Endocrine Abstracts

Aim: We conducted a systematic review aiming to:• Measure self-reported adherence to medication in patients with type 2 diabetes mellitus (T2DM) using the Morisky medication adherence scales (MMAS).• Identify barriers and facilitators associated with adherence.

Methods: The systematic review was conducted in accordance with the PRISMA Framework and was registered with PROSPERO (CRD42022359969). The Medline, Embase, Emcare and Ovid Nursing database were searched with predefined keywords and search strategy between the period of 2013 and 2022. Studies were included within the current review if they were cross-sectional and used the MMAS to measure adherence to medication in patients with Type 2 Diabetes (T2DM). Double-blinded screening was used to minimise the risk of bias. Inclusion criteria for participants in the studies were: adults > 18 years, diagnosed with T2DM and prescribed anti-glycaemic medications, including insulin. A narrative synthesis was adopted for data analysis to report factors that influenced nonadherence and MMAS adherence scores. Deductive thematic analysis utilising the COM-B Behavioural change model was used to map identified barriers and facilitators to adherence against the Capability, Opportunity and Motivation.

Results: Of the 9,990 returned records, 30 studies from 17 countries and with a total of 8,402 participants across all studies were analysed. Three studies found that >80% of their participants had high prevalence of adherence; in 15 studies participants reported high level of adherence to medication, in 3 studies participants had medium level and in 12 studies participants had low adherence to medication. The average level of high adherence was 40.93% and low adherence 42.64%, highlighting most study participants had a low level of medication adherence. Most common patient-level barriers to adherence included depression and poor diabetes knowledge, polypharmacy and healthcare related cost.

Conclusions: The MMAS scale is a reliable tool to measure self-reported adherence and yield homogenous results across studies. Adherence to medication remains low. A greater identification of diabetes-related depression, fewer medication, structured diabetes education programmes and a greater awareness of barriers by health care professionals can contribute to effective behavioural changes that could positively influence adherence to medication.