Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos

Introducción: La no adherencia al tratamiento de enfermedades crónicas como la diabetes mellitus, se asocia con un empeoramiento del estado clínico/de salud, un aumento de las hospitalizaciones relacionadas con la medicación y un mayor riesgo de mortalidad (Jensen et al., 2017). La diabetes mellitus...

Full description

Autores:
Moncada Mogollón, Karen Dayana
Castañeda Duarte, Pedro Pablo
Gallo Rojas, Jefferson
López Diaz, Jhonny Alexander
Tipo de recurso:
Trabajo de grado de pregrado
Fecha de publicación:
2024
Institución:
Universidad Cooperativa de Colombia
Repositorio:
Repositorio UCC
Idioma:
spa
OAI Identifier:
oai:repository.ucc.edu.co:20.500.12494/56431
Acceso en línea:
https://hdl.handle.net/20.500.12494/56431
Palabra clave:
Incumplimiento de la Medicación
Tratamiento
Factores de riesgo
Diabetes mellitus tipo 2
Medication noncompliance
Treatment.
Risk factors
Type 2 diabetes mellitus
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/4.0/
id COOPER2_b0d85976ca2b83a40b2ba2dfeaaa7673
oai_identifier_str oai:repository.ucc.edu.co:20.500.12494/56431
network_acronym_str COOPER2
network_name_str Repositorio UCC
repository_id_str
dc.title.none.fl_str_mv Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
title Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
spellingShingle Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
Incumplimiento de la Medicación
Tratamiento
Factores de riesgo
Diabetes mellitus tipo 2
Medication noncompliance
Treatment.
Risk factors
Type 2 diabetes mellitus
title_short Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
title_full Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
title_fullStr Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
title_full_unstemmed Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
title_sort Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos
dc.creator.fl_str_mv Moncada Mogollón, Karen Dayana
Castañeda Duarte, Pedro Pablo
Gallo Rojas, Jefferson
López Diaz, Jhonny Alexander
dc.contributor.advisor.none.fl_str_mv Contreras Ramos Luz Mery
dc.contributor.author.none.fl_str_mv Moncada Mogollón, Karen Dayana
Castañeda Duarte, Pedro Pablo
Gallo Rojas, Jefferson
López Diaz, Jhonny Alexander
dc.subject.proposal.spa.fl_str_mv Incumplimiento de la Medicación
Tratamiento
Factores de riesgo
Diabetes mellitus tipo 2
topic Incumplimiento de la Medicación
Tratamiento
Factores de riesgo
Diabetes mellitus tipo 2
Medication noncompliance
Treatment.
Risk factors
Type 2 diabetes mellitus
dc.subject.proposal.eng.fl_str_mv Medication noncompliance
Treatment.
Risk factors
Type 2 diabetes mellitus
description Introducción: La no adherencia al tratamiento de enfermedades crónicas como la diabetes mellitus, se asocia con un empeoramiento del estado clínico/de salud, un aumento de las hospitalizaciones relacionadas con la medicación y un mayor riesgo de mortalidad (Jensen et al., 2017). La diabetes mellitus tipo II afecta al paciente y tienen probabilidad de una combinación de complicaciones aun cuando los factores de riesgo están relacionados con antecedentes como la edad, el origen étnico o familiares, además la prevalencia de la DM2 es aproximadamente del 70%, lo cual es una cifra alarmante y es un problema para los pacientes inherentes al tratamiento. Objetivo: Conocer los factores influyentes en la mala adherencia al tratamiento de la Diabetes Mellitus Tipo II en adultos. Metodología: A partir de una revisión de la literatura se recolectó información de los factores de riesgo de la no adherencia en la diabetes mellitus tipo II, se seleccionaron unas variables, palabras claves y fórmulas, que sirvieron para realizar las búsquedas dentro de las bases de datos institucionales (BVS, Scopus, Sprinter, Journal, Ovid y Proquest), de los cuales se obtuvieron 40 como inclusión final, usando un excel para la clasificación de variables más prevalentes encontradas en la literatura. Resultados: Se incluyeron 40 artículos referentes a la no adherencia a la medicación que el 12,8% mostró satisfecho al recibir el tratamiento, 24,3% no cumplió con el plazo prescrito, 4,3% se mostró satisfecho, pero dejó de tomar la medicación y 20% se arrepintió del tratamiento en los factores socioeconómicos; nivel educativo, empleo y los ingresos. La mayoría eran mujeres entre 18 y 80 años que estudiaron hasta primaria, actualmente se encuentran con empleo, consumen alcohol posiblemente por el estrés laboral y obligaciones en el hogar, generalmente la no adherencia oscila entre el 86.6% para medicamentos antidiabéticos orales específicamente, incluyendo una variedad de factores como la polifarmacia, efectos secundarios, olvidó de dosis, duración de la enfermedad y complicaciones diabéticas. Se presentaron comorbilidades; hipertensión arterial y nefropatía seguramente por no llevar control periódico de su situación de salud, incumpliendo recomendaciones para adherirse al tratamiento y estilo de vida. A nivel mundial posiblemente utilizaron la escala de Morisky Green, midiendo la no adherencia con un 65% de participantes No adherentes. Se obtuvo un efecto grande en la no adherencia al tratamiento, variables significativas entre ellas son sociodemográficas, terapéuticas, clínicas y escala de Morisky Green de la no adherencia al tratamiento que influye en la necesidad de entender fácilmente el estado actual de dicha población adulta. Conclusión: Los hallazgos de esta revisión de la literatura mostraron que la mayoría de los participantes no se adhieren al tratamiento de la diabetes tipo II debido a una serie de factores sociodemográficos y terapéuticas, incluido el bajo nivel de educación, ingresos insuficientes, consumo de alcohol, frecuencia de consumo diario y la ineficacia del medicamento, evaluados a partir de escala de Morisky Green identificando las siguientes variables: olvido en la toma de los medicamentos, el desconocimiento sobre la diabetes, falta de comprensión de las fórmulas médicas, desaparición de síntomas y por poca disponibilidad de tiempo.
