Poor adherence to oral antidiabetic drugs among people living with type 2 diabetes mellitus in two healthcare facilities in the West Region (Cameroon): a cross-sectional study

Poor adherence to oral antidiabetic drugs among people living with type 2 diabetes mellitus in two healthcare facilities in the West Region (Cameroon): a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Poor adherence to oral antidiabetic drugs among people living with type 2 diabetes mellitus in two healthcare facilities in the West Region (Cameroon): a cross-sectional study Rachelle MINGOLE NJOCK, Sylvain Raoul SIMENI NJONNOU, Jerome ATEUDJIEU, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7258536/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Type 2 diabetes mellitus (T2DM) is a significant public health issue worldwide. Few individuals with T 2 DM achieve adequate glycaemic control, possibly due to poor adherence, which may be linked to adverse events. This study aimed to assess the distribution of poor adherence and examine the relationship between adverse events and poor adherence to oral antidiabetic medications in individuals with T 2 DM. Methods: We conducted a cross-sectional study at two regional hospitals in the West Region of Cameroon. Adherence was assessed using the 8-item Morisky scale questionnaire. Data were analyzed with SPSS 23. 0. The Fisher chi-square test was utilised to explore associations between categorical variables. Results were deemed statistically significant when the p-value was less than 0. 0.05. Results: A total of 248 participants (105 males) were recruited, with a median age of 62 years (IQR 52-69). The median duration of diabetes was 6 years (IQR 3.00-11.75). Only 66 participants (26.6%) had achieved glycated hemoglobin levels in the previous three months, with poor glycemic control observed in 48 (72. 2%) of these individuals. Adverse events were reported by 40 participants (16.1%), mostly related to metformin use. The most common adverse event was heartburn (19 cases, 47. 5%). The prevalence of poor adherence was 46. 4% (95% CI: 40. 3-52. 8) and was associated with the use of herbal medicine (aOr = 3. 10 [95% CI: 1. 71 – 5. 61]; p = 0. 001), lower education levels (aOr = 2. 85 [95% CI: 1. 19 – 6. 83]; p = 0. 02), overweight/obesity (aOR = 2. 41 [95% CI: 1. 21- 4. 80]; p = 0. 012), concurrent intake of antidiabetic medications with other drugs (aOr = 0. 47 [95% CI: 0. 24 – 0. 93]; p = 0. 03), and the presence of at least one complication (aOr = 0. 56 [95% CI: 0. 33-0. 95]; p = 0. 04). Conclusion: Among individuals with T2DM followed in two regional hospitals in the West Region, nearly half exhibited poor adherence. One in six reported adverse events. The use of herbal medicine, limited education, and overweight/obesity increased the risk of poor adherence. Enhanced therapeutic education is essential to improve this situation. Diabetes Adherence Oral antidiabetic Drugs West Region Cameroon Figures Figure 1 Figure 2 I. Introduction Diabetes is a group of metabolic diseases characterized by hyperglycemia caused by abnormalities in insulin secretion, insulin action, or both [1]. It is divided into several subtypes, including type 1 diabetes, type 2 diabetes, gestational diabetes, and specific diabetes [1]. The high prevalence of diabetes and its associated acute and chronic complications have led to increased rates of morbidity and mortality, making it a significant global public health issue [2]. In 2021, a report from the International Diabetes Federation (IDF) estimated that 537 million people aged between 20 and 79 years worldwide were living with type 2 diabetes (t2dm), with an estimated prevalence of 9.3% [3]. This prevalence is projected to rise to 10.2% (643 million) by 2030 and 10.9% (784 million) by 2045, according to IDF [3]. Moreover, Africa, particularly sub-Saharan Africa, is expected to record the highest incidence of type 2 diabetes cases by 2045 [3]. Diabetes remains one of the leading causes of death and disability globally [4], contributing to 11.3% of deaths worldwide in 2021 [3,5]. A study, investigating risk factors for diabetes acquisition, estimated that poor chronic metabolic control, particularly poor glycemic control, is a key factor that is increasing rapidly with high rates of morbidity and mortality [5]. Furthermore, poor adherence to oral antidiabetic drugs (OADs) is a major cause of poor glycemic control [6]. Nonadherence to treatment in people with chronic diseases such as diabetes can lead to complications, including disease progression, hospitalization, mortality and morbidity [7,8]. These findings suggest that treatment adherence is a major issue in diabetes management. To date, several studies have investigated adherence to oral antidiabetic treatment (OAT), and its associated factors have been identified worldwide. In Canada, where 14,3% of participants reported poor adherence, strong habits, older age, no perceived side effects and a longer length of time since diabetes diagnosis were some of the factors associated [10]. In Algeria, nonadherence to oral antidiabetic drugs (OADs) was observed in 31.1% of participants, and the associated factors were lack of blood glucose self-monitoring, lack of health insurance, diabetes duration of more than 6 years and lack of education [9]. In the North-West and South-West of Cameroon, a study has shown that nearly half of the people living with T2DM had poor adherence, which was explained by several factors such as being aged over 60 years, being on insulin therapy and consuming alcohol [11]. Moreover, one of the leading causes of poor adherence is the occurrence of adverse events [12]. This is all that is true, as the use of oral antidiabetic drugs is associated with the occurrence of adverse events such as weight loss, digestive disorders, hypoglycemia and many others [13]. A study of a population of people living with T2DM in Morocco revealed that nearly half of these participants had experienced adverse events related to oral antidiabetic drugs [14]. Most people living with T2DM are receiving oral antidiabetic treatment, although the majority of them, in Sub-Saharan Africa (SSA), have poor glycemic control [7,9,11,15]. In Congo, poor glycemic control was identified in 86.0% of participants [16] and in Ghana, it was 70.0% [17]. In Cameroon, a community-based study in the Bamenda III health district that included 162 adults revealed that half of these participants had poor glycemic control [18]. Following in the same footsteps, poor glycemic control has been reported among people living with T2DM at the Bafoussam Regional Hospital, mostly related to irregular/poor follow-up [19]. This report on poor glycemic control makes it necessary to determine the prevalence of nonadherence (or poor adherence), as it may contribute to poor glycemic control and the factors associated in two hospitals of the West Region of Cameroon. This study aimed to identify the factors associated with poor adherence to oral antidiabetic drugs in two healthcare facilities in the western region of Cameroon, with emphasis on the role of adverse events. II. Materials and methods 2.1. Study design This was a cross-sectional study with two components: descriptive and analytical, conducted over a six-month period (from the 1 st December 2023 to 28 th February 2024). The first component, descriptive, targeted people living with T2DM seen during medical consultations and hospitalisations at two tertiary healthcare facilities in the West Region of Cameroon: Bafoussam Regional Hospital and Dschang Regional Annex Hospital. The second component was an analytical study (nested within the cross-sectional study) of the case-control type, where cases were participants exhibiting poor adherence and controls those with good adherence. The exposure was the occurrence of adverse events. 2.2. Study setting This study involved two tertiary healthcare facilities in the West Region, namely Bafoussam Regional Hospital and Dschang Regional Annex Hospital, both of which have dedicated services for managing diabetes and its complications. The Bafoussam Regional Hospital is situated in Bafoussam, the capital of the West Region of Cameroon. It serves as a primary reference healthcare facility for the western region, particularly for the Mifi division. Its Endocrinology and Diabetology Department is headed by an endocrinologist, supported by one general practitioner and a team of nurses. Consultations are held three times a week. The Dschang Regional Annex Hospital is located within the Dschang Health District (DHD) in the Menoua Division, a semi-rural area in West Cameroon. It functions as the reference healthcare facility for 65 health facilities within the district, and hosts an Endocrinology and Diabetology Department led by an internist, supported by a general practitioner and six nurses. Consultations are also held three times weekly. 