COVID-19 PANDEMİ DÖNEMİNDE DİYABET HASTASININ TEDAVİYE UYUM DURUMUNUN DEĞERLENDİRİLMESİ

Öz

Amaç: Diyabet, yönetimi çok bileşenli olan kronik, kompleks bir hastalıktır. Tedavi başarısı ancak iyi bir tedavi uyumuyla sağlanabilmektedir. Bu çalışmada, diyabet hastalarının COVID-19 (Koronavirüs hastalığı) pandemisi döneminde tedaviye uyum durumu ve bu durumu etkileyen faktörlerin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışma, The Medication Compliance Questionnaire (MCQ) ve Dünya Sağlık Örgütü (DSÖ) uyum klavuzu 2003’e göre belirlenmiş sorularından oluşan bir anket ile 474 diyabetik hasta ile gerçekleştirilmiştir. Bulgular: MCQ ölçeğine göre tedaviye uyumsuzluk oranı %82,3 idi. Tedaviye uyumsuzluk, oral antidiyabetik (OAD) ilaç kullanımı, sigara içme durumu, glukolize hemoglobinin (HbA1c) <%7 olması ve hasta yorum sorularından; ‘’düzenli doktor takibim yok’’,’’doktorumla iyi iletişim kuramıyorum’’, ‘’şekerim belirlenen hedef değerde değil’’,’’ilaçlarım kullanım yönünden yeterince konforlu değil’’ ifadeleriyle ilişkili bulunmuştur (p=0,011; 0,010; 0,014; 0,011; 0,002; 0,019; 0,000). İnsülin kullanan, HbA1c değeri ≥%7 olan hastalar ise tedaviye daha uyumlu olarak tespit edilmiştir. Sonuç: Bu çalışmada klasik sonuçlardan farklı olarak HbA1c <%7 ve OAD kullanmakta olan diyabetik hastaların uyumsuzluğu gündeme getirilmiştir. COVID-19 pandemisi döneminde insülin kullanan ve hastalık süresi uzun olan hastalar tedaviye daha bağlı kalmışlardır. Doktor takibinin olmaması ve doktorla iyi iletişim kuramama uyumsuzluk açısından belirleyici olmuştur. 

Anahtar Kelimeler

• Diyabetes mellitus
• tedavi uyumu
• HbA1c

DIABETIC PATIENTS’ COMPLIANCE WITH TREATMENT DURING COVID-19 PANDEMIC PERIOD

Öz

Objective: Diabetes mellitus is a chronic, complex disease with many components that must be managed. Treatment success depends on excellent treatment compliance. In this study, we aimed to evaluate the treatment adherence of diabetic patients during the COVID-19 (Coronavirus Disease) pandemic and the factors affecting this condition. Material and Methods: The study was carried out on 474 diabetic patients with a questionnaire consisting of questions based on The Medication Compliance Questionnaire (MCQ) and the World Health Organization (WHO) 2003 compliance guideline. Results: The rate of non-compliance with the treatment based on the MCQ scale was 82.3%. Non-compliance with treatment was significantly associated with oral antidiabetic (OAD) drug use, smoking status, glycosylated hemoglobin (HbA1c) <7%, and patient comments of “I don’t have regular doctor follow-up,” “I can’t communicate well with my doctor,” “My blood glucose is not at the target value,” and “My medications are not comfortable enough for use”(p=0.011; 0.010; 0.014; 0.011; 0.002; 0.019; 0.001). Patients under insulin treatment or with an HbA1c value of ≥7% were found to be more compliant with the treatment. Conclusion: Unlike the classical results, the incompatibility of diabetic patients with HbA1c <7% and under OADs with the treatment was emphasized. Patients using insulin and with advanced duration of diabetes were more compliant with the treatment in the stressful period of the COVID-19 pandemic. Lack of follow- up by the doctor and low patient effort to communicate with the doctor have been decisive factors in the non-compliance. 

Anahtar Kelimeler

• Diabetes mellitus
• compliance
• HbA1c
• oral antiglycemic agent

Kaynakça

1. 1. World Health Organization. Clinical management. 2021 (January 25 2021). https://www.who.int. google scholar
2. 2. Kutlutürk F. COVID-19 pandemisi ve diabetes mellitus. Türk Diyab Obez 2020;2:130-7. [CrossRef] google scholar
3. 3. Tao J, Gao L, Liu Q, Dong K, Huang J, Peng X, et al. Factors contributing to glycemic control in diabetes mellitus patients complying with home quarantine during the coronavirus disease 2019 (COVID-19) epidemic. Diabetes Res Clin Pract 2020;170:108514. [CrossRef] google scholar
4. 4. American Diabetes Association. Standards of medical care in diabetes. 2020 (January 2020). https://www.diabetes.org google scholar
5. 5. Taşkaya S. Diyabet hastalarının tedaviye uyum düzeyleri ile sağlık hizmeti kullanımı ve yaşam kalitesini etkileyen faktörler (doktora tezi). Ankara: Hacettepe Üniversitesi Sosyal Bilimler Enstitüsü Sağlık Kurumları Yönetimi Programı. 2014. google scholar
6. 6. World Health Organization. Adherence to long-term therapies: Evidence for action. 2003. https://www.who.int. google scholar
7. 7. Ağralı H, Akyar I. Older diabetic patients attitudes and beliefs about health and illness. J Clin Nurs 2014;23(21-22):3077-86. [CrossRef] google scholar
8. 8. Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence 2013;7:525-30. [CrossRef] google scholar

