A National Survey of Adherence to Glucose-Lowering Medication Among Adults With Diabetes in Indonesia

BACKGROUND: Non-adherence to medication is a major challenge for patients with diabetes. Despite the growing burden of diabetes in Indonesia, nation-wide research on medication adherence remains limited.

OBJECTIVE: To identify factors associated with adherence to glucose-lowering medication among adults with diabetes in Indonesia.

METHODS: This cross-sectional study used data from the 2023 Indonesian National Health Survey (SKI), a nationwide survey using a stratified, multi-stage sampling method with probability-proportional-to-size household selection collecting data by personal interview at home. Respondents with diabetes using glucose-lowering medication were included. Multiple logistic regression for complex sample analysis was used to model the adherence to glucose-lowering medication, ensuring population-level representativeness and exploring the factors associated with adherence.

RESULTS: Of 13,960 respondents, 12.3% were non-adherent. Regular follow-ups at health facilities showed the strongest association with adherence (OR = 11.56, 95% CI: 8.74-15.27, p < 0.001). Other significant factors included receiving medication from medical personnel (OR = 4.13, 95% CI: 3.25-5.26, p < 0.001), insulin use (OR = 2.74, 95% CI: 1.76-4.27, p < 0.001), self-purchasing medication (OR = 1.5, 95% CI: 1.17-1.91, p = 0.001), receiving diabetes management education (OR = 1.46, 95% CI: 1.20-1.79, p < 0.001), maintaining a healthy diet (OR = 1.57, 95% CI: 1.26-1.95, p < 0.001), and regular exercise (OR = 1.34, 95% CI: 1.10-1.65, p < 0.001). In contrast, herbal medicine use was negatively associated with adherence (OR = 0.54, 95% CI: 0.44-0.65, p = 0.005).

CONCLUSIONS: Medication adherence is associated with a combination of treatment and healthcare system/healthcare provider-related factors. Improved patients' engagement and better access to glucose-lowering medications could increase medication adherence.