2.3. Study population This study targeted adults aged over 21 years of both sexes living with T2DM, who were followed at the Bafoussam Regional Hospital and Dschang Regional Annex Hospital and had been receiving oral antidiabetic treatment over the past three months. 2.4. Sample size and sampling The sample size was calculated using the Lorenz formula. With a diabetes prevalence of 5.5% [11], the minimum sample size required was 80 participants. Participants were recruited consecutively from consultations and hospital wards at both hospitals after being informed about the study and signing the informed consent form. The sampling process was exhaustive. 2.5. Inclusion and exclusion criteria Participants included those living with T2DM aged over 21 years who were followed within both healthcare facilities, receiving antidiabetic treatment for more than three months, and who provided consent to participate. Pregnant women with T2DM and individuals who withdrew their consent during the study were excluded. 2.6. Data collection Data were collected from consenting participants alone or, if necessary, with an interpreter (with the patient's consent), using a pretested, standardised, anonymised questionnaire designed for this purpose. Participants were approached with an information leaflet explaining the aims of the study, with additional explanations provided upon request. Information regarding disease management was recorded. The variables included: - Sociodemographic details: sex, age, marital status, education level, physical activity, health status, and area of residence; - Diabetes history: diagnosis and treatment duration, complications, glycated haemoglobin results, diabetes control (HbA1c <7%), distance from home to healthcare facility, and type of healthcare provider; - Chronic diseases and comorbidities: cardiovascular risk factors (hypertension, obesity, sedentary lifestyle, diabetes, gout, chronic kidney disease), history of cardiovascular events (stroke, heart failure, chronic kidney disease), alcohol and tobacco use; - Adverse events: including digestive disorders, weight gain [13], and all events reported by participants after taking oral antidiabetic medications; - Adherence assessment: using the 8-item Morisky Medication Adherence Scale (8-MMAS) [20, 21]. A score of 8 or above indicated good adherence, 6–7 indicated average adherence, and below 6 indicated poor adherence. 2.7. Operational terms - People living with diabetes mellitus (DM): those with a confirmed diagnosis of diabetes or on antidiabetic therapy; - Uncontrolled DM: an HbA1c of ≥7% in the last three months; - Diabetes duration : time since diagnosis, categorised as less than 5 years, 5–10 years, or more than 10 years; - People living with hypertensio n: those with a confirmed diagnosis of hypertension, on treatment, or with blood pressure ≥140/90 mmHg at least twice; - Good adherence: scored as 8 or above on the 8-MMAS; - Poor adherence: scored below 8 on the 8-MMAS; - Adverse events: all events, both expected and reported following intake of oral antidiabetic drugs. 2.8. Ethical considerations The study received numerous authorisations, including approval from the ethics committee of the Regional Delegation of Public Health of the West Region ( 1003/29/11/2023/CE/CRESH-OU/VP ). Approvals from Dschang Regional Annex Hospital and Bafoussam Regional Hospital were also obtained. Permission to use the 8-MMAS questionnaire was granted by the Morisky Foundation. Throughout the study, principles of safety, confidentiality, justice, and benefit were strictly respected. 2.9. Data analysis Collected data were entered into CsPro® version 7.5 and analysed using SPSS® (IBM Corp, Armonk, NY, version 23.3). Variables were summarised as frequencies, means, or medians depending on their distribution. The associations between factors and poor adherence were evaluated using Chi-squared and Fisher’s exact tests. Variables with p<0.05 were included in a multivariate logistic regression model. III. Results 1. Sociodemographic factors During this study, we contacted 264 participants who met our inclusion criteria; 16 were excluded and a total of 248 participants were recruited (Fig. 1 ). The most represented age group was 30–64 years (142, 57.3%). The median age was 62 years (IQR 52–69). Most of the participants were married (172, 69.4%) and had a secondary or higher level of education (140, 56.5%). Most of the participants were employed (181, 73.0%) and were living far from the health facility (161, 64.9%), as illustrated in Table I. 2. Clinical and therapeutic characteristics A total of 97 (39.1%) participants had a duration of T2DM < 5 years and 138 (65.0%) participants had diabetes-related complications. The most common diabetes-related complications were diabetic neuropathy (79, 57.2%), stroke (27, 19.6%), and diabetic retinopathy (20, 14.5%). The main comorbidities found were: overweight/obesity (189, 76.2%), physical inactivity (177, 71.4%) and hypertension (136, 54.8%). Concerning the antidiabetic medication, most of the participants received monotherapy and biguanide was the most common class of drug used in monotherapy (129, 52.0%). The drugs most commonly used in association among OADs were biguanides and sulfonylurea (61, 24.6%). Nearly one-third of the participants used herbal medicine (85, 34%). Among the participants, a majority had received no education on diabetes (216, 81.7%). These characteristics are described in Table II. 3. Adverse events In this study, 40 participants (16.1% [95% CI 11.7–20.6]) experienced adverse events. The most frequent adverse events were: heartburn (19, 47.5%), nausea (11, 27.5%), diarrhea (6, 15.0%), abdominal pain (5, 12.5%) and vomiting (4, 10.0%). Most of the adverse events were linked to the use of metformin in monotherapy. Figure 2 summarizes the adverse events encountered by the study population. 4. Factors associated with poor adherence to oral antidiabetic drugs. Overall, 115 participants had poor adherence, with a prevalence of 46.4% (CI 95%: 40.3–52.8). Bivariate analysis revealed that age above 75 years, professional situation, the use of biguanides associated with sulfonylurea, being overweight/obese, the use of herbal medicine, the intake of antidiabetic drugs associated with other drugs, the presence of at least one diabetes-related complication and poor education on T2DM were significantly associated with poor adherence to oral drugs. Moreover, multivariate analysis revealed that the use of herbal medicine (aOR = 3.10 [95% CI: 1.71–5.61]; p < 0.001), poor education (aOR = 2.85 [95% CI: 1.19–6.83]; p = 0.02), being overweight/obese (aOR = 2.41 [95% CI: 1.21–4.80]; p = 0.01) increased the risk of poor adherence to treatment. However, the intake of antidiabetic drugs together with other drugs (aOR = 0.47 [95% CI: 0.24–0.93]; p = 0.03) and the presence of at least one complication (aOR = 0.56 [95% CI: 0.33–0.95]; p = 0.04) were more likely to increase good adherence as shown in Table III . IV. Discussion Africa faces the greatest rise in diabetes cases. However, poverty, lack of education, and cultural or social issues limit access to care. One of the key factors for achieving glycemic control in this group is treatment adherence. This cross-sectional study of T2DM patients in two tertiary hospitals in Cameroon’s West Region aimed to identify factors linked to poor adherence to oral antidiabetic drugs in these facilities. It used the 8-MMAS to assess treatment adherence. Findings showed that nearly half the participants had poor adherence. This was associated with overweight/obesity, use of herbal medicine, having at least one complication, taking oral antidiabetic drugs alongside other medicines, and limited education about T2DM. Poor adherence was common among about half of the participants. Similar rates were reported in the North-West and South-West Regions of Cameroon, where 54.4% of participants were non-adherent to treatment [ 11 ]. However, other studies reported lower prevalence of poor adherence, such as 14.5% in Canada and 15.1% in the UK [ 10 , 22 ]. Higher rates were observed in Kenya (28.5%) and Algeria (34.4%) [ 9 , 23 ]. These variations may be due to differences in sociodemographic factors, comorbidities, diabetes education quality, and methods used to measure adherence. The study found that overweight or obese participants were more likely to have poor adherence. There is a strong link between overweight/obesity and diabetes, with another recent Cameroon study showing 96.25% of T2DM patients were overweight or obese [ 24 ]. This also indicates worse glycemic control, which is typically improved through treatment adherence: higher BMI is associated with lower chances of reaching HbA1c