\documentclass[11pt,twoside]{article}\makeatletter

\IfFileExists{xcolor.sty}%
  {\RequirePackage{xcolor}}%
  {\RequirePackage{color}}
\usepackage{colortbl}
\usepackage{wrapfig}
\usepackage{ifxetex}
\ifxetex
  \usepackage{fontspec}
  \usepackage{xunicode}
  \catcode`⃥=\active \def⃥{\textbackslash}
  \catcode`❴=\active \def❴{\{}
  \catcode`❵=\active \def❵{\}}
  \def\textJapanese{\fontspec{Noto Sans CJK JP}}
  \def\textChinese{\fontspec{Noto Sans CJK SC}}
  \def\textKorean{\fontspec{Noto Sans CJK KR}}
  \setmonofont{DejaVu Sans Mono}
  
\else
  \IfFileExists{utf8x.def}%
   {\usepackage[utf8x]{inputenc}
      \PrerenderUnicode{–}
    }%
   {\usepackage[utf8]{inputenc}}
  \usepackage[english]{babel}
  \usepackage[T1]{fontenc}
  \usepackage{float}
  \usepackage[]{ucs}
  \uc@dclc{8421}{default}{\textbackslash }
  \uc@dclc{10100}{default}{\{}
  \uc@dclc{10101}{default}{\}}
  \uc@dclc{8491}{default}{\AA{}}
  \uc@dclc{8239}{default}{\,}
  \uc@dclc{20154}{default}{ }
  \uc@dclc{10148}{default}{>}
  \def\textschwa{\rotatebox{-90}{e}}
  \def\textJapanese{}
  \def\textChinese{}
  \IfFileExists{tipa.sty}{\usepackage{tipa}}{}
\fi
\def\exampleFont{\ttfamily\small}
\DeclareTextSymbol{\textpi}{OML}{25}
\usepackage{relsize}
\RequirePackage{array}
\def\@testpach{\@chclass
 \ifnum \@lastchclass=6 \@ne \@chnum \@ne \else
  \ifnum \@lastchclass=7 5 \else
   \ifnum \@lastchclass=8 \tw@ \else
    \ifnum \@lastchclass=9 \thr@@
   \else \z@
   \ifnum \@lastchclass = 10 \else
   \edef\@nextchar{\expandafter\string\@nextchar}%
   \@chnum
   \if \@nextchar c\z@ \else
    \if \@nextchar l\@ne \else
     \if \@nextchar r\tw@ \else
   \z@ \@chclass
   \if\@nextchar |\@ne \else
    \if \@nextchar !6 \else
     \if \@nextchar @7 \else
      \if \@nextchar (8 \else
       \if \@nextchar )9 \else
  10
  \@chnum
  \if \@nextchar m\thr@@\else
   \if \@nextchar p4 \else
    \if \@nextchar b5 \else
   \z@ \@chclass \z@ \@preamerr \z@ \fi \fi \fi \fi
   \fi \fi  \fi  \fi  \fi  \fi  \fi \fi \fi \fi \fi \fi}
\gdef\arraybackslash{\let\\=\@arraycr}
\def\@textsubscript#1{{\m@th\ensuremath{_{\mbox{\fontsize\sf@size\z@#1}}}}}
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\def\abbr{}
\def\corr{}
\def\expan{}
\def\gap{}
\def\orig{}
\def\reg{}
\def\ref{}
\def\sic{}
\def\persName{}\def\name{}
\def\placeName{}
\def\orgName{}
\def\textcal#1{{\fontspec{Lucida Calligraphy}#1}}
\def\textgothic#1{{\fontspec{Lucida Blackletter}#1}}
\def\textlarge#1{{\large #1}}
\def\textoverbar#1{\ensuremath{\overline{#1}}}
\def\textquoted#1{‘#1’}
\def\textsmall#1{{\small #1}}
\def\textsubscript#1{\@textsubscript{\selectfont#1}}
\def\textxi{\ensuremath{\xi}}
\def\titlem{\itshape}
\newenvironment{biblfree}{}{\ifvmode\par\fi }
\newenvironment{bibl}{}{}
\newenvironment{byline}{\vskip6pt\itshape\fontsize{16pt}{18pt}\selectfont}{\par }
\newenvironment{citbibl}{}{\ifvmode\par\fi }
\newenvironment{docAuthor}{\ifvmode\vskip4pt\fontsize{16pt}{18pt}\selectfont\fi\itshape}{\ifvmode\par\fi }
\newenvironment{docDate}{}{\ifvmode\par\fi }
\newenvironment{docImprint}{\vskip 6pt}{\ifvmode\par\fi }
\newenvironment{docTitle}{\vskip6pt\bfseries\fontsize{22pt}{25pt}\selectfont}{\par }
\newenvironment{msHead}{\vskip 6pt}{\par}
\newenvironment{msItem}{\vskip 6pt}{\par}
\newenvironment{rubric}{}{}
\newenvironment{titlePart}{}{\par }

\newcolumntype{L}[1]{){\raggedright\arraybackslash}p{#1}}
\newcolumntype{C}[1]{){\centering\arraybackslash}p{#1}}
\newcolumntype{R}[1]{){\raggedleft\arraybackslash}p{#1}}
\newcolumntype{P}[1]{){\arraybackslash}p{#1}}
\newcolumntype{B}[1]{){\arraybackslash}b{#1}}
\newcolumntype{M}[1]{){\arraybackslash}m{#1}}
\definecolor{label}{gray}{0.75}
\def\unusedattribute#1{\sout{\textcolor{label}{#1}}}
\DeclareRobustCommand*{\xref}{\hyper@normalise\xref@}
\def\xref@#1#2{\hyper@linkurl{#2}{#1}}
\begingroup
\catcode`\_=\active
\gdef_#1{\ensuremath{\sb{\mathrm{#1}}}}
\endgroup
\mathcode`\_=\string"8000
\catcode`\_=12\relax

