title: Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria.
abstract: OBJECTIVE
  To describe the pattern of anti-diabetic drug prescribing; ascertain the level of glycemic control, adherence with prescribed anti-diabetic medications, and diabetes self management practices among patients with type-2 diabetes in a tertiary care setting in Nigeria.
  
  
  METHODS
  University College Hospital (UCH); a 900 bed teaching hospital with medical residents located in Ibadan, southwestern Nigeria.
  
  
  METHODS
  The study consisted of two phases. A cross-sectional review of randomly selected 200 case notes of type 2 diabetic patients that attended the Endocrinology clinic over 3 month; and crosssectional interviews, with a pre-tested Adherence and Self-Management Monitoring Tool (ASMMT), of 200 consecutive patients that presented their drug prescriptions at the satellite pharmacy unit over a 4 week period at a 900-bed teaching hospital located in Ibadan, South-Western Nigeria.
  
  
  RESULTS
  Oral Hypoglycemic Agents (OHA) were prescribed for 86% (171) of cohorts while insulin and OHA was prescribed in 14% (29). About 70.8% (121) of patients on OHA were on combination therapy. The most frequently prescribed OHA combination was glibenclamide and metformin (95.8%). Glibenclamide was prescribed as twice daily regimen in 69% of cohorts. The most frequently documented side effect was hypoglycemia (60.3%). Only 44% (88) of cohorts had adequate glycemic control; of these, 93% (82) were adjudged adherent with prescribed anti-diabetic drugs. Interviews with the structured ASMMT revealed that 59% of patients were non-adherent with the previous anti-diabetic drugs due to lack of finance (51.7%); side effects (34.5%); perceived inefficacy of prescribed anti-diabetic drugs leading to self-medication with local herbs (13.8%). Only 20% of non-adherent patients claimed disclosure to physicians during consultation. The identified factors for non-disclosure were lack of privacy during consultation (58%); and short consultation time (42%). The knowledge and practice of critical components of diabetes self-management behaviours were generally low among the cohort studied. However, it was significantly higher among patient judged adherent with their prescribed anti-diabetic medications (P < 0.05).
  
  
  CONCLUSIONS
  Majority of patients with type 2 diabetes in an ambulatory tertiary care setting in Nigeria are managed with OHA combinations, mainly glibenclamide and metformin. While the current prescribing strategy achieved glycemic control in about one third of patients, majority are still not meeting the recommended blood glucose targets due to poor adherence with prescribed drug regimen, and poor knowledge and practice of successful self-management.
authors.affiliation: Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria. yusuffkby@yahoo.co.uk
authors.forename: Kazeem B
authors.initials: KB
authors.lastname: Yusuff
authors.forename: Olubunmi
authors.initials: O
authors.lastname: Obe
authors.forename: Bonatson Y
authors.initials: BY
authors.lastname: Joseph
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001786:Blood Glucose / Q000187:drug effects; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D008517:Phytotherapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012648:Self Care / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
references.citation: Postgrad Med J. 1999 Oct;75(888):603-6
references.pmid: 10621901
references.citation: Ann Intern Med. 1999 Aug 17;131(4):281-303
references.pmid: 10454950
references.citation: JAMA. 1999 Jun 2;281(21):2005-12
references.pmid: 10359389
references.citation: Diabetes Care. 2001 Apr;24(4):683-9
references.pmid: 11315831
references.citation: JAMA. 2002 May 15;287(19):2570-81
references.pmid: 12020339
references.citation: Diabetes Care. 2005 Jul;28(7):1599-603
references.pmid: 15983307
references.citation: Clin Ther. 2002 Mar;24(3):460-7
references.pmid: 11952029
references.citation: Endocrinol Metab Clin North Am. 1989 Mar;18(1):163-83
references.pmid: 2645125
references.citation: Diabetes Res Clin Pract. 2000 Aug;49(2-3):93-9
references.pmid: 10963819
references.citation: Diabetes Care. 1997 Apr;20(4):556-61
references.pmid: 9096980
references.citation: West Afr J Med. 2004 Jul-Sep;23(3):232-5
references.pmid: 15587836
references.citation: Am J Health Syst Pharm. 2002 Dec 1;59 Suppl 9:S18-21
references.pmid: 12489383
references.citation: Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S70-4
references.pmid: 11054893
references.citation: Diabetes Care. 2004 Jan;27(1):17-20
references.pmid: 14693960
references.citation: Nature. 2001 Dec 13;414(6865):782-7
references.pmid: 11742409
references.citation: J Hypertens. 2005 Jun;23(6):1261-6
references.pmid: 15894903
references.citation: Lancet. 1998 Sep 12;352(9131):837-53
references.pmid: 9742976
references.citation: Drug Saf. 2000 Apr;22(4):313-20
references.pmid: 10789825
references.citation: JAMA. 1996 Nov 6;276(17):1409-15
references.pmid: 8892716
references.citation: BMJ. 2006 Jan 14;332(7533):73-8
references.pmid: 16371403
references.citation: Diabetes Care. 1998 Apr;21(4):501-5
references.pmid: 9571331
references.citation: Diabetes Care. 2005 Jul;28(7):1611-7
references.pmid: 15983309
references.citation: Lancet. 1998 Sep 12;352(9131):854-65
references.pmid: 9742977
references.citation: N Engl J Med. 1998 Jul 23;339(4):229-34
references.pmid: 9673301
references.citation: Diabetes Care. 2003 Jun;26(6):1847-51
references.pmid: 12766121
references.citation: Niger J Med. 2003 Oct-Dec;12(4):193-7
references.pmid: 14768192
references.citation: Afr J Med Med Sci. 2005 Jun;34(2):133-40
references.pmid: 16749337
references.citation: Med J Malaysia. 2004 Aug;59(3):411-7
references.pmid: 15727390
references.citation: Afr J Med Med Sci. 2005 Dec;34(4):389-94
references.pmid: 16752671
references.citation: Diabet Med. 2002 Dec;19(12):978-85
references.pmid: 12647837
references.citation: Cent Afr J Med. 1994 Oct;40(10):286-9
references.pmid: 7828181
references.citation: Diabet Med. 2002 Aug;19(8):673-80
references.pmid: 12147149
references.citation: Eur J Endocrinol. 2004 Oct;151 Suppl 2:T3-7; discussion T29-30
references.pmid: 15487977
references.citation: West Afr J Med. 2003 Jun;22(2):152-5
references.pmid: 14529227
references.citation: West Afr J Med. 2003 Jun;22(2):161-3
references.pmid: 14529229
references.citation: Diabetes Care. 1998 Sep;21(9):1414-31
references.pmid: 9727886
references.citation: Diabetes Care. 2004 Oct;27(10):2444-9
references.pmid: 15451914