targets. Additionally, complications from diabetes tend to be more frequent in overweight or obese individuals, a finding supported by recent studies and reviews [ 25 – 27 ]. Herbal medicine use among T2DM patients is very common in Cameroon, especially in the West Region. A recent survey indicated nearly 60% of T2DM patients in this area use herbal remedies, either alone or with oral antidiabetics [ 28 ]. This use reflects either cultural and social values or economic hardship—some patients may use herbal medicine because they cannot afford modern medicines. In either case, herbal medicine use correlates with poor adherence, similar to findings in Uganda [ 29 ]. However, most studies have not explored this connection [ 9 , 11 , 30 , 31 ]. Participants with limited education tended to be less adherent. Having chronic conditions requires medical education for understanding the disease and its treatment. Such education directly affects disease management, treatment compliance, diet, and mental health issues like anxiety or depression [ 32 ]. Diabetes education provides knowledge and skills but also motivates behavioural change to encourage following medical advice [ 33 ]. Without proper medical education, patients may not grasp the challenges of control and avoiding complications, resulting in poor disease management. Many studies support these findings, though some report no association [ 9 , 12 , 30 , 31 , 34 – 36 ]. Furthermore, this study showed that participants taking oral antidiabetics alongside other drugs or with at least one complication were more likely to adhere to treatment. This might be due to better education at diagnosis or during treatment of these issues. Contrasting other studies, which suggest more complex treatments lead to lower adherence [ 9 , 22 , 23 ]. Only 16.1% of participants experienced adverse events, which did not correlate with poor adherence. The rate is similar to Uganda’s 2008 report (15%) [ 37 ], while a 2015 study from Uganda reported 11% [ 29 ]. In Morocco, half of the patients on oral antidiabetics experienced adverse events [ 14 ]. The differences in adverse event rates may be due to how well patients follow precautions—like taking metformin with food to prevent digestive issues [ 13 ]. This could explain varying results across populations. Also, the lack of an association in this study contrasts with other research, possibly due to the small number of patients experiencing adverse events. This cross-sectional study has limitations. Despite the reliability provided by the 8-MMAS, certain factors should be considered. First, the sample size is smaller than in many other studies. Second, the study only included patients from tertiary hospitals in one region, limiting the ability to generalise results across all T2DM patients in Cameroon. Third, the study’s design does not permit establishing cause-and-effect relationships. V. Conclusion In conclusion, this study revealed that almost half of the people living with T2DM, followed in two hospitals in the West Region of Cameroon, had poor adherence. The factors associated with poor adherence were being overweight/obese, the use of herbal medicine, having at least one complication, the intake of oral antidiabetic drugs associated with other drugs and poor education on type 2 diabetes. Therapeutic education on diabetes and its treatment has to be reinforced to remedy this situation. Abbreviations 8-MMAS: 8-item Morisky Medication Adherence Scale BMI: Body mass index BP: Blood pressure BRH: Bafoussam Regional Hospital DRAH: Dschang Regional Annex Hospital DHD: Dschang Health District DM: Diabetes mellitus HbA1c: Glycated hemoglobin IDF: International Diabetes Federation OAD: Oral antidiabetic drug OAT: Oral antidiabetic treatment SSA: Sub-Saharan Africa T2DM: Type 2 diabetes mellitus Declarations 1. Ethics approval and consent to participate: We obtained ethical approval from the Ethical Regional Committee for the West Region (n° 1003/29/11/2023/CE/CRESH-OU/VP ) and research authorization from the institutional board of the Bafoussam Regional Hospital and the Dschang Regional Annex Hospital. We conducted this study in strict compliance with the fundamental principles of scientific research in medicine (Helsinki principles). Patients were free to participate in the study without external constraints. We obtained an informed and signed consent form from each participant. 2. Consent to Publish : Not Applicable 3. Data and document availability: The data that support the findings of this study are available from the corresponding author upon reasonable request. 4. Conflict of interest: The authors state that they have no competing interests. 5. Funding : No funding was received for this study. 6. Author contributions : Design and implementation: RMN, SRSN, JA, SPC. 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Tables Table I : Sociodemographic characteristics of the study population Variables Modalities Poor adherence OR (95% CI) p-Value Yes n (%) No n (%) Age (years) 30-64 71 (61.7) 71 (53.4) 1.41 (0.85-2.34) 0.19 65-74 36 (31.3) 42 (31.6) 0.99 (0.58-1.69 0.96 ˃75 6 (5.2) 18 (13.5) 0.35 (0.13-0.92) 0.027 Sex Male 46 (40.0) 59 (44.4) 0.84 (0.50-1.39) 0.49 Female 69 (60,0) 74 (55.6) Educational attainment None 14 (12.2) 15 (11.3) 1.09 (0.50-2.37) 0.83 Primary 37 (32.2) 42 (31.6) 1.03 (0.60-1.76) 0.92 *Others 64 (55.7) 76 (57.1) 0.94 (0.57-1.56) 0.81 Marital status Not married 37 (32.2) 39 (29.3) 1.143 (0.66-1.96) 0.63 Married 78 (67.8) 94 (70.7) Professional situation Non employed 23 (20.0) 44 (33.1) 0.51 (0.28-0.90 0.021 Employed 92 (80.0) 89 (66.9) Distance from the health facility Close 33 (28.7) 54 (40.6) 1.69 (0.99-2.89) 0.050 Far 82 (71.3) 79 (59.4) *Others (secondary and higher level of education) OR: Odd Ratio Table II: Clinical and therapeutic characteristics of the study population Variables Modalities Poor adherence OR (CI 95%) p-Value Yes n(%) No n(%) Presence of at least one complication Yes 56 (48.7) 82 (61.7) 0.56 (0.33-0.95) 0.041 No 59 (51.3) 51 (38.3) Tobacco Yes 19 (16.5) 12 (9.0) 1.10 (0.92-4.31) 0.08 No 96 (83.5) 121 (91.0) Alcohol Yes 17 (14.8) 17 (12.8) 1.18 (0.57-2.44) 0.65 No 98 (85.2) 116 (87.2) Physical inactivity Yes 82 (71.3) 95 (71.4) 0.10 (0.57-1.73) 0.98 No 33 (28.7) 38 (28.6) Overweight/obesity Yes 96 (83.5) 96 (72.2) 1.95 (1.05-3.63) 0.034 No 19 (16.5) 37 (27.8) Glycated hemoglobin (<3 months) Yes 27 (23.5) 39 (29.3) 0.74 (0.42-1.31) 0.30 No 88 (76.5) 94 (70.7) HbA1C ˃7% Yes 22 (81.5) 26 (65.0) 2.37 (0.74-7.62) 0.14 No 88 (76.5) 94 (70.7) Presence of at least one complication Yes 56 (48.7) 82 (61.7) 0.59 (0.36-0.98) 0.041 No 59 (51.3) 51 (38.3) Monotherapy Yes 66 (57.4) 71 (53.4) 1.18 (0.71-1.94) 0.53 No 49 (42.6) 62 (46.6) Bitherapy Yes 39 (33.9) 55 (41.4) 0.73 (0.43-1.22) 0.23 No 76 (66.1) 78 (58.6) Tritherapy Yes 10 (8.7) 7 (5.3) 1.71 (0.63- 4.66) 0.29 No 105 (91.3) 126 (94.7) Biguanides Yes 62 (53.9) 67 (50.4) 1.15 (0.70- 1.90) 0.58 No 53 (46.1) 66 (49.6) Sulfonyureas (SU) Yes 3 (2.6) 3 (2.3) 1,16 (0.23-5.87) 1.00 No 112 (97.4) 130 (97.7) Biguanides + SU Yes 21 (18.3) 40 (30.1) 0.52 (0.28-0.95) 0.031 No 94 (81.7) 93 (69.9) Biguanides + DPP-4 inhibitors Yes 15 (13.0) 14 (10.5) 1.27 (0.59-2.77) 0.54 No 100 (87.0) 119 (89.5) SU + Biguanides + DPP-4 inhibitors Yes 10 (8.7) 7 (5.3) 1.71 (0.63 -4.66) 0.29 No Use of herbal medicine Yes 55 (47.8) 30 (22.6) 3.15 (1.82-5.44) <0.001 No 60 (52.2) 103 (77.4) OAD associated with other drugs Yes 72 (62.6) 107 (80.5) 0.41 (0.23-0.72) <0.001 No 43 (37.4) 26 (19.5) Therapeutic education Yes 21 (18.3) 11 (8.3) 2.48 (1.14-5.39) 0.019 No 94 (81.7) 122 (91.7) HbA1c: Glycated Hemoglobin, OR: Odd Ratio, SU: Sulfonylurea, DDP-4 Inhibitors: Dipeptidyl Peptidase IV-Inhibitors Table III: Factors associated with poor adherence to oral antidiabetic drugs in multivariate analysis. Variables Modalities Poor Adherence aOR (95% CI) a p-Value Yes (%) No (%) Age ≤ 75 years 107 (94.8) 113 (86.5) 0.16 ˃ 75 years 6 (5.2) 18 (13.5) 5.92 (0.47-73.92) Professional situation Non-employed 23 (20.0) 44 (33.1) 0.57 (0.29-1.10) 0.09 Employed 92 (80.0) 89 (66.9) Overweight/obese Yes 96 (83.5) 96 (72.2) 2.35 (1.18-4.67 ) 0.015 No 19 (16.5) 37 (27.8) Biguanides + SU Yes 21 (18.3) 40 (30.1) 0.52 (0.27-1.02) 0.06 No 94 (81.7) 93 (69.9) Heartburns Yes 13 (11.3) 6 (4.5) 1.41 (0.46-4.33) 0.55 No 102 (88.7) 126 (95.5) Poor education on diabetes Yes 21 (18.3) 11 (8.3) 2.83 (1.18-5.75) 0.020 No 94 (81.7) 122 (91.7) Use of herbal medicine Yes 55 (47.8) 30 (22.6) 3.07 (1.70-5.56) < 0.001 No 60 (52.2) 103 (77.4) Intake of OAD + Other drugs Yes 72 (62.6) 107 (80.5) 0.43 (0.23-0.81) < 0.001 No 43 (37.4) 26 (19.5) Presence of at least one complication Yes 56 (48.7) 82 (61.7) 0.56(0.33-0.95) 0.032 No 59 (51.3) 51 (38.3) OAD: Oral antidiabetic Drugs; aOR: adjusted Odd Ratio; a p-value: adjusted