\usepackage[a4paper,twoside,lmargin=1in,rmargin=1in,tmargin=1in,bmargin=1in,marginparwidth=0.75in]{geometry}
\usepackage{framed}

\definecolor{shadecolor}{gray}{0.95}
\usepackage{longtable}
\usepackage[normalem]{ulem}
\usepackage{fancyvrb}
\usepackage{fancyhdr}
\usepackage{graphicx}
\usepackage{marginnote}

\renewcommand{\@cite}[1]{#1}


\renewcommand*{\marginfont}{\itshape\footnotesize}

\def\Gin@extensions{.pdf,.png,.jpg,.mps,.tif}

  \pagestyle{fancy}

\usepackage[pdftitle={Determinants and Effects of Non Adherence to Drugs in Type 2 Diabetes Melltus in a Teaching Hospital},
 pdfauthor={}]{hyperref}
\hyperbaseurl{}

	 \paperwidth210mm
	 \paperheight297mm
              
\def\@pnumwidth{1.55em}
\def\@tocrmarg {2.55em}
\def\@dotsep{4.5}
\setcounter{tocdepth}{3}
\clubpenalty=8000
\emergencystretch 3em
\hbadness=4000
\hyphenpenalty=400
\pretolerance=750
\tolerance=2000
\vbadness=4000
\widowpenalty=10000

\renewcommand\section{\@startsection {section}{1}{\z@}%
     {-1.75ex \@plus -0.5ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large\bfseries}}
\renewcommand\subsection{\@startsection{subsection}{2}{\z@}%
     {-1.75ex\@plus -0.5ex \@minus- .2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large}}
\renewcommand\subsubsection{\@startsection{subsubsection}{3}{\z@}%
     {-1.5ex\@plus -0.35ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\large}}
\renewcommand\paragraph{\@startsection{paragraph}{4}{\z@}%
     {-1ex \@plus-0.35ex \@minus -0.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\normalsize}}
\renewcommand\subparagraph{\@startsection{subparagraph}{5}{\parindent}%
     {1.5ex \@plus1ex \@minus .2ex}%
     {-1em}%
     {\reset@font\normalsize\bfseries}}


\def\l@section#1#2{\addpenalty{\@secpenalty} \addvspace{1.0em plus 1pt}
 \@tempdima 1.5em \begingroup
 \parindent \z@ \rightskip \@pnumwidth 
 \parfillskip -\@pnumwidth 
 \bfseries \leavevmode #1\hfil \hbox to\@pnumwidth{\hss #2}\par
 \endgroup}
\def\l@subsection{\@dottedtocline{2}{1.5em}{2.3em}}
\def\l@subsubsection{\@dottedtocline{3}{3.8em}{3.2em}}
\def\l@paragraph{\@dottedtocline{4}{7.0em}{4.1em}}
\def\l@subparagraph{\@dottedtocline{5}{10em}{5em}}
\@ifundefined{c@section}{\newcounter{section}}{}
\@ifundefined{c@chapter}{\newcounter{chapter}}{}
\newif\if@mainmatter 
\@mainmattertrue
\def\chaptername{Chapter}
\def\frontmatter{%
  \pagenumbering{roman}
  \def\thechapter{\@roman\c@chapter}
  \def\theHchapter{\roman{chapter}}
  \def\thesection{\@roman\c@section}
  \def\theHsection{\roman{section}}
  \def\@chapapp{}%
}
\def\mainmatter{%
  \cleardoublepage
  \def\thechapter{\@arabic\c@chapter}
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \pagenumbering{arabic}
  \setcounter{secnumdepth}{6}
  \def\@chapapp{\chaptername}%
  \def\theHchapter{\arabic{chapter}}
  \def\thesection{\@arabic\c@section}
  \def\theHsection{\arabic{section}}
}
\def\backmatter{%
  \cleardoublepage
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \setcounter{secnumdepth}{2}
  \def\@chapapp{\appendixname}%
  \def\thechapter{\@Alph\c@chapter}
  \def\theHchapter{\Alph{chapter}}
  \appendix
}
\newenvironment{bibitemlist}[1]{%
   \list{\@biblabel{\@arabic\c@enumiv}}%
       {\settowidth\labelwidth{\@biblabel{#1}}%
        \leftmargin\labelwidth
        \advance\leftmargin\labelsep
        \@openbib@code
        \usecounter{enumiv}%
        \let\p@enumiv\@empty
        \renewcommand\theenumiv{\@arabic\c@enumiv}%
	}%
  \sloppy
  \clubpenalty4000
  \@clubpenalty \clubpenalty
  \widowpenalty4000%
  \sfcode`\.\@m}%
  {\def\@noitemerr
    {\@latex@warning{Empty `bibitemlist' environment}}%
    \endlist}

\def\tableofcontents{\section*{\contentsname}\@starttoc{toc}}
\parskip0pt
\parindent1em
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\newenvironment{reflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemsep}{0pt}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\itshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{sansreflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\itemsep}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\upshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{specHead}[2]%
 {\vspace{20pt}\hrule\vspace{10pt}%
  \phantomsection\label{#1}\markright{#2}%

