Adherencia farmacológica y control glucémico en pacientes no insulinizados con Diabetes Tipo 2 de Lima Norte

Giancarlo Neill Quispe Tutaya; Félix Konrad  Llanos Tejada

doi:10.53684/csp.v6i1.194

Authors

Giancarlo Neill Quispe Tutaya Instituto de Investigaciones en Ciencias Biomédicas (INICIB). Facultad de Medicina Humana. Universidad Ricardo Palma. Lima. Perú.
Félix Konrad Llanos Tejada Unidad Especializada en Tuberculosis. Servicio de Neumología. Hospital Nacional Dos de Mayo. Lima. Perú.

DOI:

https://doi.org/10.53684/csp.v6i1.194

Keywords:

Salud mental; Calidad de vida, Satisfaccion con la vida; Adulto mayor (DeCS)

Abstract

Objectives: To determine the association between adherence to oral pharmacological treatment and glycemic control in non-insulin-treated patients with type 2 diabetes mellitus. Materials and methods: An observational, analytical, cross-sectional study was conducted in 112 patients attending a primary healthcare center in North Lima during 2025. Adherence was assessed with the MMAS-8 scale and glycemic control with the glycated hemoglobin (HbA1c) value recorded within the previous three months; HbA1c <7% was considered controlled. Descriptive statistics, Fisher's exact test, and prevalence ratios (PR) with 95% confidence intervals (95%CI) were used. Results: Medium adherence was found in 56.3%, and 65.2% had uncontrolled glycemia. No overall association was observed between adherence and glycemic control (p=0.140). However, low adherence was associated with a higher prevalence of uncontrolled glycemia compared with high adherence (PR=1.511; 95%CI: 1.010-2.260; p=0.044). Forgetfulness or carelessness showed no overall association (p>0.90). For intentional omission or discontinuation, the overall test was borderline (p=0.064), although the low category showed a higher prevalence of the outcome (PR=1.961; 95%CI: 1.373-2.801; p<0.001). Conclusions: No overall association was demonstrated; localized differences suggest that low adherence and intentional discontinuation may identify patients with a higher prevalence of inadequate glycemic control.

References

World Health Organization. Diabetes [Internet]. Geneva: WHO; 2024 [citado 12 ene 2026]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/diabetes

International Diabetes Federation. IDF Diabetes Atlas [Internet]. 11th ed. Brussels: International Diabetes Federation; 2025 [citado 15 ene 2026]. Disponible en: https://diabetesatlas.org/resources/idf-diabetes-atlas-2025/

Pan American Health Organization. Diabetes [Internet]. Washington (DC): PAHO; [citado 18 ene 2026]. Disponible en: https://www.paho.org/en/topics/diabetes

Instituto Nacional de Salud. INS advierte que más de 2 millones 500 mil peruanos sufre de diabetes y recomienda evaluaciones preventivas al menos una vez al año [Internet]. Lima: INS; 2025 [citado 20 ene 2026]. Disponible en: https://www.gob.pe/institucion/ins/noticias/1190543-ins-advierte-que-mas-de-2-millones-500-mil-peruanos-sufre-de-diabetes-y-recomienda-evaluaciones-preventivas-al-menos-una-vez-al-ano

Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 diabetes. Lancet [Internet]. 2022 [citado 22 ene 2026];400(10365):1803-20. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36332637/

American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: Standards of Care in Diabetes-2025. Diabetes Care [Internet]. 2025 [citado 24 ene 2026];48(Suppl 1):S128-45. Disponible en: https://diabetesjournals.org/care/article/48/Supplement_1/S128/157561/6-Glycemic-Goals-and-Hypoglycemia-Standards-of

Chantzaras A, Yfantopoulos J. Determinants of medication adherence in patients with diabetes, hypertension, and hyperlipidemia. Hormones (Athens) [Internet]. 2025 [citado 26 ene 2026];24:443-59. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39971883/

Religioni U, Barrios-Rodríguez R, Requena P, Borowska M, Ostrowski J. Enhancing therapy adherence: impact on clinical outcomes, healthcare costs, and patient quality of life. Medicina (Kaunas) [Internet]. 2025 [citado 28 ene 2026];61(1):153. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39859135/

Sendekie AK, Netere AK, Kasahun AE, Belachew EA. Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: a multicenter cross-sectional study in Northwest Ethiopia. PLoS One [Internet]. 2022 [citado 30 ene 2026];17(9):e0274971. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36130160/

Li H, Min H, Zhang L, Li Y, Wang J, Jia X. The relationships between social support, medication adherence, and glycemic control among inpatients with type 2 diabetes: a cross-sectional survey in Xi'an, China. Front Pharmacol [Internet]. 2025 [citado 1 feb 2026];16:1634768. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40642014/

Nascimento T, Andrade A, Pinto E, Cabrita C, Pais S, de la Puerta R. Medication adherence and glycemic control in older adults with type 2 diabetes: a cross-sectional study in a community setting. Diabetology [Internet]. 2025 [citado 3 feb 2026];6(5):33. Disponible en: https://www.mdpi.com/2673-4540/6/5/33

Briones A, Wong LI, Flores DM, Guzmán M, Castellanos M, Albavera C. Falta de adherencia al tratamiento farmacológico y factores asociados en pacientes mexicanos con diabetes mellitus tipo 2. Rev Med Chil [Internet]. 2022 [citado 5 feb 2026];150(8):985-93. Disponible en: https://pubmed.ncbi.nlm.nih.gov/37358145/