p-value Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 15 Sep, 2025 Reviewers agreed at journal 04 Sep, 2025 Reviewers invited by journal 04 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Editor invited by journal 11 Aug, 2025 Submission checks completed at journal 10 Aug, 2025 First submitted to journal 10 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7258536","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":511119949,"identity":"41d438ab-1651-408c-aa6c-2522e195cc82","order_by":0,"name":"Rachelle MINGOLE NJOCK","email":"","orcid":"","institution":"University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Rachelle","middleName":"MINGOLE","lastName":"NJOCK","suffix":""},{"id":511119950,"identity":"008bc0d1-cbdc-44a7-b3bb-2c881ce4223a","order_by":1,"name":"Sylvain Raoul SIMENI 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Dschang","correspondingAuthor":false,"prefix":"","firstName":"Simeon","middleName":"Pierre","lastName":"CHOUKEM","suffix":""}],"badges":[],"createdAt":"2025-07-31 06:08:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7258536/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7258536/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91075385,"identity":"dd98f70d-7224-4b18-8f9a-3d1a7d50bef8","added_by":"auto","created_at":"2025-09-11 11:06:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":94174,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7258536/v1/8d058271178713bb6175abfc.png"},{"id":91075387,"identity":"b973597d-a673-44a0-91a2-f843c95b776d","added_by":"auto","created_at":"2025-09-11 11:06:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23900,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of adverse events associated with oral antidiabetic drugs\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7258536/v1/0e5af6af6aa8b4ada44b2cd9.png"},{"id":91080113,"identity":"e996843e-03c6-41d4-ace6-3febc27db9c2","added_by":"auto","created_at":"2025-09-11 11:30:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1798466,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7258536/v1/f86f2710-1039-4418-b6dd-6eb5b6ec454b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Poor adherence to oral antidiabetic drugs among people living with type 2 diabetes mellitus in two healthcare facilities in the West Region (Cameroon): a cross-sectional study","fulltext":[{"header":"I. Introduction","content":"\u003cp\u003eDiabetes is a group of metabolic diseases characterized by hyperglycemia caused by abnormalities in insulin secretion, insulin action, or both [1]. It is divided into several subtypes, including type 1 diabetes, type 2 diabetes, gestational diabetes, and specific diabetes [1]. The high prevalence of diabetes and its associated acute and chronic complications have led to increased rates of morbidity and mortality, making it a significant global public health issue [2]. In 2021, a report from the International Diabetes Federation (IDF) estimated that 537 million people aged between 20 and 79 years worldwide were living with type 2 diabetes (t2dm), with an estimated prevalence of 9.3% [3]. This prevalence is projected to rise to 10.2% (643 million) by 2030 and 10.9% (784 million) by 2045, according to IDF [3]. Moreover, Africa, particularly sub-Saharan Africa, is expected to record the highest incidence of type 2 diabetes cases by 2045 [3]. Diabetes remains one of the leading causes of death and disability globally [4], contributing to 11.3% of deaths worldwide in 2021 [3,5].\u003c/p\u003e\n\u003cp\u003eA study, investigating risk factors for diabetes acquisition, estimated that poor chronic metabolic control, particularly poor glycemic control, is a key factor that is increasing rapidly with high rates of morbidity and mortality [5]. Furthermore, poor adherence to oral antidiabetic drugs (OADs) is a major cause of poor glycemic control [6]. \u0026nbsp; Nonadherence to treatment in people with chronic diseases such as diabetes can lead to complications, including disease progression, hospitalization, mortality and morbidity [7,8]. These findings suggest that treatment adherence is a major issue in diabetes management. To date, several studies have investigated adherence to oral antidiabetic treatment (OAT), and its associated factors have been identified worldwide. In Canada, where 14,3% of participants reported poor adherence, strong habits, older age, no perceived side effects and a longer length of time since diabetes diagnosis were some of the factors associated [10]. In Algeria, nonadherence to oral antidiabetic drugs (OADs) was observed in 31.1% of participants, and the associated factors were lack of blood glucose self-monitoring, lack of health insurance, diabetes duration of more than 6 years and lack of education [9]. In the North-West and South-West of Cameroon, a study has shown that nearly half of the people living with T2DM had poor adherence, which was explained by several factors such as being aged over 60 years, being on insulin therapy and consuming alcohol [11]. Moreover, one of the leading causes of poor adherence is the occurrence of adverse events [12]. This is all that is true, as the use of oral antidiabetic drugs is associated with the occurrence of adverse events such as weight loss, digestive disorders, hypoglycemia and many others [13]. A study of a population of people living with T2DM in Morocco revealed that nearly half of these participants had experienced adverse events related to oral antidiabetic drugs [14]. Most people living with T2DM are receiving oral antidiabetic treatment, although the majority of them, in Sub-Saharan Africa (SSA), have poor glycemic control [7,9,11,15]. In Congo, poor glycemic control was identified in 86.0% of participants [16] and in Ghana, it was 70.0% [17]. In Cameroon, a community-based study in the Bamenda III health district that included 162 adults revealed that half of these participants had poor glycemic control [18]. Following in the same footsteps, \u0026nbsp; poor glycemic control has been reported among people living with T2DM at the Bafoussam Regional Hospital, mostly related to irregular/poor follow-up [19]. This report on poor glycemic control makes it necessary to determine the prevalence of nonadherence (or poor adherence), as it may contribute to poor glycemic control and the factors associated in two hospitals of the West Region of Cameroon. This study aimed to identify the factors associated with poor adherence to oral antidiabetic drugs in two healthcare facilities in the western region of Cameroon, with emphasis on the role of adverse events.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e"},{"header":"II. Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study design \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study with two components: descriptive and analytical, conducted over a six-month period (from the 1\u003csup\u003est\u003c/sup\u003e December 2023 to 28\u003csup\u003eth\u003c/sup\u003e February 2024). The first component, descriptive, targeted people living with T2DM seen during medical consultations and hospitalisations at two tertiary healthcare facilities in the West Region of Cameroon: Bafoussam Regional Hospital and Dschang Regional Annex Hospital. The second component was an analytical study (nested within the cross-sectional study) of the case-control type, where cases were participants exhibiting poor adherence and controls those with good adherence. The exposure was the occurrence of adverse events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Study setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved two tertiary healthcare facilities in the West Region, namely Bafoussam Regional Hospital and Dschang Regional Annex Hospital, both of which have dedicated services for managing diabetes and its complications.\u003c/p\u003e\n\u003cp\u003eThe Bafoussam Regional Hospital is situated in Bafoussam, the capital of the West Region of Cameroon. It serves as a primary reference healthcare facility for the western region, particularly for the Mifi division. Its Endocrinology and Diabetology Department is headed by an endocrinologist, supported by one general practitioner and a team of nurses. Consultations are held three times a week.\u003c/p\u003e\n\u003cp\u003eThe Dschang Regional Annex Hospital is located within the Dschang Health District (DHD) in the Menoua Division, a semi-rural area in West Cameroon. It functions as the reference healthcare facility for 65 health facilities within the district, and hosts an Endocrinology and Diabetology Department led by an internist, supported by a general practitioner and six nurses. Consultations are also held three times weekly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study targeted adults aged over 21 years of both sexes living with T2DM, who were followed at the Bafoussam Regional Hospital and Dschang Regional Annex Hospital and had been receiving oral antidiabetic treatment over the past three months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Sample size and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using the Lorenz formula. With a diabetes prevalence of 5.5% [11], the minimum sample size required was 80 participants. Participants were recruited consecutively from consultations and hospital wards at both hospitals after being informed about the study and signing the informed consent form. The sampling process was exhaustive.