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Background <p>Non-adherence to oral antidiabetic medications is a critical, multifactorial challenge that undermines disease management nationwide. This study aimed to determine the prevalence and predictors of non-adherence among patients with type 2 diabetes (T2DM) across Pakistan.</p> <p>We conducted a nationwide cross-sectional study between December 2023 and March 2025 in 225 healthcare facilities across all provinces of Pakistan. A total of 41,095 participants were selected using a multistage random sampling approach.</p> <p>Medication adherence was evaluated with self-reported pill counts and the Self-Efficacy for Appropriate Medication Use Scale (SEAMS). Multivariable logistic regression using a generalized linear model (GLM) logit approach was employed integrated with Interaction analysis to discover predictors of non-adherence.</p> Result <p>Non-adherence was present in 59.9% (n=24,616) of cases (n=24,616). Factors associated with reduced adherence included being female (AOR = 0.229, 95% CI: 0.067–0.779, P = 0.02), having only primary or secondary education (AOR = 0.186, 95% CI: 0.166–0.208, P &lt; 0.001), absence of hospitalization, taking fewer medications per day, less frequent dosing schedules, and uncontrolled HbA1c levels. In contrast, factors linked to increased adherence were being married (AOR = 4.118, 95% CI: 3.611–4.695, P &lt; 0.001), being a non-smoker (AOR = 12.98, 95% CI: 11.53–14.62, P &lt; 0.001), having no family history of diabetes (AOR = 1.074, 95% CI: 1.021–1.129, P = 0.005), and having more than one comorbid&#xa0;condition. </p> Conclusion <p>Non-adherence to oral antidiabetic medication is prevalent and influenced by diverse personal, socioeconomic, and health-related factors. Targeted interventions addressing modifiable risk factors could improve adherence, ultimately reduce the healthcare burden and enhancing outcomes for patients with diabetes in Pakistan.</p>

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Non-adherence to oral antidiabetic medications among patients with type 2 diabetes: evidence from a nationwide multicentre study in a lower-middle-income country

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月20日

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  • Muhammad Arshed,
  • Mehwish Kiran,
  • Waseela Ashraf,
  • Muhammad Kashif Shahzad Virk,
  • Shafqat Qamer,
  • Muhammad Farooq Umer,
  • Ahmad Umar,
  • Javeria Saleem,
  • Ali Hassan Gillani,
  • Asif Hanif,
  • Muhammad Naeem,
  • Muhammad Maaz Arif,
  • Syed Hanzila Azhar

摘要

Background

Non-adherence to oral antidiabetic medications is a critical, multifactorial challenge that undermines disease management nationwide. This study aimed to determine the prevalence and predictors of non-adherence among patients with type 2 diabetes (T2DM) across Pakistan.

We conducted a nationwide cross-sectional study between December 2023 and March 2025 in 225 healthcare facilities across all provinces of Pakistan. A total of 41,095 participants were selected using a multistage random sampling approach.

Medication adherence was evaluated with self-reported pill counts and the Self-Efficacy for Appropriate Medication Use Scale (SEAMS). Multivariable logistic regression using a generalized linear model (GLM) logit approach was employed integrated with Interaction analysis to discover predictors of non-adherence.

Result

Non-adherence was present in 59.9% (n=24,616) of cases (n=24,616). Factors associated with reduced adherence included being female (AOR = 0.229, 95% CI: 0.067–0.779, P = 0.02), having only primary or secondary education (AOR = 0.186, 95% CI: 0.166–0.208, P < 0.001), absence of hospitalization, taking fewer medications per day, less frequent dosing schedules, and uncontrolled HbA1c levels. In contrast, factors linked to increased adherence were being married (AOR = 4.118, 95% CI: 3.611–4.695, P < 0.001), being a non-smoker (AOR = 12.98, 95% CI: 11.53–14.62, P < 0.001), having no family history of diabetes (AOR = 1.074, 95% CI: 1.021–1.129, P = 0.005), and having more than one comorbid condition.

Conclusion

Non-adherence to oral antidiabetic medication is prevalent and influenced by diverse personal, socioeconomic, and health-related factors. Targeted interventions addressing modifiable risk factors could improve adherence, ultimately reduce the healthcare burden and enhancing outcomes for patients with diabetes in Pakistan.