THERAPEUTIC ADHERENCE IN OLDER ADULTS WITH TYPE 2 DIABETES MELLITUS
Keywords:
Treatment Adherence and Compliance, Diabetes mellitus Type 2, Community Health Planning, Health Education, Chronic diseasesAbstract
DOI: https://doi.org/10.46296/gt.v8i16.0322
Abstract
Introduction: Type 2 diabetes mellitus is considered a chronic condition that predominantly affects the elderly population and requires ongoing management to reduce metabolic complications. However, adherence to treatment is generally limited by emotional, social, and cultural factors that affect the patient and their family environment. Objective: To analyze therapeutic adherence in the elderly population with Type 2 Diabetes Mellitus treated at the Totoras Type B Health Center and to describe the factors that influence compliance. Method: This is a mixed-method, cross-sectional study. In the qualitative phase, information was collected through semi-structured interviews with family members and caregivers, analyzed using Braun and Clarke's Reflective Thematic Analysis, and the quantitative phase was developed using the Morisky-Green Test (MMAS-8) on a population of 60 older adults diagnosed with Type 2 Diabetes Mellitus “DM2” who were treated at the Totoras Health Center. Results: It was found that 1.7% of participants showed adherence to therapeutic adherence, while 28.3% showed moderate adherence, and 70% of participants showed low adherence. From a family perspective, the difficulties that prevent adherence to treatment include the number of medications, lack of support, economic barriers, and preferences for natural medicine practices. Conclusions: Therapeutic adherence in older adults with type 2 diabetes mellitus is related to cultural, economic, and family factors. Family support is essential for full treatment adherence, so it is necessary to implement therapeutic education and support strategies from the first level of care.
Keywords: Treatment Adherence and Compliance, Diabetes mellitus Type 2, Community Health Planning, Health Education, Chronic diseases.
Downloads
References
Xi Lu QXXPRZXZGPYZSS+NT. Type 2 diabetes mellitus in adults: pathogenesis, prevention and therapy. Signal Transduction and Targeted Therapy. [Revista de internet]. 2024 October. [citado 11 de Noviembre del 2025]; 9(1): p. 262. Disponible en: https://www.nature.com/articles/s41392-024-01951-9.
International Diabetes Federation (IDF). IDF Diabetes Atlas. 10th Edition. Atlas epidemiológico / Informe mundial. Brussels: International Diabetes Federation (IDF), IDF Epidemiology and Public Health Research Division; 2021. Report No.: 978-2-930229-93-4.
Andrea M Russell LO,EYSCBMOMSW. Association between medication regimen complexity and glycemic control among patients with type 2 diabetes. Journal of the American Pharmacists Association. [Revista de internet]. 2023 May-June. [citado 4 de noviembre del 2025]; 63(3): p. 769-777. Disponible en: https://www.japha.org/article/S1544-3191(22)00458-7/abstract.
Organización Panamericana de la Salud. Panorama de la diabetes en la Región de las Américas. Informe Tecnico. Washington, D.C.: Organización Panamericana de la Salud, Organización Panamericana de la Salud OPS - Departamento de Enfermedades No Transmisibles y Salud Mental (NMH).; 2023. Report No.: 978-92-75-32633-6.
International Diabetes Federation (IDF). IDF Diabetes Atlas. 10th Edition. Atlas epidemiológico / reporte mundial. Brussels, Bélgica: International Diabetes Federation, IDF Epidemiology and Public Health Research Division; 2021. Report No.: 978-2-930229-93-4.
Alicia Zavala-Calahorrano EF. Diabetes mellitus tipo 2 en el Ecuador:revisión epidemiológica. Mediciencias UTA. [Revista de internet]. 2018 Diciembre. [citado 11 de Noviembre del 2025]; 2(4): p. 3-9. Disponible en: https://www.erevista.bibliolatino.com/index.php/medi/article/view/1219.
Miranda DNEP, Orellana DOPC, Vera DMEB, Intriago DGIZ, Cantos DCAC, Mera DJGZ. Factores Asociados a la no Adherencia Terapéutica en Pacientes con Diabetes Mellitus Tipo 2. Ciencia Latina Revista Multidisciplinar. [Revista de internet]. 2024 Septiembre-Octubre. [citado 11 de Noviembre del 2025]; 8(5). Disponible en: https://ciencialatina.org/index.php/cienciala/article/view/14064.
