Marijana Jandrić-Kočić, Snežana Knežević

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Diabetes mellitus, including type 2 diabetes, is a global health issue with less than 50% of individuals achieving optimal glycemic control. A study at Health Center Krupa na Uni, Republic Srpska, assessed adherence in 159 adults with type 2 diabetes, during the study conducted during 2019-2020. The research used a general and specific questionnaire The Adherence in Chronic Diseases Scale. Findings showed 72.9% had moderate adherence, 16.4% had low adherence, and only 10.7% had high adherence. The female gender predicted higher adherence (p=0.048). The type of oral hypoglycemic agents (p=0.520) was not associated with adherence. Older age (p=0.316) and lower education level (p=0.182) were associated with lower adherence, but not significantly. Age over 60 years and level of education had no significant effects on adherence. Although there was no statistical significance, employed respondents (p=0.076) and those living in rural areas had a higher level of adherence (p=0.064). Some respondents took medications based on their physical needs and beliefs, indicating the need to address beliefs and behaviors influencing adherence. Poor adherence remains a significant issue, and addressing adherence barriers, particularly those related to gender, can improve health outcomes for individuals with type 2 diabetes. Ongoing research and interventions are crucial to improve adherence rates and health outcomes in individuals with type 2 diabetes.


Diabetes Mellitus, adherence, sociodemographic factors, primary healthcare

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WHO. Diabetes [Internet]. [cited 2023 Apr 7]. Available from:

Goyal R, Jialal I. Diabetes Mellitus Type 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Apr 7]. Available from:

Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2020; 396(10267):2019–82.

Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022; 183:109119.

Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019; 157:107843.

Goodall R, Alazawi A, Hughes W, Bravis V, Salciccioli JD, Marshall DC, et al. Trends in type 2 diabetes mellitus disease burden in European Union countries between 1990 and 2019. Sci Rep 2021; 11(1):15356.

IDF. International diabetes federation [Internet]. [cited 2023 Apr 7]. Available from:

Global report on diabetes [Internet]. [cited 2023 Apr 8]. Available from:

Stegbauer C, Falivena C, Moreno A, Hentschel A, Rosenmöller M, Heise T, et al. Costs and its drivers for diabetes mellitus type 2 patients in France and Germany: a systematic review of economic studies. BMC Health Serv Res 2020; 20:1043.

Catic T, Popovic SP, Asimi ZV, Hlavinkova L. Costs of Diabetes Mellitus and Its Complications in Bosnia and Herzegovina. Mater Socio-Medica 2022; 34(2):149–54.

Sabaté E, World Health Organization, editors. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

Jandrić-Kočič MC, Knežević SB. Influence of socio-demographic factors and length of disease on adherence of patients with arterial hypertension. Timoč Med Glas 2020; 45(4):140–4.

Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Fam Pract 2019; 20(1):132.

Xie Z, Liu K, Or C, Chen J, Yan M, Wang H. An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health 2020; 20:1227.

Ong SE, Koh JJK, Toh SAES, Chia KS, Balabanova D, McKee M, et al. Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS ONE 2018;13(3):e0195086.

Rezaei M, Valiee S, Tahan M, Ebtekar F, Ghanei Gheshlagh R. Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study. Diabetes Metab Syndr Obes Targets Ther 2019; 12:589–99.

Pourhabibi N, Sadeghi R, Mohebbi B, Shakibazadeh E, Sanjari M, Tol A, et al. Factors affecting nonadherence to treatment among type 2 diabetic patients with limited health literacy: Perspectives of patients, their families, and healthcare providers. J Educ Health Promot 2022; 11:388.

Pourhabibi N, Mohebbi B, Sadeghi R, Shakibazadeh E, Sanjari M, Tol A, et al. Determinants of Poor Treatment Adherence among Patients with Type 2 Diabetes and Limited Health Literacy: A Scoping Review. J Diabetes Res 2022; 2022:2980250.

Świątoniowska-Lonc N, Tański W, Polański J, Jankowska-Polańska B, Mazur G. Psychosocial Determinants of Treatment Adherence in Patients with Type 2 Diabetes – A Review. Diabetes Metab Syndr Obes Targets Ther. 2021; 14:2701–15.

Huang J, Ding S, Xiong S, Liu Z. Medication Adherence and Associated Factors in Patients With Type 2 Diabetes: A Structural Equation Model. Front Public Health [Internet]. 2021 [cited 2023 Apr 7];9. Available from:

Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, et al. Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care 2020; 44(1):258–79.

Kosobucka A, Michalski P, Pietrzykowski Ł, Kasprzak M, Obońska K, Fabiszak T, et al. Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction. Patient Prefer Adherence 2018; 12:333–40.

Michalski P, Pietrzykowski Ł, Wawrzyniak M, Kasprzak M. The Adherence in Chronic Diseases Scale — a new tool to monitor implementation of a treatment plan. In 2017 [cited 2023 Apr 8]. Available from:

Buszko K, Obońska K, Michalski P, Kosobucka A, Jurek A, Wawrzyniak M, et al. The Adherence Scale in Chronic Diseases (ASCD). The power of knowledge: the key to successful patient-health care provider cooperation. Med Res J 2016; 1:37–42.

Kubica A, Kosobucka A, Michalski P, Pietrzykowski Lukasz, Jurek A, Wawrzyniak M, et al. The Adherence in Chronic Diseases Scale—a new tool to monitor implementation of a treatment plan. Folia Cardiol 2017; 12(1):19–26.

