Medication Adherence of Diabetic Patients in Erbil City: A Cross-Sectional Study

Rasti Ibrahim Hama Faraj; Namir Ghanim Al-Tawil

doi:10.54133/ajms.v9i1.2285

Authors

Rasti Ibrahim Hama Faraj Department of Community Health, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq https://orcid.org/0009-0006-6072-8521
Namir Ghanim Al-Tawil Department of Community Health, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq https://orcid.org/0000-0002-5143-0057

DOI:

https://doi.org/10.54133/ajms.v9i1.2285

Keywords:

Advice seeking behavior, Glycemic control, Sociodemographic factors, T2DM, Treatment adherence

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major health problem in Iraq. In Erbil, differences in access to healthcare, socioeconomic level, and taking medications as directed made treatment much harder. Few studies are conducted on these dynamics outside of clinical settings, where selection bias might hide problems that happen in the real world. Objectives: To find out how socioeconomic and clinical characteristics, as well as the rate of medication adherence, affect glycemic control in people with T2DM. Methods: Community-based cross-sectional research was undertaken on 400 T2DM patients in Erbil, purposefully sampled from mosques, salary-collecting places, public parks, the Ministry of Education, and retirement offices. Data were obtained by standardized questionnaires, encompassing demographics, occupation, medication adherence, and health-seeking behavior. Glycemic control was categorized using HbA1c values. Results: Out of 400 participants, 38 had controlled diabetes, while 90.5% had uncontrolled T2DM. Only 40.8% adhered to their suggested regimen. 28.3% were obese, 45.8% overweight, and 26.5% had normal BMI. The primary adherence challenges were financial restrictions, lack of regular follow-up, and insufficient health literacy. Obesity and being overweight were highly connected with poor diabetic control. Conclusions: Uncontrolled diabetes is dangerously common in Erbil’s society, driven by medication non-adherence and obesity. Public health policies must focus on pharmaceutical preparation costs, weight control measures, and community diabetes education, especially targeting jobless and low-income groups—to improve results.

Downloads

Download data is not yet available.

References

Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, et al. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203–234. doi: 10.1016/S0140-6736(23)01301-6. DOI: https://doi.org/10.1016/S0140-6736(23)01301-6

Huang X, Wu Y, Ni Y, Xu H, He Y. Global, regional, and national burden of type 2 diabetes mellitus caused by high BMI from 1990 to 2021, and forecasts to 2045: analysis from the global burden of disease study 2021. Front Public Health. 2025;13:1515797. doi: 10.3389/fpubh.2025.1515797. DOI: https://doi.org/10.3389/fpubh.2025.1515797

Hauwanga WN, Abdalhamed TY, Ezike LA, Chukwulebe IS, Ko Oo A, Wilfred A, et al. The pathophysiology and vascular complications of diabetes in chronic kidney disease: A comprehensive review. Cureus. 2024. dooi: 10.7759/cureus.327365. DOI: https://doi.org/10.7759/cureus.76498

Pulgaron ER, Delamater AM. Type 2 Diabetes Mellitus. In: Gellman MD, (Ed.), Encyclopedia of Behavioral Medicine. Cham: Springer International Publishing; 2020. p. 2283–2284. doi: 10.1007/978-3-030-39903-0_781. DOI: https://doi.org/10.1007/978-3-030-39903-0_781

Mudaliar S, Henry RR. Management and prevention of diabetic complications. In: Skyler J, editor. Atlas of Diabetes. Boston, MA: Springer US; 2012. p. 233–48. doi:10.1007/978-1-4614-1028-7_11. DOI: https://doi.org/10.1007/978-1-4614-1028-7_11

Yahia M. Diabetes in the Arab world: A soaring epidemic. Nature Middle East. 2014. doi: 10.1038/nmiddleeast.2014.265. DOI: https://doi.org/10.1038/nmiddleeast.2014.265

Mansour AA. Diabetes in Iraq: Facing the Epidemic. A systematic review. Wulfenia J. 2015;22(3):258-273.

Zamil A, Amin S. Insulin resistance in association with metabolic syndrome in Wasit university students in Iraq. Iraqi J Pharm Sci. 2023;32(2):65–73. doi: 10.31351/vol32iss2pp65-73. DOI: https://doi.org/10.31351/vol32iss2pp65-73

Fadheel QJ. Prevalence of diabetes mellitus and it’s complications in Iraq. IJPQA. 2018;9(2). DOI: https://doi.org/10.25258/ijpqa.v9i2.13631

Williams JLS, Walker RJ, Smalls BL, Campbell JA, Egede LE. Effective interventions to improve medication adherence in Type 2 diabetes: a systematic review. Diabetes Management. 2014;4(1):29–48. doi: 10.2217/dmt.13.62. DOI: https://doi.org/10.2217/dmt.13.62

Latunji OO, Akinyemi OO. Factors influencing health-seeking behavior among civil servants in Ibadan, Nigeria. Ann Ib Postgrad Med. 2018;16(1):52–60.

