Akshaya Institute of Pharmacy, Tumakuru, Karnataka, India.
Background: Type 2 diabetes mellitus (T2DM) is one of the leading chronic metabolic disorders in India, where medication non-adherence contributes to avoidable complications, hospitalization, reduced quality of life, and mortality. Understanding patients’ knowledge, attitude, and practice (KAP) toward medication use is essential to improving therapeutic outcomes. Objective: To evaluate the level of knowledge, attitude, and practice toward medication adherence among individuals with T2DM attending a district hospital in Tumakuru, Karnataka. Methods: A cross-sectional observational study was conducted for three months among 150 adult T2DM patients receiving antidiabetic therapy for at least six months. Data were collected using a validated self-designed questionnaire assessing sociodemographic characteristics and KAP toward medication adherence. Descriptive statistics were used for data analysis. Results: The study population included 57 males (38%) and 93 females (62%), with most participants aged 40–60 years (53.3%). A majority had diabetes for 1–5 years (56.6%). Although 76.6?lieved that regular medicine use prevents long-term complications, only 12% correctly knew their medication name and dosage. Forgetfulness, lack of knowledge, and belief in herbal substitutes were commonly reported barriers. Poor practice levels were observed despite moderate awareness. Conclusion: Participants demonstrated moderate knowledge and positive attitudes but poor medication adherence practices. Low understanding of dosage, fasting glucose targets, and reliance on alternative therapies were key contributors. Targeted patient counseling and pharmacist-led education programs could improve long-term glycemic outcomes.
Diabetes Mellitus (DM) is a complex metabolic disorder characterized by chronic elevated blood glucose levels due to deficiencies in insulin secretion, action, or both. This persistent hyperglycemia is associated with severe long-term microvascular and macrovascular complications. T2DM accounts for 80-90% of all DM cases. The prevalence in India is substantial, affecting an estimated 77 million individuals over 18 years old.
Types of Diabetes Mellitus
Type 1 Diabetes Mellitus (T1DM): Absolute insulin deficiency due to autoimmune destruction of beta-cells.
Type 2 Diabetes Mellitus (T2DM): Characterized by insulin resistance and a relative insulin deficiency. It is strongly linked to obesity and sedentary lifestyle.
Gestational Diabetes Mellitus (GDM): Diabetes onset during pregnancy.
Pathogenesis of Type 2 DM
The disease arises from two key mechanisms:
Insulin Resistance: Peripheral tissues (muscle, liver) fail to respond adequately to insulin, impairing glucose utilization.
Impaired Insulin Secretion: Pancreatic \beta-cells eventually fail to secrete enough insulin to overcome resistance, a condition aggravated by glucose toxicity and lipotoxicity.
Treatment (Pharmacological Classes)
Management involves various classes of anti-hyperglycemic drugs, including:
Biguanides (Metformin)
Sulfonylureas
Thiazolidinediones (TZD)
DPP-4 Inhibitors
SGLT2 Inhibitors
Type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic metabolic disorders worldwide and is characterized by insulin resistance, reduced insulin secretion, and persistent hyperglycemia. Nearly 90–95% of global diabetes cases are attributable to T2DM, with a rapidly increasing burden in low- and middle-income countries. India ranks among the highest contributors, with an accelerating rise in incidence particularly in semi-urban and rural populations due to sedentary lifestyles, unhealthy dietary patterns, ageing, obesity, and genetics.
Sustained hyperglycemia leads to progressive microvascular and macrovascular complications, including nephropathy, retinopathy, neuropathy, myocardial infarction, and peripheral vascular disease.² Effective glycaemic control significantly reduces these risks; however, it is largely dependent on long-term adherence to pharmacotherapy combined with lifestyle modification. Despite availability of effective medications, non-adherence remains a major barrier to therapeutic success and is associated with increased hospitalization, poor quality of life, and higher treatment costs.
Medication adherence is affected by multiple factors, including socioeconomic status, health literacy, beliefs about medicines, pill burden, forgetfulness, and perceived symptom severity. In India, where education and awareness levels vary widely, misconceptions regarding antidiabetic drugs, the use of herbal remedies, and irregular follow-up practices contribute substantially to uncontrolled diabetes. Measuring patients’ knowledge, attitude, and practice (KAP) provides valuable insight into behavioral barriers and helps in the design of pharmacotherapeutic counseling programs.
Although several studies have assessed KAP among diabetic patients in different regions of India, limited evidence is available from semi-urban populations in Karnataka. Understanding adherence behaviour in such settings is important, as this population often presents late, shows poor awareness of complications, and may lack structured diabetes education.
The present study therefore aimed to evaluate the knowledge, attitude, and practice toward medication adherence among individuals with T2DM attending a district hospital in Tumakuru, Karnataka. The findings are expected to support the development of targeted patient education strategies to improve adherence and glycaemic outcomes.
Materials and methods
Study Site:
The study was conducted at the District Hospital, Tumakuru, Karnataka.
Study Period:
The study was carried out for a duration of three months.
Study Design:
A cross-sectional observational study design was adopted.