  \pdfbookmark[2]{#2}{#1}%
  \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}%
  }{}
      \def\TheFullDate{2013-01-15 (revised: 15 January 2013)}
\def\TheID{\makeatother }
\def\TheDate{2013-01-15}
\title{Determinants and Effects of Non Adherence to Drugs in Type 2 Diabetes Melltus in a Teaching Hospital}
\author{}\makeatletter 
\makeatletter
\newcommand*{\cleartoleftpage}{%
  \clearpage
    \if@twoside
    \ifodd\c@page
      \hbox{}\newpage
      \if@twocolumn
        \hbox{}\newpage
      \fi
    \fi
  \fi
}
\makeatother
\makeatletter
\thispagestyle{empty}
\markright{\@title}\markboth{\@title}{\@author}
\renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@
\belowdisplayskip \abovedisplayskip
\abovedisplayshortskip \z@ plus2\p@
\belowdisplayshortskip 4\p@ plus2\p@ minus2\p@
\def\@listi{\leftmargin\leftmargini
               \topsep 2\p@ plus1\p@ minus1\p@
               \parsep 2\p@ plus\p@ minus\p@
               \itemsep 1pt}
}
\makeatother
\fvset{frame=single,numberblanklines=false,xleftmargin=5mm,xrightmargin=5mm}
\fancyhf{} 
\setlength{\headheight}{14pt}
\fancyhead[LE]{\bfseries\leftmark} 
\fancyhead[RO]{\bfseries\rightmark} 
\fancyfoot[RO]{}
\fancyfoot[CO]{\thepage}
\fancyfoot[LO]{\TheID}
\fancyfoot[LE]{}
\fancyfoot[CE]{\thepage}
\fancyfoot[RE]{\TheID}
\hypersetup{citebordercolor=0.75 0.75 0.75,linkbordercolor=0.75 0.75 0.75,urlbordercolor=0.75 0.75 0.75,bookmarksnumbered=true}
\fancypagestyle{plain}{\fancyhead{}\renewcommand{\headrulewidth}{0pt}}

\date{}
\usepackage{authblk}

\providecommand{\keywords}[1]
{
\footnotesize
  \textbf{\textit{Index terms---}} #1
}

\usepackage{graphicx,xcolor}
\definecolor{GJBlue}{HTML}{273B81}
\definecolor{GJLightBlue}{HTML}{0A9DD9}
\definecolor{GJMediumGrey}{HTML}{6D6E70}
\definecolor{GJLightGrey}{HTML}{929497} 

\renewenvironment{abstract}{%
   \setlength{\parindent}{0pt}\raggedright
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
   \textcolor{GJBlue}{\large\bfseries\abstractname\space}
}{%   
   \vskip8pt
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
}

\usepackage[absolute,overlay]{textpos}

\makeatother 
      \usepackage{lineno}
      \linenumbers
      
\begin{document}

             \author[1]{Nagendra  Gowda}

             \affil[1]{  Basaveshwara Medical College and Hospital}

\renewcommand\Authands{ and }

\date{\small \em Received: 15 December 2012 Accepted: 4 January 2013 Published: 15 January 2013}

\maketitle


\begin{abstract}
        


Abstract Background The adherence to diabetic drugs is a key issue to maintain the glucose levels in optimal limits and prevention of complications. The health care system cannot provide individual care to each patient due to paucity in resources. The problem with poor self management of diabetes despite improved technology is escalating the problem of diabetes related problems. This study was mainly taken up to study the rates and factors influencing the non adherence in a chronic disease such as diabetes mellitus. Materials and methods A cross sectional study was undertaken for a period of three months in outpatient department of Basaveshwara Medical College Hospital and Research Centre, Chitardurga. The patients were chosen randomly, and a predesigned and structured questionnaire was administered for the participants. The data thus obtained compiled and analysed using appropriate statistics.  

\end{abstract}


\keywords{}

\begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) 
\textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark}
\end{textblock*}

\begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) 
\textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}}
\end{textblock*}