Sahoo J, Mohanty S, Kundu A, Epari V. Medication adherence among patients of type II diabetes mellitus and its associated risk factors: A cross-sectional study in a tertiary care hospital of Eastern India. Cureus. 2022;14(12):e33074. doi: 10.7759/cureus.33074. DOI: https://doi.org/10.7759/cureus.33074

Deori TJ, Das J. Prevalence of diabetes and patterns of health seeking nehaviour among known diabetics in a rural area of Lucknow District. Chettinad Health City Med J. 2024;13(2):46–53. doi: 10.24321/2278.2044.202428. DOI: https://doi.org/10.24321/2278.2044.202428

Mouri Mi, Badireddy M. Hyperglycemia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jun 11]. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK430900/

Hamalaw S, Hama Salih A, Weli S. Non-adherence to anti-diabetic prescriptions among type 2 diabetes mellitus patients in the Kurdistan Region of Iraq. Cureus. 2024. doi: 10.7759/cureus.246134. DOI: https://doi.org/10.7759/cureus.60572

Rask-Madsen C, King GL. Vascular complications of diabetes: Mechanisms of injury and protective factors. Cell Metab. 2013;17(1):20–33. doi: 10.1016/j.cmet.2012.11.003. DOI: https://doi.org/10.1016/j.cmet.2012.11.012

Alhaiti AH, Senitan M, Dator WLT, Sankarapandian C, Baghdadi NA, Jones LK, et al. Adherence of type 2 diabetic patients to self-care activity: Tertiary care setting in Saudi Arabia. J Diabetes Res. 2020;2020:4817637. doi: 10.1155/2020/4817637. DOI: https://doi.org/10.1155/2020/4817637

Lafta R, Al-Shatari S, Cherewick M, Galway L, Mock C, Hagopian A, et al. Injuries, death, and disability associated with 11 years of conflict in Baghdad, Iraq: A randomized household cluster survey. PLoS One. 2015;10(8):e0131834. doi: 10.1186/1472-6963-10-196. DOI: https://doi.org/10.1371/journal.pone.0131834

Beck RW, Connor CG, Mullen DM, Wesley DM, Bergenstal RM. The fallacy of average: How using HbA1c alone to assess glycemic control can be misleading. Diabetes Care. 2017;40(8):994–999. doi: 10.2337/dc17-0155. DOI: https://doi.org/10.2337/dc17-0636

Gadó K, Tabák GyÁ, Vingender I, Domján G, Dörnyei G. Treatment of type 2 diabetes mellitus in the elderly – Special considerations. PhysInt. 2024;111(2):143–164. doi: 10.1556/2060.2024.00317. DOI: https://doi.org/10.1556/2060.2024.00317

Hameed S, Morton JR, Jaffé A, Field PI, Belessis Y, Yoong T, et al. Early glucose abnormalities in cystic fibrosis are preceded by poor weight gain. Diabetes Care. 2010;33(2):221–226. doi: 10.2337/dc09-1492. DOI: https://doi.org/10.2337/dc09-1492

Pahkala K, Hietalampi H, Laitinen TT, Viikari JSA, Rönnemaa T, Niinikoski H, et al. Ideal cardiovascular health in adolescence: Effect of lifestyle intervention and association with vascular intima-media thickness and elasticity. Circulation. 2013;127(21):2088–2096. doi: 10.1161/circulationaha.112.000761. DOI: https://doi.org/10.1161/CIRCULATIONAHA.112.000761

Kavookjian J, Wittayanukorn S. Interventions for adherence with oral chemotherapy in hematological malignancies: A systematic review. Res Soc Admin Pharm. 2015;11(3):303–314. doi: 10.1016/j.sapharm.2014.08.006. DOI: https://doi.org/10.1016/j.sapharm.2014.08.006

Brekke KR, Levaggi R, Siciliani L, Straume OR. Patient mobility and health care quality when regions and patients differ in income. J Health Economics. 2016;50:372–387. doi: 10.1016/j.jhealeco.2016.05.003. DOI: https://doi.org/10.1016/j.jhealeco.2016.05.003

Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570. doi: 10.11124/jbisrir-2015-2380. DOI: https://doi.org/10.1136/bmjopen-2012-001570

Jain R, Shastri J. Study of ocular drug delivery system using drug-loaded liposomes. Int J Pharma Investig. 2011;1(1):35. doi: 10.4103/2230-973X.76727. DOI: https://doi.org/10.4103/2230-973X.76727