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Efficacy of structured education in enhancing medication adherence in type-2 diabetic patients admitted to a rural tertiary care hospital – A randomized control trial

Kiron Jacob Johncy, Jogy Mathew, Anna Mathew, George Koshy, John Michael Raj.


Background: It is known that good blood sugar management prevents microvascular complications of type-2 diabetes mellitus. Effective diabetic control calls for adherence to the treatment regimen. According to the World Health Organization, only 50% of patients with chronic diseases adhere to their medications.

Aim and Objectives: In this parallel-group, randomized controlled clinical trial, we assessed the role of a structured educational module in enhancing the participants’ adherence to diabetic medications.

Materials and Methods: After receiving institutional ethics committee approval, 66 consenting type-2 diabetic patients between 40 and 70 years of age were consecutively recruited. We assessed the adherence to antidiabetic medications using the validated Morisky Medication adherence scale – 8 (MMAS-8). The participants were then randomized by permuted block randomization with allocation concealment to either receive the structured educational intervention (Group A) or standard care (Group B). The intervention consisted of an interactive teaching module, instruction on maintaining a diabetic medication log, and a handout in addition to the standard care. The follow-up MMAS-8 was administered by a blinded assessor after two weeks.

Results: Patients with scores less than six were classified as having low adherence, while those with a score of 8 were in the high adherence group, with those in between in the medium adherence group. Only 8 (25%) participants had high-adherence scores in the initial assessment. After the intervention, high adherence scores were obtained by 14 (43.8%) participants in Group A and 6 (18.8%) in Group B. This reflects a significantly greater adherence to medication after the intervention in Group A. (P = 0.008).

Conclusions: A significant increase in adherence to diabetic medication was observed using the MMAS-8 after the planned educational intervention given to the participants in Group A.

Key words: Drug Adherence; Type-2 Diabetes Mellitus; Patient Education

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