Factors Associated with Poor Compliance in Type 2 Diabetic Patients Presenting to Ayub Teaching Hospital

Abstract

Background: Type 2 diabetes mellitus (T2DM) requires sustained adherence to pharmacological therapy, dietary modification, and regular follow-up to achieve optimal glycemic control. However, poor treatment adherence remains a major barrier to effective diabetes management, particularly in low- and middle-income countries where socioeconomic, educational, geographic, and psychological factors may influence patient behavior and access to healthcare services. Objective: To determine the prevalence of poor treatment adherence and identify factors associated with poor adherence among patients with type 2 diabetes mellitus presenting to Ayub Teaching Hospital, Abbottabad, Pakistan. Methods: A hospital-based cross-sectional analytical study was conducted from July to December 2024 including 213 adults aged ≥30 years with diagnosed T2DM receiving oral hypoglycemic agents and/or insulin therapy. Participants were recruited using consecutive sampling. Data were collected through structured interviews and medical record review, capturing demographic, clinical, socioeconomic, educational, geographic, and psychological variables. Poor adherence was defined as failure to follow prescribed medication, dietary, or follow-up recommendations. Associations between adherence status and independent variables were evaluated using chi-square tests and logistic regression analysis, with p<0.05 considered statistically significant. Results: Poor adherence was observed in 34.7% of participants. Higher prevalence of poor adherence was associated with increasing age, insulin-based or combination therapy, lower socioeconomic status, lower educational attainment, remote residence, and fear of insulin injections (p<0.05). Gender was not significantly associated with adherence status. Conclusion: Poor adherence affects approximately one-third of patients with T2DM and is strongly influenced by socioeconomic disadvantage, limited education, geographic barriers, treatment complexity, and psychological resistance to insulin therapy. Targeted educational, socioeconomic, and accessibility-based interventions are essential to improve adherence and long-term diabetes outcomes.