Diabetes mellitus (DM) is considered one of the oldest fast-growing public health problems.
It's a chronic metabolic disorder characterized mainly by high level of glucose level,
associated globally with increased morbidity and mortality particularly in developing
countries [1].
DM leads to serious problems in heart, blood vessels, kidney and nerves. The World Health
Organization (WHO) had anticipated that DM is going to become the seventh most significant
primary cause of death worldwide by the year 2030 [2].
Main types of DM include type1 DM where the body stops making insulin, and type 2 DM which is
more common, usually in adults when the body becomes resistant to insulin or doesn't make
enough insulin [3].
Currently, 463 million persons suffer from diabetes worldwide. In addition, 55 million in
Middle East and North Africa (MENA) Region suffer from diabetes, and it is estimated that by
2045 this will rise to 108 million according to the International Diabetes Federation (IDF)
[4] Egypt is considered the ninth leading country in the world for the number of type 2
diabetes patients and its prevalence was nearly tripled over the last 2 decades, reaching
15.2% as nearly 8 million of adults suffer from type 2 DM, expecting to be doubled by 2045,
urging the global community to recognize DM as one of the most important health challenges of
the twenty first century [4].
Hence comes the importance of self-management in patients with type 2 DM in reducing
complications from the disease and improving overall health outcomes. These important
self-management behaviors include taking medications regularly, healthy diet, doing physical
activities, quitting smoking, foot care and self-monitoring blood glucose level [5].
Adherence of patients with type 2 DM to medication is associated with better balanced
glycemic control (HbA1c <7%), thus helping in reduction of microvascular and macrovascular
complications [6].
Adherence to medication is mainly influenced by several factors such as demographic,
socioeconomic, cultural, health system related factors, educational and personal factors such
as patient's age, complexity of medication, side effects, cost, availability, accessibility
and whether they're receiving emotional and social support from their families [7].
Mental representation of DM affect patients' coping behavior. Many patients lack the
understanding of type 2 DM. Perception of the disease is important, it's not just about
taking the prescribed medication, it's about the extent to which the patient follows medical
instructions [8].
Studies have showed that illness perception and beliefs about medication by type 2 DM
patients is commonly linked with their adherence to medication and in return better glycemic
control [9].
Perception is about everything regarding the illness such as illness identity, time line of
the disease, consequences, comorbid conditions, number of hospital admission, whether it can
be controlled or not, and emotional response to being diabetic [10]. Beliefs in self-control
and self-management over health will affect adherence to treatment regimens and glycemic
control [9].
Perception about illness shapes self-management behavior. If patients have strong perception
about treatment plan and regimen with personal control, it'll lead to lower level of HbA1c
and better health outcome [10].
Patients' beliefs about medication are mainly about the necessity of taking the prescribed
medication to maintain their health now and in the future, and concerns about the possible
negative effects of taking the medication such as addiction or long-term adverse effects from
regular use. Some patients believe that medication helps them, while others believe that
multiple harmful effects of the treatment may outweigh any positive outcomes. Some of the
patients who have strong opinions about their medication avoid taking it or, conversely,
abuse it [11].
Patients who are convinced that a specific medication is essential for their health are much
more likely to adhere to the treatment than those who do not hold such a belief [12].
We hypothesize that some factors associated with non-adherence to medication can be
investigated so that interventions can be implemented to increase adherence to medication,
helping in achieving better glycemic control and better health outcomes and reducing
complications.
As data concerning diabetic patients' adherence are deficient in upper Egypt, this study will
help in filling the gap on illness perception and beliefs about medication, which in turn
affects patients' adherence to medication and thus better glycemic control in type 2 DM.