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-07-19T22:53:20Z
dc.date.available.none.fl_str_mv 2024-07-19T22:53:20Z
dc.date.issued.none.fl_str_mv 2024-07-19
dc.type.none.fl_str_mv Trabajo de grado - Pregrado
dc.type.coar.none.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.content.none.fl_str_mv Text
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TP
dc.type.version.none.fl_str_mv info:eu-repo/semantics/acceptedVersion
format http://purl.org/coar/resource_type/c_7a1f
status_str acceptedVersion
dc.identifier.citation.none.fl_str_mv Castañeda Duarte, P. P, Gallo Rojas, J., López Diaz, J. A., Moncada Mogollón, K. D. (2024). Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos. Revisión de la literatura. [Tesis de pregrado, Universidad Cooperativa de Colombia]. Repositorio Institucional Universidad Cooperativa de Colombia. https://hdl.handle.net/20.500.12494/56431
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12494/56431
identifier_str_mv Castañeda Duarte, P. P, Gallo Rojas, J., López Diaz, J. A., Moncada Mogollón, K. D. (2024). Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos. Revisión de la literatura. [Tesis de pregrado, Universidad Cooperativa de Colombia]. Repositorio Institucional Universidad Cooperativa de Colombia. https://hdl.handle.net/20.500.12494/56431
url https://hdl.handle.net/20.500.12494/56431
dc.language.iso.none.fl_str_mv spa
language spa
dc.relation.references.none.fl_str_mv Abate, T. (2019). Medication non-adherence and associated factors among diabetes patients in Felege Hiwot Referral Hospital, Bahir Dar city administration, Northwest Ethiopia. BMC Research Notes, 12(1), 1–6. https://doi.org/10.1186/s13104-019-4205-4
Afaya, R., Bam, V., Azongo, T., Afaya, A., Kusi-Amponsah, A., Ajusiyine, J., & Hamid, T. (2020). Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana. PLOS ONE, 15(8), 1–14. https://doi.org/10.1371/journal.pone.0237710
Alanazi, M., & Alatawi, A. (2022). Adherence to Diabetes Mellitus Treatment Regimen Among Patients With Diabetes in the Tabuk Region of Saudi Arabia. Cureus, 14(10), 1–14. https://doi.org/10.7759/cureus.30688
Alfulayw, R., Almansour, A., Aljamri, K., Ghawas, H., Alhussain, S., Althumairi, A., Almuthaffar, A., Alhuwayji, A., Almajed, A., Al-Yateem, S., Alamri, A., Alhussaini, N., Almutairi, M., Alali, A., & Alkhateeb, F. (2022). Factors Contributing to Noncompliance With Diabetic Medications and Lifestyle Modifications in Patients With Type 2 Diabetes Mellitus in the Eastern Province of Saudi Arabia: A Cross-Sectional Study. Cureus, 14(11), 1–16. https://doi.org/10.7759/cureus.31965
Al-Haj Mohd, M. M. M., Phung, H., Sun, J., & Morisky, D. E. (2015). The predictors to medication adherence among adults with diabetes in the United Arab Emirates. Journal of Diabetes & Metabolic Disorders, 15(10), 1–17. https://doi.org/10.1186/s40200-016-0254-6
Almaghaslah, D., Khled, A., Khaled, S., Mohammed, L., Mostafa, B., Mohammed, W., & Ali Alqhatani, B. (2018). Factors contributing to non-adherence to insulin therapy among type 1 and type2 diabetes mellitus patients in Asser region, Saudi Arabia. Biomedical Research, 29(10), 1–6. https://doi.org/10.4066/biomedicalresearch.29-18-503
Alosaimi, K., Alwafi, H., Alhindi, Y., Falemban, A., Alshanberi, A., Ayoub, N., & Alsanosi, S. (2022). Medication Adherence among Patients with Chronic Diseases in Saudi Arabia. International Journal of Environmental Research and Public Health, 19(16), 1–9. https://doi.org/10.3390/ijerph191610053
Alqarni, A., Alrahbeni, T., Al Qarni, A., & Al Qarni, H. (2018). Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia – a cross-sectional survey. Dovepress, 13(1), 63–71. https://doi.org/10.2147/PPA.S176355
Aminde, L., Tindong, M., Ngwasiri, A., Aminde, A., Njim, T., Fondong, A., & Takah, N. (2019). Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocrine Disorders, 19(1), 1–10. https://doi.org/10.1186/s12902-019-0360-9
Araya, E., Gebrezgabiher, H., Tekulu, G., Alema, N., Getnet, D., Gebru, H., & Adamu, B. (2020). Medication Non-Adherence and Associated Factors Among Diabetic Patients Visiting General Hospitals in the Eastern Zone of Tigrai, Northern Ethiopia. Patient Preference and Adherence, 14(2), 2071–2083. https://doi.org/10.2147/PPA.S278148
Asheq, A., Ashames, A., Al-Tabakha, M., Hassan, N., & Jairoun, A. (2021). Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates. F1000Research, 10(4), 1–19. https://doi.org/10.12688/f1000research.51729.1
Asociación Latinoamericana de Diabetes. (2019). Guías ALAD sobre el Diagnóstico, Control y Tratamiento de la Diabetes Mellitus Tipo 2 con Medicina Basada en Evidencia Edición 2019. Alad, 1–125. https://www.revistaalad.com/guias/5600AX191_guias_alad_2019.pdf
Balkhi, B., Alwhaibi, M., Alqahtani, N., Alhawassi, T., Alshammari, M., Mahmoud, M., Almetwazi, M., Ata, S., & Kamal, M. (2019). Oral antidiabetic medication adherence and glycaemic control among patients with type 2 diabetes mellitus: A cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open, 9(7), 1–12. https://doi.org/10.1136/bmjopen-2019-029280
Barbosa, M., & Quintero, J. (2018). Estilo de vida y adherencia al tratamiento de pacientes con diabetes mellitus tipo 2 Lifestyle and adherence to treatment of patients with type 2 diabetes mellitus. Revista Facultad de Salud, 10(1), 1–7. https://journalusco.edu.co/index.php/rfs/article/view/3187
Basu, S., Khobragade, M., Kumar, A., & Raut, D. K. (2015). Medical adherence and its predictors in Diabetes Mellitus patients attending government hospitals in the Indian Capital, Delhi, 2013: a cross sectional study. International Journal of Diabetes in Developing Countries, 35(2), 95–101. https://doi.org/10.1007/s13410-014-0232-9
Boshe, B., Yimar, G., Dadhi, A., & Bededa, W. (2021). The magnitude of non-adherence and contributing factors among adult outpatient with Diabetes Mellitus in Dilla University Referral Hospital, Gedio, Ethiopia. PLOS ONE, 16(3), 1–12. https://doi.org/10.1371/journal.pone.0247952
Castillo, M., Libertad, I., Alonso, M., Almenares, K., & Rodríguez, I. (2017). Adherencia terapéutica y factores influyentes en pacientes con diabetes mellitus tipo 2. Revista Cubana de Medicina General Integral, 33(4), 1–10. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252017000400006
Chefik, F., Tadesse, T., Quisido, B., & Roba, A. (2022). Adherence to insulin therapy and associated factors among type 1 and type 2 diabetic patients on follow up in Madda Walabu University Goba Referral Hospital, South East Ethiopia. PLoS ONE, 17(6), 1–13. https://doi.org/10.1371/journal.pone.0269919
Demoz, G., Berha, A., Alebachew, W., Yifter, H., Shibeshi, W., & Engidawork, E. (2019). Drug therapy problems, medication adherence and treatment satisfaction among diabetic patients on follow-up care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. PLOS ONE, 14(10), 1–17. https://doi.org/10.1371/journal.pone.0222985
Demoz, G., Wahdey, S., Bahrey, D., Kahsay, H., Woldu, G., Niriayo, Y., & Collier, A. (2020). Predictors of poor adherence to antidiabetic therapy in patients with type 2 diabetes: a cross-sectional study insight from Ethiopia. Diabetology & Metabolic Syndrome, 12(1), 1–8. https://doi.org/10.1186/s13098-020-00567-7
Domínguez Gallardo, L. A., & Ortega Filártiga, E. (2019). Factors associated with lack of adherence to treatment in patients with type 2 diabetes mellitus. Revista Virtual de La Sociedad Paraguaya de Medicina Interna, 6(1), 63–74. https://doi.org/10.18004/rvspmi/2312-3893/2019.06(01)63-074
Escamilla N., & Cáceres, P. (2017). Adherence to drug treatment in older adults with type 2 diabetes and its associated factors. Gerokomos, 28(2), 73–77. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2017000200073&lng=es&tlng=es.