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Inclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants included those living with T2DM aged over 21 years who were followed within both healthcare facilities, receiving antidiabetic treatment for more than three months, and who provided consent to participate. Pregnant women with T2DM and individuals who withdrew their consent during the study were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6. Data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected from consenting participants alone or, if necessary, with an interpreter (with the patient\u0026apos;s consent), using a pretested, standardised, anonymised questionnaire designed for this purpose. Participants were approached with an information leaflet explaining the aims of the study, with additional explanations provided upon request. Information regarding disease management was recorded.\u003c/p\u003e\n\u003cp\u003eThe variables included:\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eSociodemographic details:\u003c/strong\u003e sex, age, marital status, education level, physical activity, health status, and area of residence;\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eDiabetes history:\u003c/strong\u003e diagnosis and treatment duration, complications, glycated haemoglobin results, diabetes control (HbA1c \u0026lt;7%), distance from home to healthcare facility, and type of healthcare provider;\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eChronic diseases and comorbidities:\u003c/strong\u003e cardiovascular risk factors (hypertension, obesity, sedentary lifestyle, diabetes, gout, chronic kidney disease), history of cardiovascular events (stroke, heart failure, chronic kidney disease), alcohol and tobacco use; \u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eAdverse events:\u003c/strong\u003e including digestive disorders, weight gain [13], and all events reported by participants after taking oral antidiabetic medications;\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eAdherence assessment:\u003c/strong\u003e using the 8-item Morisky Medication Adherence Scale (8-MMAS) [20, 21]. A score of 8 or above indicated good adherence, 6\u0026ndash;7 indicated average adherence, and below 6 indicated poor adherence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.7. Operational terms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003ePeople living with diabetes mellitus (DM):\u003c/strong\u003e those with a confirmed diagnosis of diabetes or on antidiabetic therapy;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Uncontrolled DM:\u003c/strong\u003e an HbA1c of \u0026ge;7% in the last three months;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Diabetes duration\u003c/strong\u003e: time since diagnosis, categorised as less than 5 years, 5\u0026ndash;10 years, or more than 10 years;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- People living with hypertensio\u003c/strong\u003en: those with a confirmed diagnosis of hypertension, on treatment, or with blood pressure \u0026ge;140/90 mmHg at least twice;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Good adherence:\u003c/strong\u003e scored as 8 or above on the 8-MMAS;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Poor adherence:\u003c/strong\u003e scored below 8 on the 8-MMAS;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Adverse events:\u003c/strong\u003e all events, both expected and reported following intake of oral antidiabetic drugs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.8. Ethical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received numerous authorisations, including approval from the ethics committee of the Regional Delegation of Public Health of the West Region (\u003cstrong\u003e1003/29/11/2023/CE/CRESH-OU/VP\u003c/strong\u003e). Approvals from Dschang Regional Annex Hospital and Bafoussam Regional Hospital were also obtained. Permission to use the 8-MMAS questionnaire was granted by the Morisky Foundation. Throughout the study, principles of safety, confidentiality, justice, and benefit were strictly respected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.9. Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCollected data were entered into CsPro\u0026reg; version 7.5 and analysed using SPSS\u0026reg; (IBM Corp, Armonk, NY, version 23.3). Variables were summarised as frequencies, means, or medians depending on their distribution. The associations between factors and poor adherence were evaluated using Chi-squared and Fisher\u0026rsquo;s exact tests. Variables with p\u0026lt;0.05 were included in a multivariate logistic regression model. \u003c/p\u003e"},{"header":"III. Results","content":"\u003ch3\u003e1. Sociodemographic factors\u003c/h3\u003e\n\u003cp\u003eDuring this study, we contacted 264 participants who met our inclusion criteria; 16 were excluded and a total of 248 participants were recruited (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The most represented age group was 30–64 years (142, 57.3%). The median age was 62 years (IQR 52–69). Most of the participants were married (172, 69.4%) and had a secondary or higher level of education (140, 56.5%). Most of the participants were employed (181, 73.0%) and were living far from the health facility (161, 64.9%), as illustrated in \u003cb\u003eTable I.\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003e2. Clinical and therapeutic characteristics\u003c/h3\u003e\n\u003cp\u003eA total of 97 (39.1%) participants had a duration of T2DM \u0026lt; 5 years and 138 (65.0%) participants had diabetes-related complications. The most common diabetes-related complications were diabetic neuropathy (79, 57.2%), stroke (27, 19.6%), and diabetic retinopathy (20, 14.5%). The main comorbidities found were: overweight/obesity (189, 76.2%), physical inactivity (177, 71.4%) and hypertension (136, 54.8%).\u003c/p\u003e\u003cp\u003eConcerning the antidiabetic medication, most of the participants received monotherapy and biguanide was the most common class of drug used in monotherapy (129, 52.0%). The drugs most commonly used in association among OADs were biguanides and sulfonylurea (61, 24.6%). Nearly one-third of the participants used herbal medicine (85, 34%). Among the participants, a majority had received no education on diabetes (216, 81.7%). These characteristics are described in \u003cb\u003eTable II.\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003e3. Adverse events\u003c/h3\u003e\n\u003cp\u003eIn this study, 40 participants (16.1% [95% CI 11.7–20.6]) experienced adverse events. The most frequent adverse events were: heartburn (19, 47.5%), nausea (11, 27.5%), diarrhea (6, 15.0%), abdominal pain (5, 12.5%) and vomiting (4, 10.0%). Most of the adverse events were linked to the use of metformin in monotherapy. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the adverse events encountered by the study population.\u003c/p\u003e\n\u003ch3\u003e4. Factors associated with poor adherence to oral antidiabetic drugs.\u003c/h3\u003e\n\u003cp\u003eOverall, 115 participants had poor adherence, with a prevalence of 46.4% (CI 95%: 40.3–52.8). Bivariate analysis revealed that age above 75 years, professional situation, the use of biguanides associated with sulfonylurea, being overweight/obese, the use of herbal medicine, the intake of antidiabetic drugs associated with other drugs, the presence of at least one diabetes-related complication and poor education on T2DM were significantly associated with poor adherence to oral drugs.\u003c/p\u003e\u003cp\u003eMoreover, multivariate analysis revealed that the use of herbal medicine (aOR = 3.10 [95% CI: 1.71–5.61]; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), poor education (aOR = 2.85 [95% CI: 1.19–6.83]; \u003cem\u003ep\u003c/em\u003e = 0.02), being overweight/obese (aOR = 2.41 [95% CI: 1.21–4.80]; \u003cem\u003ep =\u003c/em\u003e 0.01) increased the risk of poor adherence to treatment. However, the intake of antidiabetic drugs together with other drugs (aOR = 0.47 [95% CI: 0.24–0.93]; \u003cem\u003ep\u003c/em\u003e = 0.03) and the presence of at least one complication (aOR = 0.56 [95% CI: 0.33–0.95]; \u003cem\u003ep\u003c/em\u003e = 0.04) were more likely to increase good adherence as shown in \u003cb\u003eTable III\u003c/b\u003e.