Luo Z-N LKCAQQYCYXXLZWLJHWYBCJY. The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy. BMC Public Health. [Revista de internet]. 2024 December. [citado 11 de Noviembre del 2025]; 24(1). Disponible en: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-20906-x.
Ministerio de Salud Pública del Ecuador (MSP). Política Nacional para la Atención Integral de Enfermedades No Transmisibles. Política Pública Nacional. Quito, Ecuador: Ministerio de Salud Pública del Ecuador, Subsecretaría de Promoción, Prevención y Control de la Salud – Dirección Nacional de Prevención y Control de Enfermedades No Transmisibles (ENT); 2023.
Peñafiel BDG, Merino GYJ, Celi NJM, Chamba CND. Estilos de vida en pacientes con diagnóstico de Diabetes Mellitus. Revista InveCom. [Revista de internet]. 2025 Noviembre. [citado 11 de Noviembre del 2025]; 15(1). Disponible en: https://ve.scielo.org/scielo.php?script=sci_arttext&pid=S2739-00632025000102010.
Amudha Kadirvelu SSSHN. Apoyo social en la atención de la diabetes tipo II: un caso de insuficiente y tardío. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. [Revista de internet]. 2012 November. [citado 11 de Noviembre del 2025]; 5(5): p. 407-417. Disponible en: https://www.dovepress.com/article/download/11577.
Huang YM, Shiyanbola OO. Investigation of Barriers and Facilitators to Medication Adherence in Patients With Type 2 Diabetes Across Different Health Literacy Levels: An Explanatory Sequential Mixed Methods Study. Frontiers in Pharmacology. [Revista de internet]. 2021 October. [citado 12 de Noviembre del 2025]; 12(745749): p. 745-749. Disponible en: https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.745749/full.
Evans M, Engberg S, Faurby M, Polonsky WH. 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, Obesity and Metabolism. [Revista de internet]. 2022 March. [citado 12 de Noviembre del 2025]; 24(3): p. 377-390. Disponible en: https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.14603.
Niko Dima Kristaningrum DARYSHS. Correlación entre la carga de los cuidadores familiares y el estado de salud de las personas con diabetes mellitus. Journal of Public Health Research. [Revista de internet]. 2021 April. [citado 11 de Noviembre del 2025]; 10(2): p. 2227. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8129740/.
Edward Appiah Boateng RAIAVMDLOP. Perspectives of Family Caregivers on Healthcare Provided to Older Adults With Hypertension and/or Diabetes Mellitus in Ghana. Gerentology and Geriatric Medicine. [Revista de internet]. 2024 June. [citado 12 de Noviembre del 2025]; 10. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11186387/.
Suárez M CRAC. Adherencia al tratamiento en adultos mayores con enfermedades crónicas. Rev Salud Pública. [Revista de internet]. 2021.; 23(2).
Guerrero M PL. Terapias en DM2 y adherencia en población rural. Rev Méd Chile.. [Revista de internet]. 2020.; 148(5).
Ayele A. Medication adherence among older adults with chronic diseases: A systematic review. BMC Geriatr. [Revista de internet]. 2022.; 22.
Caruso R. Cognitive impairment and treatment adherence in diabetes. Aging Ment Health. [Revista de internet]. 2020 24.; 3: p. 417 - 424.
Gómez J. Mild cognitive impairment and medication management in older adults. J Diabetes Complications. [Revista de internet]. 2021 35.; 4: p. 107-115.
Lee M. Factors affecting adherence in older adults with type 2 diabetes. Patient Prefer Adherence. [Revista de internet]. 2019.; 13.
Kristaningrum N. Family caregiver burden and adherence in older adults. Int J Nurs Stud. [Revista de internet]. 2021.; 118: p. 103-110.
Boateng E. Family support and adherence to diabetes treatment.. BMC Endocr Disord. [Revista de internet]. 2024.; 24.