\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
ealthcare mainly relies on prescription of medicines mainly to allay the disease and promotion of health. Millions of prescriptions are generated everyday by the medical professionals for treatment of various diseases. \hyperref[b0]{1} In a chronic disease like diabetes mellitus needs constant attention to diet, exercise, glucose monitoring and medication to achieve good glycemic control and to prevent further complications. But most of the patients with Diabetes do not adhere to their medications which can be frustrating for both health care workers and family members. \hyperref[b1]{2,}\hyperref[b2]{3} In general the non-adherence rates for most of the chronic diseases are approximately 50\%. \hyperref[b3]{4} As per WHO the term adherence is defined as "the extent to which a person's behavior -taking medication, following diet, and/or executing lifestyle changes -corresponds with agreed recommendations from a health care provider". \hyperref[b4]{5} The available literature shows that, the adherence rates were 65\% for the diet and 19\% for the exercise. \hyperref[b5]{6,}\hyperref[b6]{7} The electronic measurements of adherence to oral medications in two of the studies were 53 and 67\%. In another study the adherence rates to sulfonylureas by pill count was 104\% to one day regimen and 87\% to twice and thrice a day regimens. On electronic monitoring the same rates were reduced to 94 and 57\% respectively. \hyperref[b7]{8} Several factors influences the nonadherence in diabetes mellitus like demographic, psychological and social factors. \hyperref[b1]{2} But the literature is scarce especially in country like India to show the exact role of these factors in nonadherence.\par
The literature available also shown that diabetes accelerates the natural course of atherosclerosis and many diseases like hypertension needs to be treated. \hyperref[b8]{9} In the era of increase in diabetes mellitus, especially in older patients and overweight with cardiovascular risks medication adherence plays a key role. The health care systems cannot provide support to each patient due to paucity of the resources. The problem with poor self management of diabetes despite improved technology is escalating the problem of diabetes related problems. \hyperref[b9]{10} Since there is paucity of literature regarding the nonadherence rates and factors which are influencing the nonadherence, this study was taken up in a resource scarce setting like Karnataka. This study was mainly taken up with the aim of studying the adherence rates and factors influencing the nonadherence. 
\section[{II.}]{II.} 
\section[{Materials and Methods}]{Materials and Methods}\par
A cross sectional study was conducted in a tertiary care hospital in order to meet the objectives of the study. This study was conducted for a period of three months between January, 2013 and March 2013. included demographic particulars, family history of diabetes mellitus and drug compliance among family members, recent fasting blood sugar and HbA 1c levels and reasons for non compliance. The data thus obtained was compiled and analysed using Statistical Package for Social Services (SPSS vs 18). Univariate ANOVA was used to study the influence of different factors of nonadherence and its effects in type 2 Diabetes Mellitus.  \hyperref[tab_0]{1} shows the demographic factors of the study sample. Most of the patients with type 2 diabetes mellitus were aged between 40 -70 years and males were more than females. Almost 80.5\% of them were married and had income of more than one lakh INR per year. More than half of the patients had diabetes within 6 years and had family history of type 2 diabetes mellitus. The drug compliance was good in 37.1\% of the patients and poor in 16.2\% with type 2 diabetes mellitus. About 15\% of the patients in this study had nonadherence to the diabetic drugs. Most of them were aged more than 40 years. Females were non adherent more than males. The participants who were married had lower rates of nonadherence compared to those who were single, divorced and widowed. The nonadherence rates were higher in economically weak patients and who had diabetes since 6 years or more and those with family history of diabetes. The family member's adherence rates had shown that it was poor in 33\% in the family members of the diabetic patients. The rate of nonadherence to insulin was more compared to those who were on oral hypoglycemis drugs. Only 28.1\% of the patients were on controlled healthy diet in this study. 
\section[{III.}]{III.} 
\section[{Results}]{Results}\par
A multivariate analysis had shown that marital status and family income were significant risk factors for nonadherence to drugs in diabetes mellitus. The table \hyperref[tab_1]{2} shows the fasting blood sugar and HbA 1c levels in the study group. Almost all the non adherent diabetic patients had fasting blood sugar levels of more than 200 mg/dl and more than half of them had HbA 1c level of more than 7 \%. Table no 3 displays the effect of nonadherence to diabetic drugs among the study group. About 56.0\% of the non adherent subjects were consuming diet rich in fats and only 36.0\% were consuming controlled healthy diet. About 32.0\% of the non diabetic increased their weight and 20\% decreased their weights. About 24\% of the non adherent diabetics had changes of vision and 80\% had abnormal lipid profiles. Eighty percent of the non adherent diabetics had microalbunuria and 72\% had BUN/ CR ratios compatible with the diabetic nephropathy. Among the non adherent diabetic subjects 44\% had hypoglycemic episodes 2 -3 times in a month.\par