\u003c/p\u003e"},{"header":"IV. Discussion","content":"\u003cp\u003eAfrica faces the greatest rise in diabetes cases. However, poverty, lack of education, and cultural or social issues limit access to care. One of the key factors for achieving glycemic control in this group is treatment adherence. This cross-sectional study of T2DM patients in two tertiary hospitals in Cameroon’s West Region aimed to identify factors linked to poor adherence to oral antidiabetic drugs in these facilities. It used the 8-MMAS to assess treatment adherence. Findings showed that nearly half the participants had poor adherence. This was associated with overweight/obesity, use of herbal medicine, having at least one complication, taking oral antidiabetic drugs alongside other medicines, and limited education about T2DM.\u003c/p\u003e\u003cp\u003ePoor adherence was common among about half of the participants. Similar rates were reported in the North-West and South-West Regions of Cameroon, where 54.4% of participants were non-adherent to treatment [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, other studies reported lower prevalence of poor adherence, such as 14.5% in Canada and 15.1% in the UK [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Higher rates were observed in Kenya (28.5%) and Algeria (34.4%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These variations may be due to differences in sociodemographic factors, comorbidities, diabetes education quality, and methods used to measure adherence.\u003c/p\u003e\u003cp\u003eThe study found that overweight or obese participants were more likely to have poor adherence. There is a strong link between overweight/obesity and diabetes, with another recent Cameroon study showing 96.25% of T2DM patients were overweight or obese [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This also indicates worse glycemic control, which is typically improved through treatment adherence: higher BMI is associated with lower chances of reaching HbA1c targets. Additionally, complications from diabetes tend to be more frequent in overweight or obese individuals, a finding supported by recent studies and reviews [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e–\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHerbal medicine use among T2DM patients is very common in Cameroon, especially in the West Region. A recent survey indicated nearly 60% of T2DM patients in this area use herbal remedies, either alone or with oral antidiabetics [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This use reflects either cultural and social values or economic hardship—some patients may use herbal medicine because they cannot afford modern medicines. In either case, herbal medicine use correlates with poor adherence, similar to findings in Uganda [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, most studies have not explored this connection [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eParticipants with limited education tended to be less adherent. Having chronic conditions requires medical education for understanding the disease and its treatment. Such education directly affects disease management, treatment compliance, diet, and mental health issues like anxiety or depression [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Diabetes education provides knowledge and skills but also motivates behavioural change to encourage following medical advice [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Without proper medical education, patients may not grasp the challenges of control and avoiding complications, resulting in poor disease management. Many studies support these findings, though some report no association [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e–\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Furthermore, this study showed that participants taking oral antidiabetics alongside other drugs or with at least one complication were more likely to adhere to treatment. This might be due to better education at diagnosis or during treatment of these issues. Contrasting other studies, which suggest more complex treatments lead to lower adherence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOnly 16.1% of participants experienced adverse events, which did not correlate with poor adherence. The rate is similar to Uganda’s 2008 report (15%) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], while a 2015 study from Uganda reported 11% [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In Morocco, half of the patients on oral antidiabetics experienced adverse events [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The differences in adverse event rates may be due to how well patients follow precautions—like taking metformin with food to prevent digestive issues [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This could explain varying results across populations. Also, the lack of an association in this study contrasts with other research, possibly due to the small number of patients experiencing adverse events.\u003c/p\u003e\u003cp\u003eThis cross-sectional study has limitations. Despite the reliability provided by the 8-MMAS, certain factors should be considered. First, the sample size is smaller than in many other studies. Second, the study only included patients from tertiary hospitals in one region, limiting the ability to generalise results across all T2DM patients in Cameroon. Third, the study’s design does not permit establishing cause-and-effect relationships.\u003c/p\u003e"},{"header":"V. Conclusion","content":"\u003cp\u003eIn conclusion, this study revealed that almost half of the people living with T2DM, followed in two hospitals in the West Region of Cameroon, had poor adherence. The factors associated with poor adherence were being overweight/obese, the use of herbal medicine, having at least one complication, the intake of oral antidiabetic drugs associated with other drugs and poor education on type 2 diabetes. Therapeutic education on diabetes and its treatment has to be reinforced to remedy this situation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e8-MMAS:\u003c/strong\u003e 8-item Morisky Medication Adherence Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBMI:\u003c/strong\u003e Body mass index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBP:\u003c/strong\u003e Blood pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBRH:\u003c/strong\u003e Bafoussam Regional Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDRAH:\u003c/strong\u003e Dschang Regional Annex Hospital\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDHD:\u003c/strong\u003e Dschang Health District\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDM:\u003c/strong\u003e Diabetes mellitus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHbA1c:\u003c/strong\u003e Glycated hemoglobin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIDF:\u003c/strong\u003e International Diabetes Federation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOAD:\u003c/strong\u003e Oral antidiabetic drug\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOAT:\u003c/strong\u003e Oral antidiabetic treatment\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSSA:\u003c/strong\u003e Sub-Saharan Africa\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eT2DM:\u003c/strong\u003e Type 2 diabetes mellitus\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e1. Ethics approval and consent to participate:\u003c/strong\u003e We obtained ethical approval from the Ethical Regional Committee for the West Region (n° \u003cstrong\u003e1003/29/11/2023/CE/CRESH-OU/VP\u003c/strong\u003e) and research authorization from the institutional board of the Bafoussam Regional Hospital and the Dschang Regional Annex Hospital. We conducted this study in strict compliance with the fundamental principles of scientific research in medicine (Helsinki principles). Patients were free to participate in the study without external constraints. We obtained an informed and signed consent form from each participant. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e: Not Applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData and document availability:\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e The authors state that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No funding was received for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: Design and implementation: RMN, SRSN, JA, SPC. Data collection: RMN, SRSN. Data analysis and interpretation: RMN, SRSN, JA, SPC. Manuscript writing: RMN, SRSN, CMT, FKL, CNO, MJNE, GRBS, SON, MCEE. Manuscript revision: JA, CMT, SPC. All the authors read and approved the final version for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe thank the participants and all the staff of the Internal Medicine Department of the Bafoussam Regional Hospital and the Dschang Regional Hospital Annex. A particular thank you to the Morisky team for the permission (certificate number \u003cstrong\u003e9153-1963-3159-5308-0707\u003c/strong\u003e) they gave us to use this scale for the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican Diabetes Association of professionals. 