Comprehensive Treatment Adherence Scale for Diabetes Mellitus: The Need of the Hour

The prevalence of type 2 diabetes mellitus (T2DM) has significantly increased over the past few decades, and among recognized cases, the prevalence of uncontrolled diabetes is approximately 65.4%.[1] Over time, this uncontrolled diabetes causes harm to several body organs. Nonadherence causes avoidable illness and mortality and wastes a significant amount of health resources (e.g., unneeded hospital stays and unused medications). According to World Health Organization (WHO), T2DM treatment includes medication, diet, physical activity, regular blood sugar checkup, regular doctor's visit, and foot care.[2] Diabetes cannot be treated solely with medication, diet, exercise, or other methods; rather, all these factors must be combined. There are various ways to measure adherence to treatments, such as pill counting, pill box method, electronic methods, and questionnaire-based scales.[2] Scales are the most used method; the majority of scales focus on medication adherence and leave out other treatment domains. The most used scale for measuring adherence in diabetic patients was Morisky Medication Adherence Scale 8, which only focuses on medication adherence.[3] Some of the available scales are the Measurement of Adherence to Treatment (MAT),[4] Diabetes Mellitus Treatment Adherence Scale (DMTAS),[5] Diabetes Self-Management Questionnaire—Revised (DSMQ-R),[6] and Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS).[7] Of these, DMAS, DMTAS, and DMSQ-R have included the majority of the domains of diabetes treatment but have failed to incorporate the foot care component. Few other scales have gone beyond by covering various aspects that are not included in treatment domains but are vital in health care, such as healthcare accessibility, cooperation with the diabetes team, knowledge of patients regarding complications, and motivation toward treatment. The details of the domains included in these scales are presented in Table 1.Table 1: Different domains included in some of the available scalesThe adherence measuring scale should ideally have a good inter-item correlation coefficient and internal consistency. Cronbach's alpha shows the internal consistency of the scale and increases proportionally with the increase in inter-item correlation at a fixed number of questions. These were the scales we came across that were openly accessible across various public domains. Though the scoring of the scales has been criticized, these are essential and time-saving compared with wider qualitative assessments. Some limitations are recall bias, time-consuming, lengthy to be used in the outpatient department, operational difficulties in the clinic setting or in hospitals, and subjective answers. In conclusion, while there are several scales available to measure adherence to treatment for diabetes mellitus, still there is a need for a comprehensive scale that incorporates all the domains of diabetes treatment. Such a scale would not only serve as a valuable tool for healthcare professionals but also as an educational tool for patients and caregivers. It is important for all stakeholders to work together to promote adherence to treatment as a positive behavior rather than a burden. Further research and development of such a scale should be encouraged to improve the health outcomes of diabetic patients. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.