Faisal, K., & Tusiimire, J. (2021). Factors Associated With Non-Adherence To Antidiabetic Medication Among Patients at Mbarara Regional Referral Hospital, Mbarara, Uganda. ResearchSquare, 11(1), 1–22. https://doi.org/10.21203/rs.3.rs-571953/v1
Fayyaz, F., Aghamahdi, F., Noorian, S., Tabatabaei-Malazy, O., & Qorbani, M. (2022). Associated factors to insulin adherence in type 1 diabetes in Tehran and Karaj, Iran. Journal of Diabetes and Metabolic Disorders, 21(2), 1591–1597. https://doi.org/10.1007/s40200-022-01105-0
Ge, L., Heng, B., & Yap, C. (2023). Understanding reasons and determinants of medication non-adherence in community-dwelling adults: a cross-sectional study comparing young and older age groups. BMC Health Services Research, 23(1), 1–11. https://doi.org/10.1186/s12913-023-09904-8
Hacene, M., Zatla, Y., Saker, M., Abbou, Z., Youcef, A., Boulenouar, H., Fekir, H., Khaldi, K., Brikci, N., Lounici, A., & Meguenni, K. (2022). Factors associated with non-adherence to insulin in Type 1 and Type 2 diabetes mellitus patients in Western region of Algeria, Tlemcen: a cross-sectional study. Pan African Medical Journal, 41(1), 1–14. https://doi.org/10.11604/pamj.2022.41.172.32972
Jankowska, B., Świątoniowska, N., Karniej, P., Polański, J., Tański, W., & Grochans, E. (2021). Influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension. Diabetes Research and Clinical Practice, 173(1), 1–10. https://doi.org/10.1016/j.diabres.2021.108693
Jannoo, Z., & Mamode, K. (2019). Medication Adherence and Diabetes Self-Care Activities among Patients with Type 2 Diabetes Mellitus. Value in Health Regional Issues, 18(1), 30–35. https://doi.org/10.1016/j.vhri.2018.06.003
Jensen, M., Jorgensen, M., Hansen, E., Aagaard, L., & Carstensen, B. (2017). Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation. PLOS ONE, 12(6), 1–10. https://doi.org/10.1371/journal.pone.0179546
Jeyalakshmi, K., Mahadev, R., Shashidhara, Y., Thunga, G., Ravishankar, N., Sudhakar, C., & Sanatombi, E. (2023). Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India. Dovepress, 17(1), 1641–1656. https://doi.org/10.2147/PPA.S380784
Kalyango, J. N., Owino, E., & Nambuya, A. P. (2008). Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. African Health Sciences, 8(2), 67–73. https://pubmed.ncbi.nlm.nih.gov/19357753/
Kassahun, T., Gesesew, H., Mwanri, L., & Eshetie, T. (2016). Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey. BMC Endocrine Disorders, 16(28), 1–11. https://doi.org/10.1186/s12902-016-0114-x
Machado, E., Gomes, J., Winter, F., & Peres, R. (2020). Medication non-adherence in patients with type 2 diabetes mellitus with full access to medicines. Journal of Diabetes & Metabolic Disorders, 19(1), 1105–1113. https://doi.org/10.1007/s40200-020-00612-2
Manterola, C., Astudillo, P., Arias, E., & Claros, N. (2013). Revisiones sistemáticas de la literatura. Qué se debe saber acerca de ellas. Cirugía Española, 91(3), 149–155. https://doi.org/10.1016/j.ciresp.2011.07.009
Mariye, T., Girmay, A., Birhanu, T., Tasew, H., Teklay, G., Baraki, Z., Gerensea, H., Teklu, T., & Bezabeh, G. (2019). Adherence to insulin therapy and associated factors among patients with diabetes mellitus in public hospitals of Central Zone of Tigray, Ethiopia, 2018: a cross-sectional study. Pan African Medical Journal, 33(309), 1–10. https://doi.org/10.11604/pamj.2019.33.309.17547
MINSALUD (1993). resolución 8430. Tomado de. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
Morisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. The Journal of Clinical Hypertension, 10(5), 348–354. https://doi.org/10.1111/j.1751-7176.2008.07572.x
Murwanashyaka, J., Ndagijimana, A., Biracyaza, E., Sunday, F., & Umugwaneza, M. (2022). Non-adherence to medication and associated factors among type 2 diabetes patients at Clinique Medicale Fraternite, Rwanda: a cross-sectional study. BMC Endocrine Disorders, 22(1), 1–14. https://doi.org/10.1186/s12902-022-01133-0
Naranjo, Y. (2016). La diabetes mellitus: un reto para la Salud Pública Diabetes Mellitus: A Public Health Challenge. SciELO, 6(1), 1–5. https://revfinlay.sld.cu/index.php/finlay/article/view/399/1453
National Library of Medicine. (2023). Medical Subject Headings: MeSH. Internet. https://www.ncbi.nlm.nih.gov/mesh/
Organización Mundial de la Salud. (2023). Diabetes. https://www.who.int/es/news-room/fact-sheets/detail/diabetes
Organización Panamericana de la Salud. (2021). Diabetes. https://www.paho.org/es/temas/diabetes.
Ortega, J., Sánchez, D., & Rodríguez, O. (2018). Adherencia terapéutica: un problema de atención médica. Acta Médica Grupo Ángeles, 16(3), 1–7. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-72032018000300226&lng=es&tlng=es.
Pinilla, E., & Barrera, M. (2018). Prevention of diabetes mellitus and cardiovascular risk: Medical and nutritional approach. Revista Facultad de Medicina, 66(3), 459-468. https://doi.org/10.15446/revfacmed.v66n3.60060
Quiñones, A., Ugarte, C., Chávez C., & Mañalich, J. (2018). Psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus. Rev Med Chile, 146, 1151–1158. https://www.scielo.cl/pdf/rmc/v146n10/0034-9887-rmc-146-10-01151.pdf
Raharinavalona, S., Raherison, E., Razanamparany, T., Ralamboson, A., Rakotomalala, A., Vololontiana, M., & Lazasoa, L. (2021). Factors of Non-adherence to Antidiabetic Drugs in Type 2 Diabetics, Antananarivo Madagascar. International Journal of Diabetes and Endocrinology, 6(4), 125–130. https://doi.org/10.11648/j.ijde.20210604.11
Rojas, E., Molina, R., & Rodríguez, C. (2012). Definición, clasificación y diagnóstico de la diabetes mellitus. Revista Venezolana de Endocrinología y Metabolismo, 10(1) (pp. 7–12). http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S1690-31102012000400003&lng=es&tlng=es.