The multivariate analysis had shown significant results for microalbuminuria, BUN \& creatinine ratio and hypoglycemic episodes and nonadherence. In this study the main reason for nonadherence was non affordability to purchase the drugs and psychiatric illness. This was followed by lack of awareness, hate towards insulin injection, increased hypoglycemic episodes and side effects of drugs were the other reasons for nonadherence in the study group. 
\section[{IV.}]{IV.} 
\section[{Discussion}]{Discussion}\par
Adherence is a key issue especially in a chronic illness like diabetes mellitus. The nonadherence results elevation of the blood sugar levels and subsequent micro and macro vascular complications. \hyperref[b1]{2,}\hyperref[b2]{3} This cross sectional study was undertaken with the aim studying the prevalence, risk factors, effects and reasons for nonadherence in diabetic patients.\par
The prevalence of nonadherence to diabetic drugs was 15\% in this study. The nonadherence rate was more for patients who were on insulin than oral hypoglycemics. In a study by  {\ref Mason 11} et al, the adherence to oral medication was 53\% and Paes \hyperref[b11]{12} et al had shown 67\% of the adherence to oral hypoglycemics. However this study had shown higher adherence compared other studies in the past. The literature also shows that the adherence rates decreases with increase in complexity of the diabetic drug regimen. \hyperref[b1]{2} The literature had documented that a number of factors related the diabetes regimen adherence problems including demographic, psychological, social factors health care provider, medical system, disease and treatment related factors . \hyperref[b1]{2,}\hyperref[b12]{13} In this study, marital status and family income were the significant risk factors for nonadherence. However other studies had shown age, sex, ethnicity, income, education and co morbidity with physical or psychiatric illness were considered as the predictors of non adherence. \hyperref[b2]{3,}\hyperref[b13]{14} The marital status influences the adherence that the spouses usually help in consumption of diabetic drugs. Since diabetes is a chronic disease requiring lifelong medication usually affects the people belonging to lower socioeconomic status. Similar findings were also noticed by Glasgow et al. \hyperref[b14]{15} The fasting blood sugar was raised above 200 mg/dl and HbA 1c levels were raised above 7 mg/dl in patients who were non adherent to diabetic drugs. The diabetes patients can regulate the blood sugar levels by drugs, diet and physical exercise. However if there disturbance in any of these control factors the sugar levels shoots up. This finding was also supported by similar studies. \hyperref[b15]{16,}\hyperref[b16]{17} Self reported increase in weight, changes in vision, microalbuminuria, abnormal BUN \& Creatinine ratio were the common abnormal lipid profiles and increased hypoglycemic episodes were the effects noticed more frequently in nonadherent groups than adherent group. The multivariate analysis also had shown the significant results for microalbuminuria, BUN \& creatinine ratio and hypoglycemic episodes. While ENTRED study had noticed increased odds ratio for dyslipidemia presence of micro vascular complications in non adherence group compared adherence group. \hyperref[b16]{17} In another study by Ho et al, the non adherent patients were younger and had low comorbidities compared to their counterparts. The non adherent group noticed increased glycosylated hemoglobin, and increased low density lipoproteins. The study had also shown that the medication adherence also had increased risk for all causes of hospitalization and all cause mortality. \hyperref[b17]{18} In this study the main reason for nonadherence was financial constraints to purchase the drugs and psychiatric illness. Similar findings were also reported by Pascal et al in a study in Nigeria. \hyperref[b15]{16} In a study in Saudi Arabia, male sex, level of education, urban population, irregularity in follow up, non adherence to insulin were found to as risk factors for non compliance for diabetes mellitus. \hyperref[b18]{19} The non adherence to drug regimens of diabetes mellitus is serious health care concern in successful health care delivery. The non adherence results in improper control of glycemic levels and subsequent complications. The adherence to drug regimens is the responsibility of the patients. The health care worker including doctors can facilitate in adherence but cannot substitute the non modifiable risk factors.\par
Health education is the main tool in dealing with the non adherence rates.\par
