Barriers against the use of an optimal dose of metformin among patients with T2DM in Thi-Qar province, Iraq

Abstract

Diabetes mellitus is a disease with a high burden and prevalence and serious complications. Glycemic control is vital in delaying or preventing complications. Although many people do not take optimal doses, metformin is a cornerstone in managing type 2 diabetes mellitus (T2DM) in all guidelines. This study determined the barriers interfering with optimal metformin dosage. A cross-sectional study was conducted in Thi-Qar Specialized, Diabetes, Endocrine and Metabolism Center (TDEMC) at Thi-Qar, southern Iraq, from January 2019 to January 2020. 475 patients (274 females and 201 males) were included, and examination and lab investigations were performed. Only 22 (4.6%) patients took the optimal dose with no differences between gender. Of those who took metformin, 255 (74%) took it as a regular pill, 79 (23%) as a combined form with sulfonylureas (SUs), while only 10 (0.3%) took combined pills with Dipeptidyl Peptidase-4 inhibitors (DPP4i). 188 patients (65%) took metformin with meals, 84 (29%) before meals, and 19 (6%) after meals. Ignorance caused poor adherence to optimal dose in 165 patients (38.6%), neglect in 75 (17.6%), the cost in 5 (1.2%), 11 patients (2.6%) thought they did not need metformin, 37(8.7%) and 12 (2.8%) blame side effects and shortage of supply from public health care clinics (PHCC) as a cause, respectively. The rest of the patients had more than one cause. The most common side effects were abdominal pain and bloating, 5.9% and 3.8%, respectively. Other side effects were diarrhea in 0.2%, and 7.8% of patients developed more than one side effect. Ignorance and neglect were major obstacles, so educating doctors and patients and supplying the patient with optimal doses through PHCC may overcome the problem.