Ramírez García, M. C., Anlehu Tello, A., & Rodríguez León, A. (2020). Factors influencing adherence behavior of patients with Type 2 Diabetes Mellitus. Scielo, 18(3). https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2007-74592019000300383
Sah, B. K., Basyal, D., & Gaire, A. (2021). Clinical Pharmacology & Biopharmaceutics Medication Non-Adherence among Type-II Diabetes Mellitus Out-Patients Attending at Tertiary Care Hospital, Nepal. ResearchGate, 10(10), 1–7. https://doi.org/10.4172/2167-065X.1000236
Salama, H. M., Saudi, R. A. (2020). Effect of patients beliefs about medications on adherence to drugs in diabetic patients attending family medicine outpatient clinic in Ismailia, Egypt. Journal of Diabetes & Metabolic Disorders, 19(1), 951–958. https://doi.org/10.1007/s40200-020-00587-0
Saleh, A. (2022). People with diabetes adherence to drug, dietary, and lifestyle changes in Erbil city, Iraq. BMC Endocrine Disorders, 22(3), 1–8. https://doi.org/10.1186/s12902-022-01230-0
Sánchez Cruz, J. F., Hipólito-Lóenzo, A., Mugártegui-Sánchez, S. G., & Yáñez-González, R. M. (2016). Estrés y depresión asociados a la no adherencia al tratamiento en pacientes con Diabetes Mellitus tipo 2. Aten Fam, 23(2), 43–47. https://www.sciencedirect.com/science/article/pii/S1405887116301122
Shamsi, A., Khodaifar, F., Arzaghi, S. M., Sarvghadi, F., & Ghazi, A. (2014). Is there any relationship between medication compliance and affective temperaments in patients with type 2 diabetes? Journal of Diabetes and Metabolic Disorders, 13(1), 1–6. https://doi.org/10.1186/s40200-014-0096-z
Shams, N., Amjad, S., Kumar, N., Ahmed, W., & Saleem, F. (2016). Drug Non-Adherence In Type 2 Diabetes Mellitus; Predictors And Associations. Journal of Ayub Medical College, Abbottabad: 28(2), 302–307. https://pubmed.ncbi.nlm.nih.gov/28718543/
Silva, G., Germán, E., Silva, E., Galeano, J., Orlando C, Enrique, G., & Sarmiento, S. (2005). Adherencia al tratamiento Implicaciones de la no-adherencia Compliance with the treatment Implications of non-compliance. Hot Topic. Acta Médica Colombina, 30(4), 268–273. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-24482005000400004
Singer, A. G., LaBine, L., Katz, A., Yogendran, M., & Lix, L. (2022). Primary medication nonadherence in a large primary care population: Observational study from Manitoba. Canadian family physician Medecin de famille canadien, 68(7), 520–527. https://doi.org/10.46747/cfp.6807520
Thapar, R., Holla, R., Kumar, N., Aithal, S., Karkera, S., Rao, C., Pujari, N., Zahida, A., Unnikrishnan, B., Mithra, P., Swamy, D., Kulkarni, V., Bhagawan, D., & Kumar, A. (2020). Factors influencing adherence to anti-diabetes medications among type 2 diabetes patients attending tertiary care hospitals in Mangaluru. Clinical Epidemiology and Global Health, 8(4), 1089–1093. https://doi.org/10.1016/j.cegh.2020.03.025
Waari, G., Mutai, J., & Gikunju, J. (2018). Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. Pan African Medical Journal, 29(8), 1–15. https://doi.org/10.11604/pamj.2018.29.82.12639
Wabe, N., Angamo, M., & Hussein, S. (2011). Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. North American Journal of Medical Sciences, 3(9), 418–423. https://doi.org/10.4297/najms.2011.3418
Xu, N., Xie, S., Chen, Y., Li, J., & Sun, L. (2020). Factors influencing medication non-adherence among chinese older adults with diabetes mellitus. International Journal of Environmental Research and Public Health, 17(17), 1–10. https://doi.org/10.3390/ijerph17176012
Zheng, Y., Ley, H., & Hu, B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88–98. https://doi.org/10.1038/nrendo.2017.151
dc.rights.uri.none.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.accessrights.none.fl_str_mv info:eu-repo/semantics/openAccess
dc.rights.creativecommons.none.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.coar.none.fl_str_mv http://purl.org/coar/access_right/c_abf2
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
Attribution-NonCommercial-NoDerivatives 4.0 International
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.extent.none.fl_str_mv 58 p.
dc.format.mimetype.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Enfermería, Bucaramanga
dc.publisher.program.none.fl_str_mv Enfermería
dc.publisher.faculty.none.fl_str_mv Ciencias de la Salud
dc.publisher.place.none.fl_str_mv Bucaramanga
dc.publisher.branch.none.fl_str_mv Bucaramanga
publisher.none.fl_str_mv Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Enfermería, Bucaramanga
institution Universidad Cooperativa de Colombia
bitstream.url.fl_str_mv https://repository.ucc.edu.co/bitstreams/34627d19-94cf-46ed-bab7-8317e98fe409/download
https://repository.ucc.edu.co/bitstreams/43c10cf5-46d1-4a4e-8cfe-30a5df61cb49/download
https://repository.ucc.edu.co/bitstreams/7b6ce5f7-9619-43d8-94b5-1625d459ea47/download
https://repository.ucc.edu.co/bitstreams/ef66e935-2730-4859-9a96-2eb05dcf32f1/download
https://repository.ucc.edu.co/bitstreams/348a9566-65a3-41a0-814a-8213c1f36f1b/download
https://repository.ucc.edu.co/bitstreams/29ae3248-a75c-498b-8b4b-f8bda7b10a51/download
https://repository.ucc.edu.co/bitstreams/d3227914-c9c5-4328-9dcd-f5122ffb99fd/download
https://repository.ucc.edu.co/bitstreams/0c533703-e6d6-41b2-841e-e4364a6852c8/download
https://repository.ucc.edu.co/bitstreams/b1ceeb2b-b4dc-4145-a56b-145da6264ee0/download
https://repository.ucc.edu.co/bitstreams/62470726-806a-405a-bb85-11128f4fae79/download
https://repository.ucc.edu.co/bitstreams/b40b367c-59cc-4398-8308-3613457787b9/download
bitstream.checksum.fl_str_mv 4460e5956bc1d1639be9ae6146a50347
3bce4f7ab09dfc588f126e1e36e98a45
af2a3441e5a5240f005fc7609e7baa5e
b0c3b61e69768e9d4d2e6d07b8b95985
80d816924c4699908a81ee639ea8efc1
85ae0b70fbebee6f8ee4373dbbfaf66b
8587313c1f6359c497bfe756af7539a8
d570e8a0df695a4c158f357f1411f710
181ddcdae55ff6271b1e1d00dbd0c8ea
250841a17a3629954cf4420a7fe4dd8c
de7e35db458999d10398d4965d83fe07
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
repository.name.fl_str_mv Repositorio Institucional Universidad Cooperativa de Colombia
repository.mail.fl_str_mv bdigital@metabiblioteca.com
_version_ 1814246535073890304