Soto A. Sociodemographic factors and treatment adherence in chronic diseases. Int J Environ Res Public Health. [Revista de internet]. 2019.; 16(23).
Buawangpong N. Medication adherence and health literacy in T2DM. Diabetes Metab Syndr.. [Revista de internet]. 2020.; 14(5).
Llamas A. Cultural beliefs and diabetes care in indigenous communities. J Transcult Nurs. [Revista de internet]. 2021.; 32(4): p. 389-398.
Cahua J. Adherencia y prácticas tradicionales en poblaciones indígenas. Rev Peru Med Exp Salud Pública. [Revista de internet]. 2020.; 37(4): p. 650-657.
Martínez B. Socioeconomic barriers to diabetes care in low-income settings. Lancet Diabetes Endocrinol. [Revista de internet]. 2022.; 10(3): p. 175-183.
Mamatsharaga F. Emotional stress in caregivers of older adults. Gerontologist. [Revista de internet]. 2022.; 62(4): p. 569-578.
Aranda M. Emotional dynamics in caregiving roles. J Aging Health. [Revista de internet]. 2022.; 34(1).
Schmidt E. Family-centered diabetes interventions. Diabetes Spectr. [Revista de internet]. 2020.; 33(4): p. 346-354.
Kolarić B. Lifestyle changes and diabetes management in older adults. Nutrients. [Revista de internet]. 2023.; 15.
Plakas S MDMMATFGBATCMD. Validation of the 8-Item Morisky Medication Adherence Scale in Chronically Ill Ambulatory Patients in Rural Greece. Open Journal of Nursing. [Revista de internet]. 2016 March. [citado 11 de Noviembre del 2025]; 6(3): p. 158–169. Disponible en: https://www.scirp.org/journal/paperinformation?paperid=64445.
Francisco Pérez Peña MCISVP,RA. Aspectos generales del uso de métodos mixtos para investigación en salud. Medwave. [Revista de internet]. 2023 Noviembre. [citado 11 de Noviembre del 2025]; 23(10): p. 2767. Disponible en: https://www.medwave.cl/medios//revisiones/metodinvestreport/2767/medwave_2023_2767a.pdf.
Alicia Sarahy Martin del Campo Navarro PMQRIHPSECVSLPPMRV. Grado de Sobrecarga y Caracterización de Cuidadores de Personas Adultas Mayores con Diabetes Mellitus tipo 2. Enfermeria Global. [Revista de internet]. 2019 Octubre. [citado 11 de Noviembre del 2025]; 18(56): p. 57–67. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1695-61412019000400003.
MARTÍNEZ-ROYERT JC, GUZMÁN JLL, ARISTA SAR, MENA SCM, PÁJARO-MARTÍNEZ MC, GÓMEZ KEP. Calidad de vida en el adulto mayor con diabetes mellitus tipo II. Revista Salud Uninorte. [Revista de internet]. 2021 Abril. [citado 11 de Noviembre del 2025]; 37(2): p. 302-315. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-55522021000200302.
Covarrubias MMF, Valdes RES, Ortega FJG. DETERMINANTES DE ADHERENCIA AL TRATAMIENTO EN PACIENTES CONDIABETES TIPO 2 IDENTIFICADOS EN CENTROS DE ATENCIÓN PRIMARIA DE LA CIUDAD DE CIUDAD DE VERACRUZ. Ciencia Latina Revista Cientifica Multidisciplinar. [Revista de internet]. 2025 Julio- Agosto. [citado 14 de Noviembre del 2025]; 9(4): p.. 7013-7029. Disponible en: https://ciencialatina.org/index.php/cienciala/article/view/19298.
Sharma LR, Bidari S, Bidari D, Neupane S, Sapkota R. Exploring the Mixed Methods Research Design: Types, Purposes, Strengths, Challenges, and Criticisms. Global Academic Journal of Linguistics and Literature. [Revista de internet]. 2023 January. [citado 11 de Noviembre del 2025]; 5(1): p. 3–12. Disponible en: https://www.gajrc.com/media/articles/GAJLL_51_3-12.pdf.