The adherence to diabetic drugs is the key issue in delivery of effective health care. The adherence can be influenced by several factors. The adherence drug medication is influenced by demographic, psychological, social factors, health care provider, medical system, disease and treatment related factors. Some of these factors are modifiable and some are non modifiable. It is a combined effort from the patient, the treating physician and policy makers to reduce the non adherence and promote the health. The awareness programs of primary health care workers and patients are of utmost important to maintain the glycemic level and prevention of complications.\begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.072630173564753\textwidth}P{0.0011348464619492656\textwidth}P{0.22072763684913219\textwidth}P{0.16682242990654206\textwidth}P{0.14015353805073433\textwidth}P{0.16171562082777036\textwidth}P{0.0380173564753004\textwidth}P{0.04879839786381843\textwidth}}
\tabcellsep \tabcellsep Characteristics\tabcellsep \multicolumn{2}{l}{Drug adherence}\tabcellsep Total\tabcellsep \multicolumn{2}{l}{Multivariate analysis}\\
\tabcellsep \tabcellsep \tabcellsep Yes\tabcellsep No\tabcellsep \tabcellsep F value\tabcellsep p value, sig\\
\tabcellsep \tabcellsep \tabcellsep N (\%)\tabcellsep N (\%)\tabcellsep N (\%)\tabcellsep \tabcellsep \\
Age\tabcellsep \tabcellsep 25 -40 years\tabcellsep 8 (5.6)\tabcellsep 6 (24)\tabcellsep 14 (8.4)\tabcellsep 0.229\tabcellsep 0.633, NS\\
\tabcellsep \tabcellsep 40 -55 years\tabcellsep 72 (50.7)\tabcellsep 8 (32.0)\tabcellsep 80 (47.9)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep 55 -70 years\tabcellsep 51 (35.9)\tabcellsep 6 (24.0)\tabcellsep 57 (34.1)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep More than 70 years\tabcellsep 11 (7.7)\tabcellsep 5 (20)\tabcellsep 16 (9.6)\tabcellsep \tabcellsep \\
Sex\tabcellsep \tabcellsep Male\tabcellsep 79 (85.9)\tabcellsep 13 (14.1)\tabcellsep 92 (55.1)\tabcellsep 0.032\tabcellsep 0.857, NS\\
\tabcellsep \tabcellsep Female\tabcellsep 63 (84.0)\tabcellsep 12 (16.0)\tabcellsep 75 (44.9)\tabcellsep \tabcellsep \\
Marital status\tabcellsep \tabcellsep Married\tabcellsep 118 (88.1)\tabcellsep 16 (11.9)\tabcellsep 134 (80.2)\tabcellsep 5.653\tabcellsep 0.019, Sig\\
\tabcellsep \tabcellsep Single\tabcellsep 16 (76.2)\tabcellsep 5 (23.8)\tabcellsep 21 (12.6)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Divorced\tabcellsep 6 (75.0)\tabcellsep 2 (25.0)\tabcellsep 8 (4.8)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Widowed\tabcellsep 2 (50.0)\tabcellsep 2 (50.0)\tabcellsep 4 (2.4)\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{Family Income}\tabcellsep 10000 -50000\tabcellsep 23 (67.2)\tabcellsep 11 (32.4)\tabcellsep 34 (20.4)\tabcellsep 7.180\tabcellsep 0.008, Sig\\
INR\tabcellsep \tabcellsep 50000 -100000\tabcellsep 34 (91.9)\tabcellsep 3 (8.1)\tabcellsep 37 (22.2)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep 100000 -200000\tabcellsep 45 (90.0)\tabcellsep 5 (10.0)\tabcellsep 50 (29.9)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep More than 200000\tabcellsep 40 (87.0)\tabcellsep 6 (13.0)\tabcellsep 46 (27.5)\tabcellsep \tabcellsep \\
Duration\tabcellsep of\tabcellsep 1 -3 years\tabcellsep 41 (89.1)\tabcellsep 5 (10.9)\tabcellsep 46 (27.5)\tabcellsep 2.153\tabcellsep 0.144, NS\\
diabetes\tabcellsep \tabcellsep 3 -6 years\tabcellsep 35 (87.5)\tabcellsep 5 (12.5)\tabcellsep 40 (24.0)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep 6 -10 years\tabcellsep 41 (80.4)\tabcellsep 10 (19.6)\tabcellsep 51 (30.5)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep More than 10 years\tabcellsep 25 (83.3)\tabcellsep 5 (16.5)\tabcellsep 30 (18.0)\tabcellsep \tabcellsep \\
Family history\tabcellsep \tabcellsep Yes\tabcellsep 92 (82.9)\tabcellsep 19 (17.1)\tabcellsep 111 (66.5)\tabcellsep 0.34\tabcellsep 0.561, NS\\
\tabcellsep \tabcellsep No\tabcellsep 50 (89.3)\tabcellsep 6 (10.7)\tabcellsep 56 (33.5)\tabcellsep \tabcellsep \\
Drug\tabcellsep \tabcellsep Good\tabcellsep 52 (83.9)\tabcellsep 10 (16.1)\tabcellsep 62 (37.1)\tabcellsep 0.000\tabcellsep 0.997, NS\\
\multicolumn{2}{l}{compliance in}\tabcellsep Poor\tabcellsep 18 (66.7)\tabcellsep 9 (33.3)\tabcellsep 27 (16.2)\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{family members}\tabcellsep Unknown\tabcellsep 22 (100)\tabcellsep 0\tabcellsep 22 (13.2)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep No family history\tabcellsep 50 (89.3)\tabcellsep 6 (10.7)\tabcellsep 56 (33.5)\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{Type of anti-}\tabcellsep Only on insulin\tabcellsep 44 (81.5)\tabcellsep 10 (18.5)\tabcellsep 54 (32.3)\tabcellsep 2.853\tabcellsep 0.093, NS\\
diabetics\tabcellsep \tabcellsep Only on Oral hypoglycemic\tabcellsep 90 (85.7)\tabcellsep 15 (14.3)\tabcellsep 105 (62.9)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Both on insulin and OHGs\tabcellsep 8 (100)\tabcellsep 0\tabcellsep 8 (4.8)\tabcellsep \tabcellsep \\
Diet\tabcellsep \tabcellsep High in carbohydrates and proteins\tabcellsep 90 (63.4)\tabcellsep 6 (24.0)\tabcellsep 96 (57.5)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep High in fats\tabcellsep 38 (26.8)\tabcellsep 14 (56.0)\tabcellsep 52 (31.1)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Junk food\tabcellsep 14 (9.9)\tabcellsep 4 (16.0)\tabcellsep 18 (10.8)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Controlled health diet\tabcellsep 38 (26.8)\tabcellsep 9 (36.0)\tabcellsep 47 (28.1)\tabcellsep \tabcellsep \\
