Factors affecting the level of medication adherence to anti-diabetic treatment: A multi- center cross-sectional study in Eastern Bhutan

Background: Worldwide, Diabetes Mellitus affects millions of people. It is a chronic and progressive disease requiring a long-term treatment plan, adherence to which becomes extremely challenging. Globally, there is a poor level of medication adherence to anti-diabetic treatment and several studies have explored the factors affecting medication adherence. However, in Bhutan, there is limited data on the rate of medication adherence and factors affecting it. . Therefore, the study aimed to find the level of anti- diabetic medication adherence and factors affecting it. Methods: A multicenter cross-sectional observational study was conducted involving six eastern district hospitals from June 2019 to February 2020. Research participants were randomly selected from the daily cohort of patients visiting diabetic clinics. Results: Amongst the 390 participants, the overall level of adherence reported in this study was intermediate with a mean Morisky Medication Adherence Scale 8 Items (MMAS-8) score of 6.06 (95% CI 5.91-6.22). Nearly 40% demonstrated a low level of adherence (MMAS-8 score <6). There was a statistically significant (p<0.05) association between mean MMAS-8 scores and adverse drug reactions, the drug regimen (polypharmacy or monotherapy) and the type of diabetes mellitus. Conclusion: This study revealed an intermediate level of medication adherence to anti-diabetic treatment in the eastern region of Bhutan. Adverse drug reactions and polypharmacy resulted in a lower level of adherence. However, further studies are needed to draw a definitive conclusion.