients’ socio-economical levels, encouraging patients to monitor their blood glucose level regularly, simplifying drug regimen with decreasing the number of drug taken as can as possible as well as reducing in the medication cost which is considered as a new strategy of Ministry of Health in Egypt nowadays. This strategy aimed to optimize medication costs for the majority of chronically ill patients and this may give a sound regarding adherence to medication in the near future .
Recommendation
• Early prevention and risk reduction strategy should be adopted by health providers through frequent health promotional activities to reduce the onset of the disease since the origins of many risk factors to DM are in early life.
• Effective intervention to battle the non-adherence to DM treatment regimen is to build healthy public health policy and reorienting existing health services to be to focus much on prevention and strengthen community action to understand the effect of certain lifestyle and behaviors and to support healthy lifestyle choices.
• Treatment of diabetics should not be the sole responsibilities of the patients because of the physical and psychological burden the disease brings on such patients.
• Efforts to have an integrated family support during the treatment process will aid in better treatment adherence and integration into the society or family.
• The reorienting of the health system and services should incorporate measures to ensure that chronic diseases such as DM services ranging from counselling to regular blood sugar level checking should be available in all basic primary health care.