Medication Burden and Side Effect Perception Associated with Medication Non-adherence in Type 2 Diabetes: A Comparative Study Based on Multimorbidity Status
Abstract
Abstract Medication non-adherence is a major challenge to optimal glycemic control in type 2 diabetes mellitus (T2DM), particularly when compounded by multimorbidity. The aim of this study was to evaluate the relationships between objective medication burden (regimen complexity) and subjective side effect perception with self-reported medication non-adherence among patients with T2DM across a spectrum of chronic comorbidities. A hospital-based, cross-sectional study was conducted among 213 patients with T2DM at a specialized tertiary care facility in Bangladesh. Purposive sampling was used to recruit participants from the outpatient department. Structured interviews recorded demographics, dosing frequencies, and six comorbidities. The overall proportion of patients classified as non-adherent due to dose-skipping behaviors was 76.1% ( n = 162). Subjective side effect perception escalated across the multimorbidity spectrum, rising from 31.6% in isolated T2DM to 83.3% in patients managing four concurrent comorbidities ( P = 0.011). In the adjusted multivariate logistic regression model, standard demographic factors, the absolute number of daily medications ( P = 0.707), and the total comorbidity score ( P = 0.080) were not significantly associated with non-adherence. However, the subjective perception of side effects showed a strong, statistically significant association with non-adherence, with patients perceiving side effects being four times more likely to report dose-skipping behaviors (adjusted odds ratio = 4.08, 95% confidence interval: 1.98–8.40, P < 0.001). Multimorbidity is cross-sectionally linked to higher regimen complexity and an increased reporting of drug side effects. Self-reported medication non-adherence is more strongly associated with the subjective experience of physical side effects than the objective count of chronic illnesses or prescribed pills.