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PMCID: PMC2584325.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable I\u003c/strong\u003e: \u003cstrong\u003eSociodemographic characteristics\u003c/strong\u003e \u003cstrong\u003eof the study population\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor adherence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-Value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e30-64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e71 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e71 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.41 (0.85-2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e65-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e36 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e42 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e0.99 (0.58-1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e˃75\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e6 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e18 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e0.35 (0.13-0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e46 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e59 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.84 (0.50-1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e69 (60,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e74 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational attainment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e14 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.09 (0.50-2.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e37 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e42 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.03 (0.60-1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e*Others\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e64 (55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e76 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e0.94 (0.57-1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;Not married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e37 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e39 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003e1.143 (0.66-1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e78 (67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e94 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional situation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNon employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e23 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e44 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.51 (0.28-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e92 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e89 (66.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance from the health facility\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eClose\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e33 (28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e54 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.69 (0.99-2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.050\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eFar\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e82 (71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e79 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Others (secondary and higher level of education) \u0026nbsp; OR: Odd Ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable II: Clinical and therapeutic characteristics of the study population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModalities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor adherence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (CI 95%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-Value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of at least one complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e56 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e82 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.56 (0.33-0.95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e59 (51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e51 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTobacco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.10 (0.92-4.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e96 (83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e121 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e17 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e17 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.18 (0.57-2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e98 (85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e116 (87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical inactivity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e82 (71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e95 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.10 (0.57-1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e33 (28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e38 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverweight/obesity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e96 (83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e96 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.95 (1.05-3.63)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGlycated hemoglobin (\u0026lt;3 months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e27 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e39 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.74 (0.42-1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e88 (76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e94 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1C ˃7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.37 (0.74-7.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e88 (76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e94 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of at least one complication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e56 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e82 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.59 (0.36-0.98)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e59 (51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e51 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66 (57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e71 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.18 (0.71-1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e49 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e62 (46.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBitherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e39 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e55 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.73 (0.43-1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e76 (66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e78 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTritherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.71 (0.63- 4.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e105 (91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e126 (94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiguanides\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e62 (53.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e67 (50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.15 (0.70- 1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e53 (46.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66 (49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Sulfonyureas (SU)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1,16 (0.23-5.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e112 (97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e130 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiguanides + SU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e40 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.52 (0.28-0.95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e94 (81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e93 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiguanides + DPP-4 inhibitors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.27 (0.59-2.