spelling Contreras Ramos Luz MeryMoncada Mogollón, Karen DayanaCastañeda Duarte, Pedro PabloGallo Rojas, JeffersonLópez Diaz, Jhonny Alexander2024-07-19T22:53:20Z2024-07-19T22:53:20Z2024-07-19Castañeda Duarte, P. P, Gallo Rojas, J., López Diaz, J. A., Moncada Mogollón, K. D. (2024). Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultos. Revisión de la literatura. [Tesis de pregrado, Universidad Cooperativa de Colombia]. Repositorio Institucional Universidad Cooperativa de Colombia. https://hdl.handle.net/20.500.12494/56431https://hdl.handle.net/20.500.12494/56431Introducción: La no adherencia al tratamiento de enfermedades crónicas como la diabetes mellitus, se asocia con un empeoramiento del estado clínico/de salud, un aumento de las hospitalizaciones relacionadas con la medicación y un mayor riesgo de mortalidad (Jensen et al., 2017). La diabetes mellitus tipo II afecta al paciente y tienen probabilidad de una combinación de complicaciones aun cuando los factores de riesgo están relacionados con antecedentes como la edad, el origen étnico o familiares, además la prevalencia de la DM2 es aproximadamente del 70%, lo cual es una cifra alarmante y es un problema para los pacientes inherentes al tratamiento. Objetivo: Conocer los factores influyentes en la mala adherencia al tratamiento de la Diabetes Mellitus Tipo II en adultos. Metodología: A partir de una revisión de la literatura se recolectó información de los factores de riesgo de la no adherencia en la diabetes mellitus tipo II, se seleccionaron unas variables, palabras claves y fórmulas, que sirvieron para realizar las búsquedas dentro de las bases de datos institucionales (BVS, Scopus, Sprinter, Journal, Ovid y Proquest), de los cuales se obtuvieron 40 como inclusión final, usando un excel para la clasificación de variables más prevalentes encontradas en la literatura. Resultados: Se incluyeron 40 artículos referentes a la no adherencia a la medicación que el 12,8% mostró satisfecho al recibir el tratamiento, 24,3% no cumplió con el plazo prescrito, 4,3% se mostró satisfecho, pero dejó de tomar la medicación y 20% se arrepintió del tratamiento en los factores socioeconómicos; nivel educativo, empleo y los ingresos. La mayoría eran mujeres entre 18 y 80 años que estudiaron hasta primaria, actualmente se encuentran con empleo, consumen alcohol posiblemente por el estrés laboral y obligaciones en el hogar, generalmente la no adherencia oscila entre el 86.6% para medicamentos antidiabéticos orales específicamente, incluyendo una variedad de factores como la polifarmacia, efectos secundarios, olvidó de dosis, duración de la enfermedad y complicaciones diabéticas. Se presentaron comorbilidades; hipertensión arterial y nefropatía seguramente por no llevar control periódico de su situación de salud, incumpliendo recomendaciones para adherirse al tratamiento y estilo de vida. A nivel mundial posiblemente utilizaron la escala de Morisky Green, midiendo la no adherencia con un 65% de participantes No adherentes. Se obtuvo un efecto grande en la no adherencia al tratamiento, variables significativas entre ellas son sociodemográficas, terapéuticas, clínicas y escala de Morisky Green de la no adherencia al tratamiento que influye en la necesidad de entender fácilmente el estado actual de dicha población adulta. Conclusión: Los hallazgos de esta revisión de la literatura mostraron que la mayoría de los participantes no se adhieren al tratamiento de la diabetes tipo II debido a una serie de factores sociodemográficos y terapéuticas, incluido el bajo nivel de educación, ingresos insuficientes, consumo de alcohol, frecuencia de consumo diario y la ineficacia del medicamento, evaluados a partir de escala de Morisky Green identificando las siguientes variables: olvido en la toma de los medicamentos, el desconocimiento sobre la diabetes, falta de comprensión de las fórmulas médicas, desaparición de síntomas y por poca disponibilidad de tiempo.Introduction: Non-adherence to the treatment of chronic diseases, such as diabetes mellitus, is associated with a worsening of clinical/health status, an increase in medication-related hospitalizations and a higher risk of mortality (Jensen et al., 2017). Type II diabetes mellitus affects the patient and has a probability of a combination of complications even when the risk factors are related to history such as age, ethnic origin or family, in addition the prevalence of DM2 is approximately 70%, which It is an alarming figure and is a problem for patients inherent to the treatment. Objective: To know the influencing factors in poor adherence to the treatment of Type II Diabetes Mellitus in adults. Methodology: From a review of the literature, information was collected on the risk factors for non-adherence in type II diabetes mellitus; variables, keywords and formulas were selected, which were used to carry out the searches within the databases. institutional data (BVS, Scopus, Sprinter, Journal, Ovid and Proquest), of which 40 were obtained as final inclusion, using an Excel for the classification of the most prevalent variables found in the literature. Results: 40 articles were included referring to non-adherence to medication, of which 12.8% were satisfied when receiving the treatment, 24.3% did not comply with the prescribed period, 4.3% were satisfied, but stopped taking the medication and 20% regretted the treatment in socioeconomic factors; educational level, employment and income. The majority were women between 18 and 80 years old who studied until primary school, are currently employed, consume alcohol possibly due to work stress and obligations at home, generally non-adherence ranges between 86.6% for oral antidiabetic medications specifically, including a variety of factors such as polypharmacy, side effects, forgotten doses, duration of the disease and diabetic complications. Comorbidities occurred; High blood pressure and nephropathy, probably due to not regularly monitoring their health situation, failing to comply with recommendations to adhere to the treatment and lifestyle. Worldwide, they possibly used the Morisky Green scale, measuring non-adherence with 65% of non-adherent participants. A large effect was obtained in non-adherence to treatment, significant variables including sociodemographic, therapeutic, clinical and Morisky Green scale of non-adherence to treatment that influences the need to easily understand the current state of said adult population. Conclusion: The findings of this literature review showed that the majority of participants do not adhere to type II diabetes treatment due to a number of sociodemographic and therapeutic factors, including low level of education, insufficient income, alcohol consumption, frequency of daily consumption and the ineffectiveness of the medication, evaluated using the Morisky Green scale identifying the following variables: forgetting to take medications, lack of knowledge about diabetes, lack of understanding of medical formulas, disappearance of symptoms and for a short time availability.Planteamiento del problema. -- Justificación. -- Objetivo. -- Pregunta problema. -- Marco teórico. -- Diabetes