Lay Hoon Goh ASCJRSMALESTJMV&DYLY. Patient perspectives of diabetes care in primary care networks in Singapore: a mixed-methods study. BMC Health Services Research. [Revista de internet]. 2023 December. [citado 11 de Noviembre del 2025]; 23(1445). Disponible en: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-10310-3.
Delara Laghousi FRMAMAJ. The eight-item Morisky Medication Adherence Scale: validation of its Persian version in diabetic adults. Caspian Journal Of Internal Medicine. [Revista de internet]. 2021. [citado 11 de Noviembre del 2025]; 12(1): p. 77-83. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC7919181/.
Braun V, Clarke V. Conceptual and design thinking for thematic analysis. Qualitative Psychology. [Revista de internet]. 2022 May. [citado 11 de Noviembre del 2025]; 9(1): p. 3-26. Disponible en: https://psycnet.apa.org/doiLanding?doi=10.1037%2Fqup0000196.
Mamatsharaga IP, Mashau NS, Damian JU. I lack ‘me-time’: The experiences of family caregivers of elders with Diabetes Mellitus in a selected village in South Africa. HEALTH SA GESONDHEID. [Revista de internet]. 2022 Noviembre. [citado 11 de Noviembre del 2025]; 10(27). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9724022/.
Catalán-Gómez CAGVMCRÁLCVVMPMMdlÁ. Caregivers experiences about elderly with type 2 diabetes mellitus during the COVID-19 pandemic. Sanus. [Revista de internet]. 2022 August. [citado 12 de Noviembre del 2025]; 7: p. 1-14. Disponible en: https://www.scielo.org.mx/scielo.php?pid=S2448-60942022000100203&script=sci_arttext&tlng=en.
Kolarić V, Rahelić V, Šakić Z. The Quality of Life of Caregivers of People with Type 2 Diabetes Estimated Using the WHOQOL-BREF Questionnaire. Diabetology. [Revista de internet]. 2023 October. [citado 12 de Noviembre del 2025]; 4(4): p. 430-439. Disponible en: https://www.mdpi.com/2673-4540/4/4/37.
Schmidt SK, Hemmestad L, MacDonald CS, Langberg H, Valentiner LS. Motivation and Barriers to Maintaining Lifestyle Changes in Patients with Type 2 Diabetes after an Intensive Lifestyle Intervention (The U-TURN Trial): A Longitudinal Qualitative Study. International Journal of Environmental Research and Public Health. [Revista de internet]. 2020 October. [citado 12 de Noviembre del 2025]; 17(20): p. 7454. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33066239/.
CS FS, TF O, V FD, P S, J. C. [Association between health literacy and adherence to medications among older adults]. Revista Médica de Chile. [Revista de internet]. 2020 May. [citado 12 de Noviembre del 2025]; 148(5): p. 653-656. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33399758/.
Y W, H L, S W, C C. Factors Associated With Medication Compliance in Elderly Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study. Frontiers in Public Health. [Revista de internet]. 2022 January. [citado 12 de Noviembre del 2025]; 9(771593): p. 1-9. Disponible en: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.771593/full.
Al-Azayzih A KRASAQWSS. Medication Adherence and Its Associated Determinants in Older Adults with Type 2 Diabetes and Cardiovascular Comorbidities. Patient Preference and Adherence. [Revista de internet]. 2023 Noviembre. [citado 12 de Noviembre del 2025]; 17: p. 3107-3118. Disponible en: https://www.dovepress.com/medication-adherence-and-its-associated-determinants-in-older-adults-w-peer-reviewed-fulltext-article-PPA.
Iza JEC, Sillo JNP, Gahona RSC. Cuidados de enfermería en adultos mayores con diabetes mellitus tipo 2. REINCISOL – Revista de Investigación Científica y Social. [Revista de internet]. 2025 Septiembre. [citado 11 de Noviembre del 2025]; 4(8): p. 2526–2548. Disponible en: https://www.reincisol.com/ojs/index.php/reincisol/article/view/965.
Published
How to Cite
Issue
Section
Copyright (c) 2025 GESTAR Arbitrated Scientific Journal in Health Research. ISSN: 2737-6273.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