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e100 (87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e119 (89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSU + Biguanides + DPP-4 inhibitors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.71 (0.63 -4.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of herbal medicine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e55 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.15 (1.82-5.44)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60 (52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e103 (77.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOAD associated with other drugs\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e72 (62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e107 (80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.41 (0.23-0.72)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e43 (37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26 (19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTherapeutic education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.48 (1.14-5.39)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e94 (81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e122 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHbA1c: Glycated Hemoglobin, OR: Odd Ratio, SU: Sulfonylurea, DDP-4 Inhibitors: Dipeptidyl Peptidase IV-Inhibitors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable III: Factors associated with poor adherence to oral antidiabetic drugs in multivariate analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Poor Adherence \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep-Value\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026le; 75 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e107 (94.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e113 (86.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e˃ 75 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5.92 (0.47-73.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional situation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNon-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e23 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e44 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.57 (0.29-1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e92 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e89 (66.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverweight/obese\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e96 (83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e96 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.35 (1.18-4.67\u003c/strong\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e19 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e37 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiguanides + SU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e21 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e40 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.52 (0.27-1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e94 (81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e93 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeartburns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e13 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.41 (0.46-4.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e102 (88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e126 (95.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor education on diabetes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e21 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.83 (1.18-5.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e94 (81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e122 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of herbal medicine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e55 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e30 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.07 (1.70-5.56)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e60 (52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e103 (77.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntake of OAD + Other drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e72 (62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e107 (80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.43 (0.23-0.81)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e43 (37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e26 (19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of at least one complication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e56 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e82 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.56(0.33-0.95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e59 (51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e51 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOAD: Oral antidiabetic Drugs; \u0026nbsp;aOR: adjusted Odd Ratio; a\u003cem\u003ep-value: adjusted p-value\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diabetes, Adherence, Oral antidiabetic Drugs, West Region, Cameroon","lastPublishedDoi":"10.21203/rs.3.rs-7258536/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7258536/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Type 2 diabetes mellitus (T2DM) is a significant public health issue worldwide. Few individuals with T 2 DM achieve adequate glycaemic control, possibly due to poor adherence, which may be linked to adverse events. This study aimed to assess the distribution of poor adherence and examine the relationship between adverse events and poor adherence to oral antidiabetic medications in individuals with T 2 DM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a cross-sectional study at two regional hospitals in the West Region of Cameroon. Adherence was assessed using the 8-item Morisky scale questionnaire. Data were analyzed with SPSS 23. 0. The Fisher chi-square test was utilised to explore associations between categorical variables. Results were deemed statistically significant when the p-value was less than 0. 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 248 participants (105 males) were recruited, with a median age of 62 years (IQR 52-69). The median duration of diabetes was 6 years (IQR 3.00-11.75). Only 66 participants (26.6%) had achieved glycated hemoglobin levels in the previous three months, with poor glycemic control observed in 48 (72. 2%) of these individuals. Adverse events were reported by 40 participants (16.1%), mostly related to metformin use. The most common adverse event was heartburn (19 cases, 47. 5%). The prevalence of poor adherence was 46. 4% (95% CI: 40. 3-52. 8) and was associated with the use of herbal medicine (aOr = 3. 10 [95% CI: 1. 71 – 5. 61]; p = 0. 001), lower education levels (aOr = 2. 85 [95% CI: 1. 19 – 6. 83]; p = 0. 02), overweight/obesity (aOR = 2. 41 [95% CI: 1. 21- 4. 80]; p = 0. 012), concurrent intake of antidiabetic medications with other drugs (aOr = 0. 47 [95% CI: 0. 24 – 0. 93]; p = 0. 03), and the presence of at least one complication (aOr = 0. 56 [95% CI: 0. 33-0. 95]; p = 0. 04).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Among individuals with T2DM followed in two regional hospitals in the West Region, nearly half exhibited poor adherence. One in six reported adverse events. The use of herbal medicine, limited education, and overweight/obesity increased the risk of poor adherence. Enhanced therapeutic education is essential to improve this situation.\u003c/p\u003e","manuscriptTitle":"Poor adherence to oral antidiabetic drugs among people living with type 2 diabetes mellitus in two healthcare facilities in the West Region (Cameroon): a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 11:06:20","doi":"10.21203/rs.3.rs-7258536/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"16003671103976857290508922175977528190","date":"2025-09-15T08:52:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48248681086560554692734404626595042577","date":"2025-09-04T09:52:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T08:35:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T06:24:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-11T07:40:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-10T10:28:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Endocrine Disorders","date":"2025-08-10T10:25:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9212bfca-588d-4fae-89f1-6e56205ee1a1","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-11T11:06:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 11:06:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7258536","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7258536","identity":"rs-7258536","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}