mellitus. -- Clasificación. -- Diabetes tipo 1. -- Diabetes tipo 2. -- Diabetes gestacional. -- Diagnóstico. -- Factores de riesgo. -- Complicaciones. -- Tratamiento. -- Tratamiento no farmacológico. -- Tratamiento farmacológico. -- Prevención. -- Adherencia al tratamiento. -- Factores socioeconómicos. -- Factores relacionados con el paciente . -- No adherencia al tratamiento. -- Factores relacionados con el paciente. -- Deterioro cognoscitivo y estados alterados de ánimo. -- Aspectos de la enfermedad. -- Factor ambiental. -- Factor asociado al medicamento. -- Factor de interacción médico/paciente. -- Escala de Morisky Green. -- Metodología. -- Diseño. -- Población. -- Muestra. -- Variables. -- Descriptores. -- Combinación de booleanos. -- Fuentes de información. -- Bases de datos institucionales. -- Bases de datos abiertas. -- Selección. -- Criterios inclusión. -- Idioma. -- Rango de tiempo. -- Tipo de publicación. -- Criterios de exclusión. -- Inclusión. -- Consideraciones éticas. -- Resultados. -- Flujograma. -- Resultados variables de los pacientes. -- Conclusiones. -- Recomendaciones. -- Referencias bibliográficas.PregradoEnfermero Profesional58 p.application/pdfspaUniversidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Enfermería, BucaramangaEnfermeríaCiencias de la SaludBucaramangaBucaramangahttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://purl.org/coar/access_right/c_abf2Factores influyentes en la no adherencia al tratamiento de la diabetes mellitus Tipo II en adultosTrabajo de grado - Pregradohttp://purl.org/coar/resource_type/c_7a1fTextinfo:eu-repo/semantics/bachelorThesishttp://purl.org/redcol/resource_type/TPinfo:eu-repo/semantics/acceptedVersionAbate, T. (2019). Medication non-adherence and associated factors among diabetes patients in Felege Hiwot Referral Hospital, Bahir Dar city administration, Northwest Ethiopia. BMC Research Notes, 12(1), 1–6. https://doi.org/10.1186/s13104-019-4205-4Afaya, R., Bam, V., Azongo, T., Afaya, A., Kusi-Amponsah, A., Ajusiyine, J., & Hamid, T. (2020). Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana. PLOS ONE, 15(8), 1–14. https://doi.org/10.1371/journal.pone.0237710Alanazi, M., & Alatawi, A. (2022). Adherence to Diabetes Mellitus Treatment Regimen Among Patients With Diabetes in the Tabuk Region of Saudi Arabia. Cureus, 14(10), 1–14. https://doi.org/10.7759/cureus.30688Alfulayw, R., Almansour, A., Aljamri, K., Ghawas, H., Alhussain, S., Althumairi, A., Almuthaffar, A., Alhuwayji, A., Almajed, A., Al-Yateem, S., Alamri, A., Alhussaini, N., Almutairi, M., Alali, A., & Alkhateeb, F. (2022). Factors Contributing to Noncompliance With Diabetic Medications and Lifestyle Modifications in Patients With Type 2 Diabetes Mellitus in the Eastern Province of Saudi Arabia: A Cross-Sectional Study. Cureus, 14(11), 1–16. https://doi.org/10.7759/cureus.31965Al-Haj Mohd, M. M. M., Phung, H., Sun, J., & Morisky, D. E. (2015). The predictors to medication adherence among adults with diabetes in the United Arab Emirates. Journal of Diabetes & Metabolic Disorders, 15(10), 1–17. https://doi.org/10.1186/s40200-016-0254-6Almaghaslah, D., Khled, A., Khaled, S., Mohammed, L., Mostafa, B., Mohammed, W., & Ali Alqhatani, B. (2018). Factors contributing to non-adherence to insulin therapy among type 1 and type2 diabetes mellitus patients in Asser region, Saudi Arabia. Biomedical Research, 29(10), 1–6. https://doi.org/10.4066/biomedicalresearch.29-18-503Alosaimi, K., Alwafi, H., Alhindi, Y., Falemban, A., Alshanberi, A., Ayoub, N., & Alsanosi, S. (2022). Medication Adherence among Patients with Chronic Diseases in Saudi Arabia. International Journal of Environmental Research and Public Health, 19(16), 1–9. https://doi.org/10.3390/ijerph191610053Alqarni, A., Alrahbeni, T., Al Qarni, A., & Al Qarni, H. (2018). Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia – a cross-sectional survey. Dovepress, 13(1), 63–71. https://doi.org/10.2147/PPA.S176355Aminde, L., Tindong, M., Ngwasiri, A., Aminde, A., Njim, T., Fondong, A., & Takah, N. (2019). Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocrine Disorders, 19(1), 1–10. https://doi.org/10.1186/s12902-019-0360-9Araya, E., Gebrezgabiher, H., Tekulu, G., Alema, N., Getnet, D., Gebru, H., & Adamu, B. (2020). Medication Non-Adherence and Associated Factors Among Diabetic Patients Visiting General Hospitals in the Eastern Zone of Tigrai, Northern Ethiopia. Patient Preference and Adherence, 14(2), 2071–2083. https://doi.org/10.2147/PPA.S278148Asheq, A., Ashames, A., Al-Tabakha, M., Hassan, N., & Jairoun, A. (2021). Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates. F1000Research, 10(4), 1–19. https://doi.org/10.12688/f1000research.51729.1Asociación Latinoamericana de Diabetes. (2019). Guías ALAD sobre el Diagnóstico, Control y Tratamiento de la Diabetes Mellitus Tipo 2 con Medicina Basada en Evidencia Edición 2019. Alad, 1–125. https://www.revistaalad.com/guias/5600AX191_guias_alad_2019.pdfBalkhi, B., Alwhaibi, M., Alqahtani, N., Alhawassi, T., Alshammari, M., Mahmoud, M., Almetwazi, M., Ata, S., & Kamal, M. (2019). Oral antidiabetic medication adherence and glycaemic control among patients with type 2 diabetes mellitus: A cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open, 9(7), 1–12. https://doi.org/10.1136/bmjopen-2019-029280Barbosa, M., & Quintero, J. (2018). Estilo de vida y adherencia al tratamiento de pacientes con diabetes mellitus tipo 2 Lifestyle and adherence to treatment of patients with type 2 diabetes mellitus. Revista Facultad de Salud, 10(1), 1–7. https://journalusco.edu.co/index.php/rfs/article/view/3187Basu, S., Khobragade, M., Kumar, A., & Raut, D. K. (2015). Medical adherence and its predictors in Diabetes Mellitus patients attending government hospitals in the Indian Capital, Delhi, 2013: a cross sectional study. International Journal of Diabetes in Developing Countries, 35(2), 95–101. https://doi.org/10.1007/s13410-014-0232-9Boshe, B., Yimar, G., Dadhi, A., & Bededa, W. (2021). The magnitude of non-adherence and contributing factors among adult outpatient with Diabetes Mellitus in Dilla University Referral Hospital, Gedio, Ethiopia. PLOS ONE, 16(3), 1–12. https://doi.org/10.1371/journal.pone.0247952Castillo, M., Libertad, I., Alonso, M., Almenares, K., & Rodríguez, I. (2017). Adherencia terapéutica y factores influyentes en pacientes con diabetes mellitus tipo 2. Revista Cubana de Medicina General Integral, 33(4), 1–10. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252017000400006Chefik, F., Tadesse, T., Quisido, B., & Roba, A. (2022). Adherence to insulin therapy and associated factors among type 1 and type 2 diabetic patients on follow up in Madda Walabu University Goba Referral Hospital, South East Ethiopia. PLoS ONE, 17(6), 1–13. https://doi.org/10.1371/journal.pone.0269919Demoz, G., Berha, A., Alebachew, W., Yifter, H., Shibeshi, W., & Engidawork, E. (2019). Drug therapy problems, medication adherence and treatment satisfaction among diabetic patients on follow-up care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. PLOS ONE, 14(10), 1–17. https://doi.org/10.1371/journal.pone.0222985Demoz, G., Wahdey, S., Bahrey, D., Kahsay, H., Woldu, G., Niriayo, Y., & Collier, A. (2020). Predictors of poor adherence to antidiabetic therapy in patients with type 2 diabetes: a cross-sectional study insight from Ethiopia. Diabetology & Metabolic Syndrome, 12(1), 1–8. https://doi.org/10.1186/s13098-020-00567-7Domínguez Gallardo, L. A., & Ortega Filártiga, E. (2019). Factors associated with lack of adherence to treatment in patients with type 2 diabetes mellitus. Revista Virtual de La Sociedad Paraguaya de Medicina Interna, 6(1), 63–74. https://doi.org/10.18004/rvspmi/2312-3893/2019.06(01)63-074Escamilla N., & Cáceres, P. (2017). Adherence to drug treatment in older adults with type 2 diabetes and its associated factors. Gerokomos, 28(2), 73–77. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2017000200073&lng=es&tlng=es.Faisal, K., & Tusiimire, J. (2021). Factors Associated With Non-Adherence To Antidiabetic Medication Among Patients at Mbarara Regional Referral Hospital, Mbarara, Uganda. ResearchSquare, 11(1), 1–22. https://doi.org/10.21203/rs.3.rs-571953/v1Fayyaz, F., Aghamahdi, F., Noorian, S., Tabatabaei-Malazy, O., & Qorbani, M. (2022). Associated factors to insulin adherence in type 1 diabetes in Tehran and Karaj, Iran. Journal of Diabetes and Metabolic Disorders, 21(2), 1591–1597. https://doi.org/10.1007/s40200-022-01105-0Ge, L., Heng, B., & Yap, C. (2023). Understanding reasons and determinants of medication non-adherence in community-dwelling adults: a cross-sectional study comparing young and older age groups. BMC Health Services Research, 23(1), 1–11. https://doi.org/10.1186/s12913-023-09904-8Hacene, M., Zatla, Y., Saker, M., Abbou, Z., Youcef, A., Boulenouar, H., Fekir, H., Khaldi, K., Brikci, N., Lounici, A., & Meguenni, K. (2022). Factors associated with non-adherence to insulin in Type 1 and Type 2 diabetes mellitus patients in Western region of Algeria, Tlemcen: a cross-sectional study. Pan African Medical Journal, 41(1), 1–14. https://doi.org/10.11604/pamj.2022.41.172.32972Jankowska, B., Świątoniowska, N., Karniej, P., Polański, J., Tański, W., & Grochans, E. (2021). Influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension. Diabetes Research and Clinical Practice, 173(1), 1–10. https://doi.org/10.1016/j.diabres.2021.108693Jannoo, Z., & Mamode, K. (2019). Medication Adherence and Diabetes Self-Care Activities among Patients with Type 2 Diabetes Mellitus. Value in Health Regional Issues, 18(1), 30–35. https://doi.org/10.1016/j.vhri.2018.06.003Jensen, M., Jorgensen, M., Hansen, E., Aagaard, L., & Carstensen, B. (2017). Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation. PLOS ONE, 12(6), 1–10. https://doi.org/10.1371/journal.pone.0179546Jeyalakshmi, K., Mahadev, R., Shashidhara, Y., Thunga, G., Ravishankar, N., Sudhakar, C., & Sanatombi, E. (2023). Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India. Dovepress, 17(1), 1641–1656. https://doi.org/10.2147/PPA.S380784Kalyango, J. N., Owino, E., & Nambuya, A. P. (2008). Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. African Health Sciences, 8(2), 67–73. https://pubmed.ncbi.nlm.nih.gov/19357753/Kassahun, T., Gesesew, H., Mwanri, L., & Eshetie, T. (2016). Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey. BMC Endocrine Disorders, 16(28), 1–11. https://doi.org/10.1186/s12902-016-0114-xMachado, E., Gomes, J., Winter, F., & Peres, R. (2020). Medication non-adherence in patients with type 2 diabetes mellitus with full access to medicines. Journal of Diabetes & Metabolic Disorders, 19(1), 1105–1113. https://doi.org/10.1007/s40200-020-00612-2Manterola, C., Astudillo, P., Arias, E., & Claros, N. (2013). Revisiones sistemáticas de la literatura. Qué se debe saber acerca de ellas. Cirugía Española, 91(3), 149–155. https://doi.org/10.1016/j.ciresp.2011.07.009Mariye, T., Girmay, A., Birhanu, T., Tasew, H., Teklay, G., Baraki, Z., Gerensea, H., Teklu, T., & Bezabeh, G. (2019). Adherence to insulin therapy and associated factors among patients with diabetes mellitus in public hospitals of Central Zone of Tigray, Ethiopia, 2018: a cross-sectional study. Pan African Medical Journal, 33(309), 1–10. https://doi.org/10.11604/pamj.2019.33.309.17547MINSALUD (1993). resolución 8430. Tomado de. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDFMorisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. The Journal of Clinical Hypertension, 10(5), 348–354. https://doi.org/10.1111/j.1751-7176.2008.07572.xMurwanashyaka, J., Ndagijimana, A., Biracyaza, E., Sunday, F., & Umugwaneza, M. (2022). Non-adherence to medication and associated factors among type 2 diabetes patients at Clinique Medicale Fraternite, Rwanda: a cross-sectional study. BMC Endocrine Disorders, 22(1), 1–14. https://doi.org/10.1186/s12902-022-01133-0Naranjo, Y. (2016). La diabetes mellitus: un reto para la Salud Pública Diabetes Mellitus: A Public Health Challenge. SciELO, 6(1), 1–5. https://revfinlay.sld.cu/index.php/finlay/article/view/399/1453National Library of Medicine. (2023). Medical Subject Headings: MeSH. Internet. https://www.ncbi.nlm.nih.gov/mesh/Organización Mundial de la Salud. (2023). Diabetes. https://www.who.int/es/news-room/fact-sheets/detail/diabetesOrganización Panamericana de la Salud. (2021). Diabetes. https://www.paho.org/es/temas/diabetes.Ortega, J., Sánchez, D., & Rodríguez, O. (2018). Adherencia terapéutica: un problema de atención médica. Acta Médica Grupo Ángeles, 16(3), 1–7. