Factors Affecting Medication Adherence among Older Adults with Type 2 Diabetes Mellitus in Zhejiang, China
Keywords:
Medication adherence, Diabetes mellitus Type 2, Older adults, Health literacy, Self-efficacyAbstract
Background: Medication adherence is essential for achieving optimal glycemic control and preventing complications among older adults with type 2 diabetes mellitus (T2DM). Objective: This study aimed to identify predictors of medication adherence among older adults with T2DM in Zhejiang Province, China. Methods: A predictive correlational study was conducted among 102 older adults with T2DM selected through simple random sampling from Zhuji Hospital of Traditional Chinese Medicine. Data were collected from May to December 2025 using validated Chinese-language questionnaires. Self-efficacy, perceived social support, and health literacy were assessed using the Chinese versions of the Diabetes Management Self-Efficacy Scale (DMSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and the 12-item Health Literacy Short-Form Survey (HLS-SF12), respectively. Disease duration and glycated hemoglobin (HbA1c) were obtained from participants’ diabetes health records. Data were analyzed using descriptive statistics, Pearson’s correlation coefficients, and multiple linear regression analysis. Results: The mean medication adherence score indicated a moderate level of adherence (M = 6.07, SD = 1.63). The final regression model explained 86.6% of the variance in medication adherence (R² = .866, p < .001). Health literacy (β = .383, p < .001) was the strongest predictor, followed by self-efficacy (β = .361, p < .01), whereas HbA1c was negatively associated with medication adherence (β = −.179, p < .05). Conclusion: These findings highlight the importance of health literacy and self-efficacy in promoting medication adherence among older adults with T2DM. Nursing interventions that strengthen health literacy, enhance self-efficacy, and support glycemic control may help promote medication adherence in this population.
References
1. Sapra A, Bhandari P. Diabetes. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 [updated 2023 Jun 21; cited 2026 May 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/
2. Laakso M. Biomarkers for type 2 diabetes. Mol Metab. 2019;27S(Suppl):S139-S146. DOI:10.1016/j.molmet.2019.06.016
3. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203-234. DOI:10.1016/S0140-6736(23)01301-6
4. National Bureau of Statistics of China. Statistical communiqué of the People's Republic of China on the 2025 national economic and social development [Internet]. Beijing: National Bureau of Statistics of China; 2026 [cited 2026 May 22]. Available from: https://www.stats.gov.cn/english/PressRelease/202602/t20260228_1962661.html
5. Wang X, Liu Z, Li J, Zhang J, Tian S, Lu S, Qi M, Ma J, Qiu B, Dong W, Xu Y. Impacts of Type 2 Diabetes on Disease Severity, Therapeutic Effect, and Mortality of Patients With COVID-19. J Clin Endocrinol Metab. 2020;105(12):e4219-e4229. DOI:10.1210/clinem/dgaa410
6. Flood D, Zhang YS, Nichols E, Li C, Zaninotto P, Langa KM, et al. Diabetes and all-cause mortality among middle-aged and older adults in China, England, Mexico, rural South Africa, and the USA: a population-based study of longitudinal aging cohorts. BMJ Open Diabetes Res Care. 2025;13(2):e004678. DOI:10.1136/bmjdrc-2024-004678
7. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021. Available from: https://diabetesatlas.org/.
8. Thapa B, Schmittdiel JA, Arterburn D, et al. Clinical and demographic characteristics associated with diabetes remission in six integrated health care systems: a retrospective cohort study. Diabetes Care. 2025;48(10):1737-1743.
9. Leung E, Wongrakpanich S, Munshi MN. Diabetes Management in the Elderly. Diabetes Spectr. 2018;31(3):245-253. DOI:10.2337/ds18-0033
10. Weinger K, Beverly EA, Smaldone A. Diabetes self-care and the older adult. West J Nurs Res. 2014;36(9):1272-1298. DOI:10.1177/0193945914521696
11. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.Available from: https://iris.who.int/handle/10665/42682.
