Non-adherence to anti diabetic medication and associated factors in Nepal: a systematic review and meta-analysis

Nepal, being a low resource country, has a high prevalence of diabetes and its related complications. Anti-diabetic medication non-adherence is one of the common reasons for increased prevalence. Multiple factors including poverty, illiteracy, and lack of adequate health facility is the commonest cause of increased prevalence of diabetes. This systematic review and meta-analysis aim to analyze the prevalence of non-adherence to anti-diabetic medications in Nepal.

This systematic review and meta-analysis were prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Multiple electronic databases, including Google Scholar, PubMed, Cochrane Library, CINAHL Plus, Web of Science, and Scopus, were systematically searched from their inception up to November, 2024. The random-effects model with 95% confidence interval (CI) was used to calculate the non-adherence rate. Statistical heterogeneity among the included studies was assessed using the I² statistics.

A total of 10 studies involving 2276 diabetic patients were included in this meta-analysis. The overall pooled prevalence of non-adherence to anti diabetic medications was 56.3% (95% CI 0.448-0.677). Subgroup analysis revealed higher non-adherence rates in rural areas at 60.2% compared to 53.7% in urban areas. The relative risk (RR) of non-adherence was significantly higher among illiterate individuals compared to literate individuals is 1.373. Key factors contributing to non-adherence included illiteracy, poverty, lack of health facilities, forgetfulness, cost of medications and the number of medications.

This meta-analysis showed that more than half of the diabetic populations are non-adhered to their ant diabetic medications, highlighting a substantial risk of long-term diabetic complications. These findings underscore the need for treatment strategies that prioritize improving medication adherence through patient education, behavioral support, and healthcare system interventions. Policymakers should prioritize the development and implementation of national adherence programs and strengthen healthcare infrastructure to support long-term diabetes management.