Study Population:
A total of 150 participants diagnosed with Type 2 Diabetes Mellitus were included.
Materials Used:
- Informed Consent Form (English & Kannada)
- Self-Designed Questionnaire Form
- Patient Information Leaflet
Inclusion Criteria:
- Individuals aged 18 years and above of either gender.
- Participants attending the Outpatient Department of District Hospital.
- Those who have been receiving anti-hyperglycaemic medications for at least 6 months.
- Participants willing to provide consent.
Exclusion Criteria:
- Pregnant or lactating women.
- Patients with severe psychiatric illness.
- Participants with language barriers.
Data Collection:
Data were collected using a structured, self-designed questionnaire. Socio-demographic details
and KAP (Knowledge, Attitude, and Practice) regarding medication adherence were recorded.
Respondents were briefed on the purpose and duration of the study before participation.
Awareness was enhanced verbally and through distribution of information leaflets.
Study Phases:
Phase 1 – Designing of self-administered questionnaire after review of related literature.
Phase 2 – Administering questionnaire and collecting responses.
Phase 3 – Conducting awareness sessions and providing educational leaflets.
Phase 4 – Data compilation and analysis.
Statistical Analysis:
The data were entered into Microsoft Excel and analyzed using descriptive statistical methods. Results were expressed in the form of tables and bar graphs to represent the distribution of participants according to demographic variables and KAP scores.
This methodology provides a structured framework for evaluating the knowledge, attitude, and practice of diabetic patients toward medication adherence in a hospital-based setting.
Results
A total of 150 individuals with type 2 diabetes mellitus were enrolled in the study. A total of 150 participants were included in the study. The majority were female (62%) and aged 40–60 years (53.3%). Most participants were unemployed (38%) and had diabetes for 1–5 years (56.6%). Regarding education, 26% were uneducated, 34% had secondary education, and only 3% were postgraduates.
Knowledge: Only 50.6% correctly identified the normal fasting glucose range, and 44.6% recognized insulin resistance as the cause of T2DM. About 76.6% believed that regular medication prevents complications.
Attitude: 87% felt that taking diabetes medicines was a burden, while 48% believed they could manage diabetes without daily medication. Around 41% trusted herbal remedies as alternatives.
Practice: 73% were unaware of their medication dosage. Only 34% underwent regular blood sugar checkups despite ongoing treatment.
Table: Baseline demographic data of patients population
|
Sl. No |
PARAMETERS |
NO OF PATIENTS (N=150) |
PERCENTAGE (%) |
|
01 |
Gender |
|
|
|
|
Male |
57 |
38% |
|
|
female |
93 |
62% |
|
02 |
Age group |
|
|
|
|
20-40 years |
50 |
33.33% |
|
|
40-60 years |
80 |
53.33% |
|
|
>60 years |
20 |
13.13% |
|
03 |
Duration of diabetes |
|
|
|
|
1-5 years |
85 |
56.66% |
|
|
5-10 years |
46 |
30.66% |
|
|
10-15 years |
12 |
08% |
|
|
15-20 years |
07 |
04.66% |
|
04 |
occupation |
|
|
|
|
Employed |
44 |
29.33% |
|
|
Self-employed |
49 |
32.67% |
|
|
Unemployed |
57 |
38% |
|
05 |
Education |
|
|
|
|
No formal education |
39 |
26% |
|
|
Primary education |
36 |
24% |
|
|
Secondary education |
51 |
34% |
|
|
Graduate |
20 |
13% |
|
|
Post- graduate |
04 |
03% |
|
06 |
comorbidity |
|
|
|
|
yes |
90 |
60% |
|
|
No |
60 |
40% |
Distribution Of Subjects Based On Gender:
A cross-sectional observational study was conducted for 3 months among participants residing in the District Hospital, Tumakuru. A total 150 participants were included in this study. Out of 150 participants 93 (62%) are female, and 57 (38%) male participants
|
Gender |
Total Number of Participants (N=150) |
Percentage (%) |
|
Male |
57 |
38% |
|
Female |
93 |
62% |
Categorization Of Participants Based On Age:
In our study maximum number of participants was found in the age group of 40-60 years, i.e., 80(53.33%), followed by 20-40 years, 50 participants (33.33%), and the minimum number of participants was found in the above 60 years age group.
|
Age (years) |
Total number of participants (n=150) |
Percentage (%) |
|
20-40 |
50 |
33.33% |
|
40-60 |
80 |
53.33% |
|
>60 |
20 |
13.13% |
Distribution Of Participants Based on Duration of Diabetes
Among the respondents , 85 participants(56.66%) had diabetes for 1-5 years, followed by 46 participants(30.66%) for 5-10 years, 12 participants (08%) for 10-15 years , and 7 participants (4.66%) for 15-20 years.
|
Duration (in years) |
No. of participants (N=150) |
Percentage |
|
1-5 |
85 |
56.66% |
|
5-10 |
46 |
30.66% |
|
10-15 |
12 |
08% |
|
15-20 |
7 |
4.66% |
Distribution Of Participants Based on Occupation
Among the data set of 150 participants Table 03 reviews that 44 participants(29.33%) are employed , 49 participants (32.67%) are self-employed and 57 participants (38%) are unemployed were enrolled in the study.