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-72032018000300226&lng=es&tlng=es.Pinilla, E., & Barrera, M. (2018). Prevention of diabetes mellitus and cardiovascular risk: Medical and nutritional approach. Revista Facultad de Medicina, 66(3), 459-468. https://doi.org/10.15446/revfacmed.v66n3.60060Quiñones, A., Ugarte, C., Chávez C., & Mañalich, J. (2018). Psychological variables associated with adherence to treatment and complications in patients with type 2 diabetes mellitus. Rev Med Chile, 146, 1151–1158. https://www.scielo.cl/pdf/rmc/v146n10/0034-9887-rmc-146-10-01151.pdfRaharinavalona, S., Raherison, E., Razanamparany, T., Ralamboson, A., Rakotomalala, A., Vololontiana, M., & Lazasoa, L. (2021). Factors of Non-adherence to Antidiabetic Drugs in Type 2 Diabetics, Antananarivo Madagascar. International Journal of Diabetes and Endocrinology, 6(4), 125–130. https://doi.org/10.11648/j.ijde.20210604.11Rojas, E., Molina, R., & Rodríguez, C. (2012). Definición, clasificación y diagnóstico de la diabetes mellitus. Revista Venezolana de Endocrinología y Metabolismo, 10(1) (pp. 7–12). http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S1690-31102012000400003&lng=es&tlng=es.Ramírez García, M. C., Anlehu Tello, A., & Rodríguez León, A. (2020). Factors influencing adherence behavior of patients with Type 2 Diabetes Mellitus. Scielo, 18(3). https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2007-74592019000300383Sah, B. K., Basyal, D., & Gaire, A. (2021). Clinical Pharmacology & Biopharmaceutics Medication Non-Adherence among Type-II Diabetes Mellitus Out-Patients Attending at Tertiary Care Hospital, Nepal. ResearchGate, 10(10), 1–7. https://doi.org/10.4172/2167-065X.1000236Salama, H. M., Saudi, R. A. (2020). Effect of patients beliefs about medications on adherence to drugs in diabetic patients attending family medicine outpatient clinic in Ismailia, Egypt. Journal of Diabetes & Metabolic Disorders, 19(1), 951–958. https://doi.org/10.1007/s40200-020-00587-0Saleh, A. (2022). People with diabetes adherence to drug, dietary, and lifestyle changes in Erbil city, Iraq. BMC Endocrine Disorders, 22(3), 1–8. https://doi.org/10.1186/s12902-022-01230-0Sánchez Cruz, J. F., Hipólito-Lóenzo, A., Mugártegui-Sánchez, S. G., & Yáñez-González, R. M. (2016). Estrés y depresión asociados a la no adherencia al tratamiento en pacientes con Diabetes Mellitus tipo 2. Aten Fam, 23(2), 43–47. https://www.sciencedirect.com/science/article/pii/S1405887116301122Shamsi, A., Khodaifar, F., Arzaghi, S. M., Sarvghadi, F., & Ghazi, A. (2014). Is there any relationship between medication compliance and affective temperaments in patients with type 2 diabetes? Journal of Diabetes and Metabolic Disorders, 13(1), 1–6. https://doi.org/10.1186/s40200-014-0096-zShams, N., Amjad, S., Kumar, N., Ahmed, W., & Saleem, F. (2016). Drug Non-Adherence In Type 2 Diabetes Mellitus; Predictors And Associations. Journal of Ayub Medical College, Abbottabad: 28(2), 302–307. https://pubmed.ncbi.nlm.nih.gov/28718543/Silva, G., Germán, E., Silva, E., Galeano, J., Orlando C, Enrique, G., & Sarmiento, S. (2005). Adherencia al tratamiento Implicaciones de la no-adherencia Compliance with the treatment Implications of non-compliance. Hot Topic. Acta Médica Colombina, 30(4), 268–273. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-24482005000400004Singer, A. G., LaBine, L., Katz, A., Yogendran, M., & Lix, L. (2022). Primary medication nonadherence in a large primary care population: Observational study from Manitoba. Canadian family physician Medecin de famille canadien, 68(7), 520–527. https://doi.org/10.46747/cfp.6807520Thapar, R., Holla, R., Kumar, N., Aithal, S., Karkera, S., Rao, C., Pujari, N., Zahida, A., Unnikrishnan, B., Mithra, P., Swamy, D., Kulkarni, V., Bhagawan, D., & Kumar, A. (2020). Factors influencing adherence to anti-diabetes medications among type 2 diabetes patients attending tertiary care hospitals in Mangaluru. Clinical Epidemiology and Global Health, 8(4), 1089–1093. https://doi.org/10.1016/j.cegh.2020.03.025Waari, G., Mutai, J., & Gikunju, J. (2018). Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. Pan African Medical Journal, 29(8), 1–15. https://doi.org/10.11604/pamj.2018.29.82.12639Wabe, N., Angamo, M., & Hussein, S. (2011). Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. North American Journal of Medical Sciences, 3(9), 418–423. https://doi.org/10.4297/najms.2011.3418Xu, N., Xie, S., Chen, Y., Li, J., & Sun, L. (2020). Factors influencing medication non-adherence among chinese older adults with diabetes mellitus. International Journal of Environmental Research and Public Health, 17(17), 1–10. https://doi.org/10.3390/ijerph17176012Zheng, Y., Ley, H., & Hu, B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88–98. https://doi.org/10.1038/nrendo.2017.151Incumplimiento de la MedicaciónTratamientoFactores de riesgoDiabetes mellitus tipo 2Medication noncomplianceTreatment.Risk factorsType 2 diabetes mellitusPublicationCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8805https://repository.ucc.edu.co/bitstreams/34627d19-94cf-46ed-bab7-8317e98fe409/download4460e5956bc1d1639be9ae6146a50347MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-84334https://repository.ucc.edu.co/bitstreams/43c10cf5-46d1-4a4e-8cfe-30a5df61cb49/download3bce4f7ab09dfc588f126e1e36e98a45MD52ORIGINAL2024_Tesis.pdf2024_Tesis.pdfapplication/pdf469674https://repository.ucc.edu.co/bitstreams/7b6ce5f7-9619-43d8-94b5-1625d459ea47/downloadaf2a3441e5a5240f005fc7609e7baa5eMD562024_Licencia.pdf2024_Licencia.pdfapplication/pdf874857https://repository.ucc.edu.co/bitstreams/ef66e935-2730-4859-9a96-2eb05dcf32f1/downloadb0c3b61e69768e9d4d2e6d07b8b95985MD542024_Acta.pdf2024_Acta.pdfapplication/pdf140120https://repository.ucc.edu.co/bitstreams/348a9566-65a3-41a0-814a-8213c1f36f1b/download80d816924c4699908a81ee639ea8efc1MD55TEXT2024_Tesis.pdf.txt2024_Tesis.pdf.txtExtracted texttext/plain91059https://repository.ucc.edu.co/bitstreams/29ae3248-a75c-498b-8b4b-f8bda7b10a51/download85ae0b70fbebee6f8ee4373dbbfaf66bMD572024_Licencia.pdf.txt2024_Licencia.pdf.txtExtracted texttext/plain5985https://repository.ucc.edu.co/bitstreams/d3227914-c9c5-4328-9dcd-f5122ffb99fd/download8587313c1f6359c497bfe756af7539a8MD592024_Acta.pdf.txt2024_Acta.pdf.txtExtracted texttext/plain1171https://repository.ucc.edu.co/bitstreams/0c533703-e6d6-41b2-841e-e4364a6852c8/downloadd570e8a0df695a4c158f357f1411f710MD511THUMBNAIL2024_Tesis.pdf.jpg2024_Tesis.pdf.jpgGenerated Thumbnailimage/jpeg8814https://repository.ucc.edu.co/bitstreams/b1ceeb2b-b4dc-4145-a56b-145da6264ee0/download181ddcdae55ff6271b1e1d00dbd0c8eaMD582024_Licencia.pdf.jpg2024_Licencia.pdf.jpgGenerated Thumbnailimage/jpeg11732https://repository.ucc.edu.co/bitstreams/62470726-806a-405a-bb85-11128f4fae79/download250841a17a3629954cf4420a7fe4dd8cMD5102024_Acta.pdf.jpg2024_Acta.pdf.jpgGenerated Thumbnailimage/jpeg11867https://repository.ucc.edu.co/bitstreams/b40b367c-59cc-4398-8308-3613457787b9/downloadde7e35db458999d10398d4965d83fe07MD51220.500.12494/56431oai:repository.ucc.edu.co:20.500.12494/564312024-07-20 03:00:59.349http://creativecommons.org/licenses/by-nc-nd/4.0/Attribution-NonCommercial-NoDerivatives 4.0 Internationalrestrictedhttps://repository.ucc.edu.coRepositorio Institucional Universidad Cooperativa de Colombiabdigital@metabiblioteca.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