Table\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.07203389830508473\textwidth}P{0.2766101694915254\textwidth}P{0.17864406779661016\textwidth}P{0.1354237288135593\textwidth}P{0.18728813559322033\textwidth}}
\tabcellsep Characteristics\tabcellsep \multicolumn{2}{l}{Drug adherence}\tabcellsep Total\\
\tabcellsep \tabcellsep Yes\tabcellsep No\tabcellsep \\
\tabcellsep \tabcellsep N (\%)\tabcellsep N (\%)\tabcellsep N (\%)\\
Fasting blood sugar\tabcellsep 50 -130 mg/dl\tabcellsep 110 (99.1)\tabcellsep 1 (0.9)\tabcellsep 111 (66.5)\\
\tabcellsep 130 -200 mg/dl\tabcellsep 32 (100)\tabcellsep 0\tabcellsep 32 (19.2)\\
\tabcellsep 200 -350 mg/dl\tabcellsep 0\tabcellsep 21 (100)\tabcellsep 21 (12.6)\\
\tabcellsep More than 350 mg/dl\tabcellsep 0\tabcellsep 3 (100)\tabcellsep 3 (1.8)\\
HBA 1c\tabcellsep 4 -7 \%\tabcellsep 124 (96.9)\tabcellsep 4 (3.1)\tabcellsep 128 (76.6)\\
\tabcellsep More than 7 \%\tabcellsep 18 (46.2)\tabcellsep 21 (53.8)\tabcellsep 39 (23.4)\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.08519362186788154\textwidth}P{0.18878132118451024\textwidth}P{0.0038724373576309794\textwidth}P{0.007744874715261959\textwidth}P{0.15392938496583145\textwidth}P{0.13650341685649203\textwidth}P{0.15102505694760818\textwidth}P{0.056150341685649204\textwidth}P{0.0667995444191344\textwidth}}
\tabcellsep \multicolumn{2}{l}{Characteristics}\tabcellsep \tabcellsep \multicolumn{2}{l}{Drug adherence}\tabcellsep Total\tabcellsep Multivariate analysis\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep Yes\tabcellsep No\tabcellsep No\tabcellsep F value\tabcellsep p value, sig\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep N (\%)\tabcellsep N (\%)\tabcellsep N (\%)\\
Weight changes\tabcellsep Increased\tabcellsep \tabcellsep \tabcellsep 40 (28.2)\tabcellsep 8 (32.0)\tabcellsep 48 (28.7)\tabcellsep 1.009\tabcellsep 0.317, NS\\
\tabcellsep Decreased\tabcellsep \tabcellsep \tabcellsep 23 (16.2)\tabcellsep 5 (20.0)\tabcellsep 28 (16.8)\\
\tabcellsep No changes\tabcellsep \tabcellsep \tabcellsep 79 (55.6)\tabcellsep 12 (48.0)\tabcellsep 91 (54.5)\\
Changes in vision\tabcellsep Yes\tabcellsep \tabcellsep \tabcellsep 18 (12.7)\tabcellsep 6 (24.0)\tabcellsep 24 (14.4)\tabcellsep 0.067\tabcellsep 0.796, NS\\
\tabcellsep No\tabcellsep \tabcellsep \tabcellsep 124 (87.3)\tabcellsep 19 (76.0)\tabcellsep 143 (85.6)\\
Lipid profile\tabcellsep Normal\tabcellsep \tabcellsep \tabcellsep 43 (30.3)\tabcellsep 5 (20.0)\tabcellsep 48 (28.7)\tabcellsep 0.123\tabcellsep 0.726, NS\\
\tabcellsep Abnormal\tabcellsep \tabcellsep \tabcellsep 99 (69.7)\tabcellsep 20 (80.0)\tabcellsep 119 (71.3)\\
Microalbuminuria\tabcellsep Yes\tabcellsep \tabcellsep \tabcellsep 56 (39.4)\tabcellsep 20 (80.0)\tabcellsep 76 (45.5)\tabcellsep 13.577\tabcellsep 0.000, Sig\\
\tabcellsep No\tabcellsep \tabcellsep \tabcellsep 86 (60.6)\tabcellsep 5 (20.0)\tabcellsep 91 (54.5)\\
BUN / CR\tabcellsep Normal\tabcellsep \tabcellsep \tabcellsep 109 (76.8)\tabcellsep 5 (20.0)\tabcellsep 114 (68.3)\tabcellsep 31.5\tabcellsep 0.000, Sig\\
\tabcellsep Compatible nephropathy\tabcellsep with\tabcellsep diabetic\tabcellsep 31 (21.8)\tabcellsep 18 (72.0)\tabcellsep 49 (29.3)\\
\tabcellsep \multicolumn{3}{l}{Failure because of other co morbid conditions}\tabcellsep 2 (1.4)\tabcellsep 2 (8.0)\tabcellsep 4 (2.4)\\
Hypoglycemic\tabcellsep Every day\tabcellsep \tabcellsep \tabcellsep 0\tabcellsep 4 (16.0)\tabcellsep 4 (2.4)\tabcellsep 11.20\tabcellsep 0.001, Sig\\
episodes\tabcellsep \multicolumn{2}{l}{2 -3 times a week}\tabcellsep \tabcellsep 16 (11.3)\tabcellsep 4 (16.0)\tabcellsep 20 (12.0)\\
\tabcellsep \multicolumn{2}{l}{2 -3 times a month}\tabcellsep \tabcellsep 50 (35.2)\tabcellsep 11 (44.0)\tabcellsep 61 (36.5)\\
\tabcellsep Very rarely\tabcellsep \tabcellsep \tabcellsep 76 (53.5)\tabcellsep 6 (24.0)\tabcellsep 82 (49.1)\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.7164588528678304\textwidth}P{0.04239401496259352\textwidth}P{0.09114713216957605\textwidth}}
Reason for not being compliant\tabcellsep Frequency\tabcellsep Percent\\
Poverty (can't afford medications)\tabcellsep 5\tabcellsep 20.0\\
Lack of awareness and negligence\tabcellsep 4\tabcellsep 16.0\\
Hates taking insulin injections\tabcellsep 2\tabcellsep 8.0\\
Depression and other mood disorders\tabcellsep 5\tabcellsep 20.0\\
Increased hypoglycemic episodes\tabcellsep 2\tabcellsep 8.0\\
Old or no caretakers\tabcellsep 1\tabcellsep 4.0\\
Worried about drug side effects\tabcellsep 1\tabcellsep 4.0\\
Does not like the side effects\tabcellsep 2\tabcellsep 8.0\\
Drug interaction\tabcellsep 1\tabcellsep 4.0\\
Hospitalized due to chronic disease\tabcellsep 1\tabcellsep 4.0\\
Other unknown\tabcellsep 1\tabcellsep 4.0\end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
 			\footnote{© 2013 Global Journals Inc. (US)} 			\footnote{( ) B Determinants and Effects of Non Adherence to Drugs in Type 2 Diabetes Melltus in a Teaching Hospital} 			\footnote{( ) B Determinants and Effects of Non Adherence to Drugs in Type 2 Diabetes Melltus in a Teaching Hospital} 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[ World Health Organization: Report on Medication Adherence. Geneva, World Health Org ()]{b4}\label{b4} 	 		\textit{},  	 	 		\textit{World Health Organization: Report on Medication Adherence. Geneva, World Health Org}  		2003.  	 
