Association between medication adherence and glycemic control in patients with type 2 diabetes mellitus: A pilot cross-sectional study

Indira Kaibagarova, Aigul Sartayeva, Ainur Zinalieva, Akbota Zhumashova

2026

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DOI 10.54500/2790-1203-2026-1-126-amj001
Data confidence 70 medium
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Abstract

Background. In routine outpatient care, glycemic control in patients with type 2 diabetes mellitus (T2DM) is influenced by both clinical and behavioral factors. Medication adherence is considered a potentially modifiable determinant of treatment effectiveness; however, its independent association with glycemic outcomes in real-world settings may be difficult to distinguish from the effects of disease duration and patient characteristics. Objective. To examine the association between medication adherence, assessed using the Morisky–Green questionnaire, and HbA1c levels in patients with T2DM. Methods. This analytical cross-sectional pilot study included adult patients with T2DM receiving outpatient care. Medication adherence was assessed using the 8-item Morisky–Green questionnaire and categorized as low, medium, or high. HbA1c levels and clinical variables were obtained from medical records. Differences in HbA1c across adherence categories were evaluated using non-parametric methods. Multivariable linear regression analysis was performed to assess factors associated with HbA1c levels, with additional sensitivity analysis comparing low versus medium/high adherence. Results. HbA1c levels differed significantly across medication adherence categories (Kruskal–Wallis test, p = 0.041). In multivariable analysis, longer diabetes duration was independently associated with higher HbA1c levels (β = 0.24 per year, p = 0.008). Medium/high medication adherence was associated with lower HbA1c values (β = −0.53%), although this association did not reach statistical significance after adjustment. Female sex showed a non-significant trend toward lower HbA1c levels. Conclusions. In patients with T2DM receiving routine outpatient care, diabetes duration represents a key independent determinant of glycemic control. Higher medication adherence is associated with clinically relevant reductions in HbA1c; however, its independent effect may be attenuated in small real-world samples. Keywords: type 2 diabetes mellitus, medication adherence, Morisky–Green questionnaire, HbA1c, real-world data.