12. Chantzaras A, Yfantopoulos J. Association between medication adherence and health- related quality of life of patients with diabetes. Hormones (Athens). 2022;21(4):691-705. DOI:10.1007/s42000-022-00400-y
13. Presley B, Groot W, Pavlova M. Pharmacy-led interventions to improve medication adherence among adults with diabetes: a systematic review and meta-analysis. Res Social Adm Pharm. 2019;15(9):1057-1067. DOI:10.1016/j.sapharm.2018.09.021
14. Wang C, Kong LP, Li XY, Yin FX. Investigation on medication adherence and analysis of influencing factors in elderly patients with type 2 diabetes. Health Res. 2023;43(4):400-405. DOI:10.19890/j.cnki.issn1674-6449.2023.04.008 (In Chinese)
15. Sahoo J, Mohanty S, Kundu A, Epari V. Medication adherence among patients of type II diabetes mellitus and its associated risk factors: a cross-sectional study in a tertiary care hospital of eastern India. Cureus. 2022;14(12):e33074. DOI:10.7759/cureus.33074
16. Upamali S, Rathnayake S. Perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence: A qualitative study. PLoS One. 2023;18(8):e0289834. DOI:10.1371/journal.pone.0289834
17. Huang J, Ding S, Xiong S, Liu Z. Medication adherence and associated factors in patients with type 2 diabetes: a structural equation model. Front Public Health. 2021;9:730845. DOI:10.3389/fpubh.2021.730845
18. Ueno H, Ishikawa H, Suzuki R, Izumida Y, Ohashi Y, Yamauchi T, et al. The association between health literacy levels and patient-reported outcomes in Japanese type 2 diabetic patients. SAGE Open Med. 2019;7:2050312119865647. DOI:10.1177/2050312119865647
19. Fang R, Schechter C, Walker EA, Gonzalez JS. Diabetes self-efficacy: longitudinal relationships with diabetes overall self-management, medication adherence, diabetes distress, and glycemic control in adults with type 2 diabetes. Diabetes. 2025;74(Suppl 1):601-P. DOI:10.2337/db25-601-P
20. Li H, Min H, Zhang L, Li Y, Wang J, Jia X. The relationships between social support, medication adherence, and glycemic control among inpatients with type 2 diabetes: a cross-sectional survey in Xi’an, China. Front Pharmacol. 2025;16:1634768. DOI:10.3389/fphar.2025.1634768
21. Gelaw BK, Mohammed A, Tegegne GT, Defersha AD, Fromsa M, Tadesse E, et al. Nonadherence and contributing factors among ambulatory patients with antidiabetic medications in Adama Referral Hospital. J Diabetes Res. 2014;2014:617041. DOI:10.1155/2014/617041
22. Sharma D, Goel NK, Cheema YS, Garg K. Medication adherence and its predictors among type 2 diabetes mellitus patients: a cross-sectional study. Indian J Community Med. 2023;48(5):781-785. DOI:10.4103/ijcm.ijcm_744_22
23. Abdullah NF, Khuan L, Theng CA, Sowtali SN. Prevalence and reasons influenced medication non-adherence among diabetes patients: a mixed-method study. J Diabetes Metab Disord. 2022;21(2):1669-1678. DOI:10.1007/s40200-022-01118-9
24. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-159. DOI:10.5001/omj.2011.38
25. Fisher L, Polonsky WH, Hessler D. Addressing diabetes distress in clinical care: a practical guide. Diabet Med. 2019;36(7):803-812. DOI:10.1111/dme.13967
26. Wang M, Gong WW, Pan J, Fei FR, Wang H, Yu M, Zhou XY, Hu RY. Incidence and Time Trends of Type 2 Diabetes Mellitus among Adults in Zhejiang Province, China, 2007-2017. J Diabetes Res. 2020;2020:2597953. DOI:10.1155/2020/2597953
27. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41(4):1149-1160. DOI:10.3758/BRM.41.4.1149
28. Wang J, Bian RW, Mo YZ. Validation of the Chinese version of the eight-item Morisky medication adherence scale in patients with type 2 diabetes mellitus. J Clin Gerontol Geriatr. 2013;4(4):119-122. DOI:10.1016/j.jcgg.2013.06.002
29. Yang XJ, Han XY. Reliability and validity of the Chinese version of the multidimensional scale of perceived social support in primary and secondary school students [in Chinese]. Chin J Clin Psychol. 2021;29(5):952-5. DOI:10.16128/j.cnki.1005-3611.2021.05.012
30. Sun X, Lv K, Wang F, Ge P, Niu Y, Yu W, el al. Validity and reliability of the Chinese version of the Health Literacy Scale Short-Form in the Chinese population. BMC Public Health. 2023;23(1):385. DOI:10.1186/s12889-023-15237-2
31. Wu SFV, Courtney M, Edwards H, McDowell J, Shortridge-Baggett LM, Chang PJ. Development and validation of the Chinese version of the Diabetes Management Self-Efficacy Scale. Int J Nurs Stud. 2008;45(4):534-542. DOI:10.1016/j.ijnurstu.2006.08.020
32. Ma R, Zhou B, Liu T, Wang Y. Assessment of factors associated with treatment adherence among elderly patients with multimorbid type 2 diabetes mellitus using Lasso-logistic regression. Patient Prefer Adherence. 2026;20:1-16. DOI:10.2147/PPA.S506859
33. Wang X, Juntasopeepun P, Panuthai S, Suwankruhasn N. Factors influencing medication adherence among Chinese older adults with physical multimorbidity and polypharmacy: a cross-sectional study. Nurs Health Sci. 2025;27(3):e70192. DOI:10.1111/nhs.70192
34. Hoogendoorn CJ, Krause-Steinrauf H, Uschner D, et al. Emotional Distress Predicts Reduced Type 2 Diabetes Treatment Adherence in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care. 2024;47(4):629-637. DOI:10.2337/dc23-1401
35. Butayeva J, Ratan ZA, Downie S, Hosseinzadeh H. The impact of health literacy interventions on glycemic control and self-management outcomes among type 2 diabetes mellitus: a systematic review. J Diabetes. 2023;15(9):724-735. DOI:10.1111/1753-0407.13436
36. Terkes N, Bektas H, Aydemir M. Effectiveness of structured distance education on metabolic control, self-care, and health literacy in newly diagnosed type 2 diabetes: a randomized controlled trial. Prim Care Diabetes. 2025;19(6):577-583. DOI: 10.1016/j.pcd.2025.09.002
37. Wu J, Shen J, Tao Z, Song Z, Chen ZL. Self-efficacy as moderator and mediator between medication beliefs and adherence in elderly patients with type 2 diabetes. Patient Prefer Adherence. 2023;17:217-226. DOI:10.2147/PPA.S382362
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