Abstract
Diabetes mellitus and its complications have been labelled as one of the major crises in the twenty-first century. In Scotland, diabetes mellitus has increased significantly over the past few years where it affects more than one in twenty-five people (5.4%). Saudi Arabia is one of the top 10 countries for prevalence of diabetes mellitus, where in 2017 there were 3, 852, 000 cases of diabetes. The level of glycaemic management reached has been considered as the most important predictor of morbidity and mortality that arise from diabetes complications. Adherence to medical advice and to prescribed medication is essential to achieve metabolic control as non-adherence with blood glucose lowering drugs is linked with higher HbAlc levels. In addition, knowledge about health and diabetes could significantly influence adherence levels; diabetic patients should be aware of their conditions in order to follow health recommendations. Therefore, assessment of adherence and understanding of the health regimen are crucial to address the issue for non-adherence.The aims of the present research were to describe the characteristics of Scottish diabetes patients; identify the factors associated with diabetes complications in Scottish diabetes patients; establish whether appropriate metformin dose reduction is being implemented in Scottish patients with type 2 diabetes and renal disease; determine the level of medication adherence and the level of total diabetes knowledge in Saudi Arabian patients and to identify factors associated with adherence to diabetic medications and knowledge. This research was carried out in both Scotland and Saudi Arabia.
Data from two Scottish cohorts was used from Scottish Primary Care patients with diabetes in NHS Ayrshire and Arran through a clinical audit. The first cohort involved 470 type 1 and type 2 diabetes patients and this study identified that the majority of these patients were of an older age (>40 years), males, non-smokers, living in the least deprived areas, with a duration of diabetes of more than 10 years, overweight and married. The results of this study also demonstrated that several diabetic complications were present and were associated with obesity, age, duration of diabetes and type of diabetes. Moreover, the second cohort involved 10,407 type 2 diabetes patients with renal disease prescribed with metformin and this study established that inappropriate metformin dose reduction is not being implemented amongst these patients.
A total of 319 patients from King Abdelaziz Medical City (KAMC) diabetic centre were included in the Saudi Arabian study. This study showed that the level of diabetic medication adherence was 49%, where higher adherence was associated with female gender, high education level, individuals taking a higher number of diabetic medications, individuals taking a lower number of other medications, individuals self-testing their blood glucose levels and individuals taking none or few herbal medicines. There was a negative weak correlation between HbAlc and medication adherence where HbAlc was associated with high number of diabetic medications, occupation and high number of other nondiabetic medications. Findings of this study also showed that the level of knowledge was 12%, where high knowledge level is influenced by high education status, longer duration of diabetes and self-monitoring of blood glucose. There was a weak positive correlation between HbA 1c and knowledge level, where high knowledge was linked with high HbAlc. Understanding factors influencing nonadherence is the starting point of implementing effective strategies and policies that are required to produce optimal medication adherence in diabetes. These approaches could enhance the achievement of better health, better quality care and reduced costs.
| Date of Award | 2018 |
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| Original language | English |
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| Supervisor | Jane Nally (Supervisor) |