|
Occupation |
Total No. Of Participants (N=150) |
Percentage (%) |
|
Employed |
44 |
29.33% |
|
Self employed |
49 |
32.67% |
|
Un employed |
57 |
38% |
Distribution Of Participants Based on Education
Of the data collected, approximately 39 participants (26%) did not have formal education, around 36 participants (24%) are had primary level of education, 51 participants (34%) are had a secondary education, around 20 participants (13%) were graduates, and around 04 participants (03%) are post- graduate
|
Education |
Total No. of participants (N=150) |
Percentage (%) |
|
No formal |
39 |
26% |
|
Primary |
36 |
24% |
|
Secondary |
51 |
34% |
|
Graduate |
20 |
13% |
|
Post graduate |
4 |
03% |
Categorization Based on Comorbidity
The majority of respondent were i.e. 90 participants (60%) was associated with another, while 60 participants (40%) did not present with any comorbid condition.
|
Comorbidity |
Total No. Of Participants(N=150) |
Percentage (%) |
|
Yes |
90 |
60% |
|
No |
60 |
40% |
Knowledge Assessment
While 76.6% believed regular medicine prevents long-term complications, only 50.6% correctly identified the normal fasting glucose range. Nearly one-fourth were unaware of common complications of poorly controlled diabetes. Although 44.6% understood that T2DM is due to insufficient insulin secretion, only 12% could correctly name their medication and dosage.
Attitude Assessment
A large proportion (78%) strongly agreed that regular medication is essential for glycaemic control. However, 48% believed diabetes could be managed without daily medicines, and 41% felt herbal remedies could replace antidiabetic drugs. Almost 87% reported that taking medicines daily felt burdensome, indicating psychological resistance to long-term therapy.
Practice Assessment
Only 34% monitored their blood glucose regularly, even when asymptomatic. About 73% did not know their prescribed dosage, and 25% admitted skipping medicines if they felt well. Forgetfulness and lack of perceived need were the most commonly reported reasons for non-adherence. Overall, the study revealed moderate knowledge, mixed attitudes, and poor adherence-related practices among participants.
DISCUSSION
Diabetes Mellitus (DM) has become a global public health concern at an alarming rate, with projections estimating that approximately 693 million individuals will be affected by 2045. Moreover, nearly 193 million cases are expected to remain undiagnosed due to minimal early symptoms. The present study aimed to assess the knowledge, attitude, and practice (KAP) regarding Type 2 Diabetes Mellitus (T2DM) among patients. The findings revealed that most participants demonstrated adequate knowledge about diabetes and showed moderate to good adherence to their prescribed medication. T2DM was more prevalent among older adults, which may explain their relatively better knowledge and practices, as older individuals tend to be more health-conscious. Female participants also exhibited better health-seeking behavior, possibly due to greater awareness and willingness to consult healthcare providers. Although no significant association was observed between education level and KAP, participants with higher education displayed slightly better knowledge and practice scores. Education plays a vital role in improving health outcomes by enhancing personal control, promoting healthy lifestyles, and encouraging positive health behaviors, ultimately reducing healthcare costs at both individual and community levels. The study found no significant association between race and KAP toward T2DM; however, there was a notable link between race and T2DM prevalence, indicating that race may influence health status.
CONCLUSION
This cross-sectional study revealed that medication adherence among patients with type 2 diabetes mellitus (T2DM) was suboptimal, indicating a significant gap in the management of the disease. Poor adherence was found to be associated with inadequate glycemic control, which increases the risk of long-term complications. The findings underscore the importance of raising awareness and enhancing patients’ knowledge about diabetes mellitus and the significance of medication adherence. Most participants in the present study demonstrated only an average level of knowledge regarding diabetes mellitus. A limited understanding of disease susceptibility and the necessity for consistent management was evident. Therefore, there is an urgent need for implementing effective screening and prevention strategies among diabetic patients. HealthCare professionals play a vital role in promoting medication adherence and should prioritize patient education on risk factors, lifestyle modifications, and preventive measures. Conducting regular awareness programs and emphasizing the benefits of early screening and vaccination can contribute to improved health outcomes. Additionally, educating young adults about diabetes and its complications at an early stage can positively influence their future health-related decisions.
The use of educational programs involving local media and community-based initiatives may serve as an effective strategy for improving public understanding and engagement. These findings highlight the necessity of targeted health education, strengthened patient–provider communication, and system-level interventions to enhance medication adherence and reduce diabetes-related complications within this population.
REFERENCES
Praful Wadekar, Prajwal R., Premakumari T., Sahana H. C., Sahana M., Dr. Shivaraj D. R.*, A Study on Evaluation of Knowledge, Attitude, And Practice Toward Medication Adherence Among Individuals with Type 2 Diabetes Mellitus: A Cross-Sectional Observational Study, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 11, 1759-1769 https://doi.org/10.5281/zenodo.17586812
10.5281/zenodo.17586812