\bibitem[Banning ()]{b0}\label{b0} 	 		‘A review of interventions used to improve adherence to medication in older people’.  		 			M Banning 		.  	 	 		\textit{International Journal of Nursing Studies}  		2009. 46 p. .  	 
\bibitem[Cramer ()]{b2}\label{b2} 	 		‘A systematic review of adherence with medications of diabetes’.  		 			J A Cramer 		.  	 	 		\textit{Diabetes Care}  		2004. 27 p. .  	 
\bibitem[Mason et al. ()]{b10}\label{b10} 	 		‘Assessment of sulfonylurea adherence and metabolic control’.  		 			B J Mason 		,  		 			J R Matsuyama 		,  		 			S G Jue 		.  	 	 		\textit{Diabetes Educ}  		1995. 21 p. .  	 
\bibitem[Pascal et al. ()]{b15}\label{b15} 	 		‘Blood glucose control and medication adherence among adult type 2 diabetic Nigerians attending A primary care clinic in Under resourced environment of Eastern Nigeria, N’.  		 			I G Pascal 		,  		 			J N Ofoedu 		,  		 			N P Uchenna 		,  		 			A A Nkwa 		,  		 			G E Uchamma 		.  	 	 		\textit{Am J Med Sci}  		2012. July, 4.  (7)  p. .  	 
\bibitem[Haynes et al. ()]{b3}\label{b3} 	 		\textit{Compliance in health care},  		 			R B Haynes 		,  		 			D W Taylor 		,  		 			D L Sackett 		.  		1979. Baltimore, Md: Johns Hopkins University Press.  	 
\bibitem[Delamater et al. ()]{b13}\label{b13} 	 		 			A M Delamater 		,  		 			A M Jacobson 		,  		 			B J Anderson 		,  		 			D Cox 		,  		 			L Fisher 		,  		 			P Lustman 		,  		 			R Rubin 		,  		 			T Wysocki 		.  	 	 		\textit{Psychosocial therapies in diabetes: report of the Psychosocial Therapies Working Group},  				2001. 24 p. .  	 
\bibitem[Grundy et al. ()]{b9}\label{b9} 	 		‘Diabetes and cardiovascular disease: a statement for health care professionals from the’.  		 			S M Grundy 		,  		 			I J Benjamin 		,  		 			G L Burke 		,  		 			A Chait 		,  		 			R H Eckel 		,  		 			B V Howard 		,  		 			Mitch W Smith 		,  		 			S C SowersJr 		,  		 			JR 		.  	 	 		\textit{American Heart Association. Circulation}  		1999. 100 p. .  	 
\bibitem[Ho et al. (2006)]{b17}\label{b17} 	 		‘Effect of medication non adherence on hospitalization and mortality among patients with diabetes mellitus’.  		 			P M Ho 		,  		 			J S Rumsfeld 		,  		 			F A Masoudi 		,  		 			D L Mcclure 		,  		 			M E Plomondon 		,  		 			J F Steiner 		,  		 			D J Maqid 		.  	 	 		\textit{Arch Intern Med}  		2006. Sep 25. 166  (17)  p. .  	 
\bibitem[Khan et al. (2012)]{b18}\label{b18} 	 		‘Factors contributing to non compliance among diabetics attending primary health centre in the Al Hasa district of Saudi Arabia’.  		 			A R Khan 		,  		 			Zna Lateef 		,  		 			Al Aithan 		,  		 			M A Bu-Khamseen 		,  		 			M A Ibrahim 		,  		 			I A Khan 		,  		 			SA 		.  	 	 		\textit{J Family Community Med}  		2012. Jan -Apr, 19.  (1)  p. .  	 
\bibitem[Kravitz et al. ()]{b6}\label{b6} 	 		‘GreenfieldS: Recall of recommendations and adherence to advice among patients with chronic medical conditions’.  		 			R L Kravitz 		,  		 			R D Hays 		,  		 			C D Sherbourne 		,  		 			M R Dimatteo 		,  		 			W H Rogers 		,  		 			L Ordway 		.  	 	 		\textit{Arch Intern Med}  		1993. 153 p. .  	 
\bibitem[Paes et al. ()]{b11}\label{b11} 	 		‘Impact of dosage frequency on patient compliance’.  		 			Ahp Paes 		,  		 			A Bakker 		,  		 			C J Soe-Agnie 		.  	 	 		\textit{Diabetes Care}  		1997. 20 p. .  	 
\bibitem[Delamater ()]{b1}\label{b1} 	 		‘Improving patient adherence’.  		 			A M Delamater 		.  	 	 		\textit{Clinical diabetes}  		2006. 24  (2)  p. .  	 
\bibitem[Tiv et al. ()]{b16}\label{b16} 	 		‘Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study’.  		 			M Tiv 		,  		 			J-F Viel 		,  		 			F Mauny 		,  		 			E Eschwe`ge 		,  		 			A Weill 		.  	 	 		\textit{PLoS ONE}  		2012. 7  (3)  p. e32412.  	 
\bibitem[Winkler et al. ()]{b8}\label{b8} 	 		‘Monitoring adherence to prescribed medication in type 2 diabetic patients treated with sulfonylureas’.  		 			A Winkler 		,  		 			A U Teuscher 		,  		 			B Mueller 		,  		 			P Diem 		.  	 	 		\textit{Swiss Med Wkly}  		2002. 132 p. .  	 
\bibitem[Mann et al. ()]{b7}\label{b7} 	 		‘Predictors of adherence to diabetes medications: the role of disease and medication beliefs’.  		 			D M Mann 		,  		 			D Ponieman 		,  		 			H Leventhal 		,  		 			E A Halm 		.  	 	 		\textit{J Behav Med}  		2009. 32 p. .  	 
\bibitem[Glasgow et al. ()]{b5}\label{b5} 	 		‘Selfcare behaviors and glycemic control in type 1 diabetes’.  		 			R E Glasgow 		,  		 			K D Mccaul 		,  		 			L C Schafer 		.  	 	 		\textit{J Chron Dis}  		1987.  	 
\bibitem[Glasgow and Toobert ()]{b14}\label{b14} 	 		‘Social environment and regimen adherence among type II diabetic patients’.  		 			R E Glasgow 		,  		 			D J Toobert 		.  	 	 		\textit{Diabetes Care}  		1988. 11 p. .  	 
\bibitem[Dimatteo ()]{b12}\label{b12} 	 		‘Variations in patients' adherence to medical recommendations: A quantitative review of 50 years of research’.  		 			M R Dimatteo 		.  	 	 		\textit{Medical Care}  		2004. 42 p. .  	 
\end{bibitemlist}
 			 		 	 
\end{document}