9. 9. Avari P, Unsworth R, Rilstone S, Uduku C, Logan KM, Hill NE, et al. Improved glycaemia during the COVID-19 pandemic lockdown is sustained postlockdown and during the “eat out to help out” government scheme, in adults with type 1 diabetes in the United Kingdom. PLoS One 2021;16(7):e0254951. [CrossRef] google scholar
10. 10. American Diabetes Association. Standards of Medical Care in diabetes. 2021(January 2020). https://www.diabetes.org. google scholar
11. 11. Ramli A, Ahmad NS, Paraidathathu T. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Prefer Adherence 2012;6:613-22. [CrossRef] google scholar
12. 12. Morisky DE, Green DE, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24(1):67-74. [CrossRef] google scholar
13. 13. Krousel-Wood M, Muntner P, Jannu A, Desalvo K, Re RN. Reliability of a medication adherence measure in an outpatient setting. Am J Med Sci 2005;330(3):128-33. [CrossRef] google scholar
14. 14. SödergârdB, Halvarsson M, Tully MP, Mindouri S, Nordstrom ML,Lindbâck S, et al. Adherence to treatment in Swedish HIV-infected patients. J Clin Pharm Ther 2006;31(6):605-16. [CrossRef] google scholar
15. 15. Demoz GT, Berha AB, Woldu MA, Yifter H, Shibeshi W, Engidawork E. Drug therapy problems, medication adherence and treatment satisfaction among diabetic patients on follow-up care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. PLoS One 2019;14(10):e0222985. [CrossRef] google scholar
16. 16. Ölmez B.Tip 2 diyabetes mellitus’da kronik hastalık bakımı ve ilaç uyumunun değerlendirilmesi (uzmanlık tezi). Ankara: Ankara Atatürk Eğitim ve Araştırma Hastanesi. 2015. google scholar
17. 17. Sankar P, Ahmed WN, Koshy VM, Jacob R, Sasidharan S. Effects of COVID-19 lockdown on type 2 diabetes, lifestyle and psychosocial health: A hospital-based cross-sectional survey from South India. Diabetes Metab Syndr 2020;14(6):1815-9. [CrossRef] google scholar
18. 18. Alshareef R, Zahrani AA, Alzahrani A, Ghandoura L. Impact of the COVID-19 lockdown on diabetes patients in Jeddah, Saudi Arabia. Diabetes Metab Syndr 2020;14(5):1583-7. [CrossRef] google scholar
19. 19. Shimels T, Kassu RA, Bogale G, Bekele M, Getnet M, Getachew A, et al. Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19 pandemic. PLoS One 2021;16(4):e0249222 [CrossRef] google scholar
20. 20. Yavuz DG, Ozcan S, Deyneli O. Adherence to insulin treatment in insulin-na’ıve type 2 diabetic patients initiated on different insulin regimens. Patient Prefer Adherence 2015;9:1225-31. [CrossRef] google scholar
21. 21. Peeters B, Tongelen IV, Duran Z, Yüksel G, Mehuys E, Willems S, et al. Understanding medication adherence among patients of Turkish descent with type 2 diabetes: a qualitative study. Ethn Health 2015;20(1):87-105. [CrossRef] google scholar
22. 22. Ozder A, Sekeroglu M, Eker HH. Quality of life and satisfaction with treatment in subjects with type 2 diabetes: results from primary health care in Turkey. Int J Clin Exp Med 2014;7(12):5715-22. google scholar
23. 23. Önmez A, Gamsızkan Z, Özdemir Ş, Kesikbaş Ea Gökosmanoğlu F, Torun S. The effect of COVID-19 lockdown on glycemic control in patients with type 2 diabetes mellitus in Turkey. Diabetes Metab Syndr 2020;14(6):1963-6. [CrossRef] google scholar
24. 24. Tiktin M, Celik S, Berard L.Understanding adherence to medications in type 2 diabetes care and clinical trials to overcome barriers: a narrative review. Curr Med Res Opin 2016;32(2):277-87. [CrossRef] google scholar
25. 25. Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al. Sleep quality and physical activity as predictors of mental wellbeing variance in older adults during COVID-19 lockdown: ECLB COVID-19 International Online Survey. Int J Environ Res Public Health 2021;18(8):4329. [CrossRef] google scholar
26. 26. Gautam V, Dileepan S, Rustagi N, Mittal A, Patel M, Shafi S, et al. Health literacy, preventive COVID 19 behaviour and adherence to chronic disease treatment during lockdown among patients registered at primary health facility in urban Jodhpur, Rajasthan. Diabetes Metab Syndr 2021;15(1):205-11. [CrossRef] google scholar