Farías-Vílchez BA, Bardales-Ruíz D. Conocimientos sobre diabetes mellitus tipo 2 y adherencia al tratamiento en pacientes del hospital Reátegui de Piura, Perú. Acta Med Peru [Internet]. 2021 [citado 7 feb 2026];38(1):34-41. Disponible en: https://www.scielo.org.pe/scielo.php?pid=S1728-59172021000100034&script=sci_arttext

Guillén Chávez AF, Rios Bisetti L. Adherencia al tratamiento y control glucémico en pacientes diabéticos del Centro de Salud Jaime Zubieta, Lima 2025 [tesis en Internet]. Lima: Universidad Privada Norbert Wiener; 2025 [citado 9 feb 2026]. Disponible en: https://repositorio.uwiener.edu.pe/entities/publication/87418d63-d526-4d22-8ab0-3fc1f5313389

Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) [Internet]. 2008 [citado 11 feb 2026];10(5):348-54. Disponible en: https://pubmed.ncbi.nlm.nih.gov/18453793/

Valencia-Monsálvez F, Mendoza-Parra S, Luengo-Machuca L. Evaluación de la escala Morisky de adherencia a la medicación (MMAS-8) en adultos mayores de un centro de atención primaria en Chile. Rev Peru Med Exp Salud Publica [Internet]. 2017 [citado 13 feb 2026];34(2):245-9. Disponible en: https://www.scielo.org.pe/scielo.php?pid=S1726-46342017000200012&script=sci_arttext

Laghousi D, Rezaie F, Alizadeh M, Jafarabadi MA. The eight-item Morisky Medication Adherence Scale: validation of its Persian version in diabetic adults. Caspian J Intern Med [Internet]. 2021 [citado 15 feb 2026];12(1):77-83. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33680402/

Pagès-Puigdemont N, Valverde-Merino MI. Métodos para medir la adherencia terapéutica. Ars Pharm [Internet]. 2018 [citado 17 feb 2026];59(3):163-72. Disponible en: https://revistaseug.ugr.es/index.php/ars/article/view/7387

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet [Internet]. 2007 [citado 19 feb 2026];370(9596):1453-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/18064739/

World Medical Association. WMA Declaration of Helsinki: ethical principles for medical research involving human participants [Internet]. Ferney-Voltaire: WMA; 2024 [citado 20 feb 2026]. Disponible en: https://www.wma.net/policies-post/wma-declaration-of-helsinki/

Crasto LK, Menezes LV, Pinto ES, Sirimalla S, Mateti UV, Kellarai A, et al. Frailty, medication adherence, and glycemic control in patients with type 2 diabetes: a cross-sectional study among metformin- and non-metformin-exposed groups. Clin Diabetol [Internet]. 2025 [citado 21 feb 2026];14(2):88-95. Disponible en: https://journals.viamedica.pl/clinical_diabetology/article/view/104449

Hadush F, Beedemariam G, Kahissay MH, Patel SA, Habte BM. Patients' perceptions and knowledge of diabetes and medications: implications for medication adherence and glycemic control in type 2 diabetes patients, Northern Ethiopia. J Diabetes Res [Internet]. 2024 [citado 22 feb 2026];2024:3652855. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11567723/

Olickal JJ, Chinnakali P, Suryanarayana BS, Saya GK, Ganapathy K, Subrahmanyam DKS. Medication adherence and glycemic control status among people with diabetes seeking care from a tertiary care teaching hospital, South India. Clin Epidemiol Glob Health [Internet]. 2021 [citado 23 feb 2026];11:100742. Disponible en: https://www.sciencedirect.com/science/article/pii/S2213398421000464

Wu M, Xu X, Zhao R, Bai X, Zhu B, Zhao Z. Effect of pharmacist-led interventions on medication adherence and glycemic control in type 2 diabetic patients: a study from the Chinese population. Patient Prefer Adherence [Internet]. 2023 [citado 24 feb 2026];17:119-29. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36660042/

Alfalogy EH, Almatrafi RT, Alshahrani KM, Hariri NH. Prevalence and determinants of suboptimal glycemic control in type 2 diabetes mellitus patients in primary health care. Open Public Health J [Internet]. 2025 [citado 25 feb 2026];18:e18749445374735. Disponible en: https://openpublichealthjournal.com/VOLUME/18/ELOCATOR/e18749445374735/

Dinavari MF, Sanaie S, Rasouli K, Faramarzi E, Molani-Gol R. Glycemic control and associated factors among type 2 diabetes mellitus patients: a cross-sectional study of Azar cohort population. BMC Endocr Disord [Internet]. 2023 [citado 26 feb 2026];23:273. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10714613/

Evans M, Engberg S, Faurby M, Fernandes JDDR, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: a systematic literature review. Diabetes Obes Metab [Internet]. 2022 [citado 26 feb 2026];24(3):377-90. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34779107/

Lubaki JPF, Omole OB, Francis JM. Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis. Diabetol Metab Syndr [Internet]. 2022 [citado 27 feb 2026];14(1):134. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36127712/

Chin SS, Lau SW, Lim PL, Wong CM, Ujang N. Medication adherence, its associated factors and implication on glycaemic control in patients with type 2 diabetes mellitus: a cross-sectional study in a Malaysian primary care clinic. Malays Fam Physician [Internet]. 2023 [citado 27 feb 2026];18:14. Disponible en: https://pubmed.ncbi.nlm.nih.gov/37139478/

McClintock HF, Edmonds SE, Bogner HR. Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes. Prim Care Diabetes [Internet]. 2023 [citado 28 feb 2026];17(2):180-4. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36803970/