Krzemińska S, Lomper K, Chudiak A, Ausili D, Uchmanowicz I. The association of the level of self-care on adherence to treatment in patients diagnosed with type 2 diabetes. Acta Diabetol 2021; 58(4):437–45.

Bonikowska I, Szwamel K, Uchmanowicz I. Adherence to Medication in Older Adults with Type 2 Diabetes Living in Lubuskie Voivodeship in Poland: Association with Frailty Syndrome. J Clin Med. 2022; 11(6):1707.

Bonikowska I, Szwamel K, Uchmanowicz I. Analysis of the Impact of Disease Acceptance, Demographic, and Clinical Variables on Adherence to Treatment Recommendations in Elderly Type 2 Diabetes Mellitus Patients. Int J Environ Res Public Health 2021; 18(16):8658.

Cokolic M, Lalic NM, Micic D, Mirosevic G, Klobucar Majanovic S, Lefterov IN, et al. Patterns of diabetes care in Slovenia, Croatia, Serbia, Bulgaria and Romania : An observational, non-interventional, cross-sectional study. Wien Klin Wochenschr 2017; 129(5–6):192–200.

Piragine E, Petri D, Martelli A, Calderone V, Lucenteforte E. Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis. J Clin Med 2023; 12(5):1981.

Anderson LJ, Nuckols TK, Coles C, Le MM, Schnipper JL, Shane R, et al. A systematic overview of systematic reviews evaluating medication adherence interventions. Am J Health-Syst Pharm AJHP Off J Am Soc Health-Syst Pharm 2020; 77(2):138–47.

Asheq A, Ashames A, Al-Tabakha M, Hassan N, Jairoun A. Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates. F1000Research 2021; 10:435.

Gast A, Mathes T. Medication adherence influencing factors-an (updated) overview of systematic reviews. Syst Rev 2019; 8(1):112.

Marušić S, Meliš P, Lucijanić M, Grgurević I, Turčić P, Obreli Neto PR, et al. Impact of pharmacotherapeutic education on medication adherence and adverse outcomes in patients with type 2 diabetes mellitus: a prospective, randomized study. Croat Med J 2018; 59(6):290–7.

Horvat O, Popržen J, Tomas A, Paut Kusturica M, Tomić Z, Sabo A. Factors associated with non-adherence among type 2 diabetic patients in primary care setting in eastern Bosnia and Herzegovina. Prim Care Diabetes 2018; 12(2):147–54.

Sánchez-Hernández MS, Rodríguez-Caldero MC, Martín-Pérez MP, Mira-Solves JJ, Vitaller-Burillo J, Carratalá-Munuera MC. Impact of adherence to Mediterranean diet and/or drug treatment on glycaemic control in type 2 diabetes mellitus patients: DM2-CUMCYL study. Prim Care Diabetes 2020; 14(6):685–91.

Heissam K, Abuamer Z, El-Dahshan N. Patterns and obstacles to oral antidiabetic medications adherence among type 2 diabetics in Ismailia, Egypt: a cross section study. Pan Afr Med J 2015; 20:177.

Elsous A, Radwan M, Al-Sharif H, Abu Mustafa A. Medications Adherence and Associated Factors among Patients with Type 2 Diabetes Mellitus in the Gaza Strip, Palestine. Front Endocrinol 2017; 8:100.

Murwanashyaka J de D, Ndagijimana A, Biracyaza E, Sunday FX, Umugwaneza M. Non-adherence to medication and associated factors among type 2 diabetes patients at Clinique Medicale Fraternite, Rwanda: a cross-sectional study. BMC Endocr Disord 2022; 22(1):219.

Badi S, Abdalla A, Altayeb L, Noma M, Ahmed MH. Adherence to Antidiabetic Medications Among Sudanese Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Survey. J Patient Exp 2020; 7(2):163–8.

Demoz GT, Wahdey S, Bahrey D, Kahsay H, Woldu G, Niriayo YL, et al. Predictors of poor adherence to antidiabetic therapy in patients with type 2 diabetes: a cross-sectional study insight from Ethiopia. Diabetol Metab Syndr 2020; 12:62.

Araya EM, Gebrezgabiher HA, Tekulu GH, Alema NM, Getnet D, Gebru HT, et al. Medication Non-Adherence and Associated Factors Among Diabetic Patients Visiting General Hospitals in the Eastern Zone of Tigrai, Northern Ethiopia. Patient Prefer Adherence 2020; 14:2071–83.

Mannan A, Hasan MM, Akter F, Rana MM, Chowdhury NA, Rawal LB, et al. Factors associated with low adherence to medication among patients with type 2 diabetes at different healthcare facilities in southern Bangladesh. Glob Health Action. 2021;14(1): 1872895.

Olmastroni E, Galimberti F, Tragni E, Catapano AL, Casula M. Impact of COVID-19 Pandemic on Adherence to Chronic Therapies: A Systematic Review. Int J Environ Res Public Health 2023; 20(5):3825.

Kurotschka PK, Serafini A, Demontis M, Serafini A, Mereu A, Moro MF, et al. General Practitioners’ Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study. Front Public Health 2021; 9:623904.

Romagnoli A, Santoleri F, Costantini A. The impact of COVID-19 on chronic therapies: the Pescara (ASL) local health authority experience in Italy. Curr Med Res Opin 2022; 38(2):311–6.



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