«“¡™ÿ° ·≈–ªí®®—¬∑'Ë¡'º≈μàÕ §«“¡≈⡇À≈«

§«“¡™ÿ°·≈–ªí®®—¬∑’Ë¡’º≈μàÕ§«“¡≈⡇À≈«

„π°“√∫√‘À“√¬“‡∫“À«“π¢ÕߺŸâªÉ«¬‡∫“À«“π™π‘¥∑’Ë 2

π’≈π“∂ ‡®ä–¬Õ

*

*‚√ß欓∫“≈ÀπÕß®‘° ®—ßÀ«—¥ªíμμ“π’

∫∑§—¥¬àÕ °“√»÷°…“π’È¡’«—μ∂ÿª√– ß§å‡æ◊ËÕÀ“§«“¡™ÿ°·≈–ªí®®—¬∑’Ë¡’§«“¡ —¡æ—π∏å°—∫§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“π¢Õß ºŸâªÉ«¬‚√§‡∫“À«“π™π‘¥∑’Ë 2 ´÷Ëß¡“√—∫∫√‘°“√∑’˧≈‘π‘°‡∫“À«“π ‚√ß欓∫“≈ÀπÕß®‘° ®—ßÀ«—¥ªíμμ“π’ √–À«à“ß«—π∑’Ë 1  ‘ßÀ“§¡

2556 ∂÷ß«—π∑’Ë 31 ∏—𫓧¡ 2556 √«¡ 230 √“¬ ª√–‡¡‘π°“√„™â¬“‚¥¬„À⺟âªÉ«¬¥Ÿμ—«Õ¬à“߬“ æ√âÕ¡∫Õ°«‘∏’°“√„™â¬“„π

§√—Èß∑’˺à“π¡“ «‘‡§√“–Àå¢âÕ¡Ÿ≈¥â«¬‚ª√·°√¡ R 𔇠πÕ¢âÕ¡Ÿ≈‡ªìπ®”π«π √âÕ¬≈– §à“‡©≈’ˬ ·≈– à«π‡∫’ˬ߇∫π¡“μ√∞“π

«‘‡§√“–ÀåÀ“ªí®®—¬∑’Ë¡’§«“¡ —¡æ—π∏å°—∫§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“π¢ÕߺŸâªÉ«¬‚¥¬„™â multiple logistic regres- sion analysis ‚¥¬π”‡ πÕ‡ªìπ§à“ adjusted odds ratio (aOR) ·≈– 95% confidence interval (CI) ¢Õß aOR

®“°°“√»÷°…“æ∫«à“ √âÕ¬≈– 64.8 ¢ÕߺŸâªÉ«¬∑—ÈßÀ¡¥‰¡à “¡“√∂∫√‘À“√¬“‡∫“À«“π  à«πªí®®—¬∑’Ë¡’§«“¡ —¡æ—π∏å°—∫

§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ ®“°°“√«‘‡§√“–Àå¥â«¬ multiple logistic regression §◊Õ

»“ π“Õ‘ ≈“¡ (aOR 2.68, 95% CI 1.10, 6.48) °“√∫√‘À“√¬“‡Õß (aOR 8.41, 95% CI 1.13, 62.72) °“√„™â¬“‡¡Á¥√à«¡°—∫

Insulin (aOR 7.16, 95% CI 1.35, 38.13) °“√„™â¬“«—π≈– 2 §√—Èß (aOR 4.44, 95% CI 1.51, 13.06) °“√„™â¬“«—π≈– 3 §√—Èß (aOR 13.80, 95% CI 3.19, 59.78) ·≈–®”π«π‡¡Á¥¬“∑’Ë√—∫ª√–∑“π„π·μà≈–«—π (aOR 2.28, 95% CI 1.16, 4.51)

ªí≠À“§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“πæ∫¡“°„πºŸâªÉ«¬∑’Ë»÷°…“´÷ËßμâÕß√’∫¥”‡π‘π°“√·°â‰¢ °“√ª√–‡¡‘π·≈–

ª√—∫‡ª≈’ˬπ«‘∏’°“√√—°…“„Àâ∂Ÿ°μâÕß ‡À¡“– ¡ °—∫ºŸâªÉ«¬·μà≈–√“¬‡ªìπ ‘Ëß∑’Ë ”§—≠‚¥¬‡©æ“–ºŸâ∑’Ëπ—∫∂◊Õ»“ π“Õ‘ ≈“¡·≈–

∫√‘À“√¬“¥â«¬μπ‡Õß

§” ”§—≠: ºŸâªÉ«¬‡∫“À«“π™π‘¥∑’Ë 2 §«“¡ “¡“√∂∫√‘À“√¬“ §«“¡™ÿ°

Abstract Prevalence and risk factor for medication non-adherence in patients with type 2 diabetes mellitus Ninnard Cheyoe

Nong Chik Hospital, Pattani Province

This study was conducted to determine the prevalence of medication non-adherence and identify factors associated with medication non-adherence among 230 patients with type 2 diabetes mellitus in Nongjik Hospital, Pattani province from August 2013 to December 2013. Medication adherence was as- sessed by self-report patients in term of taking medications. Frequency, percentage, mean and standard deviation were used to present the analysis results. Multiple logistic regression analysis was used to de- termine factors associated with medication non-adherence. Adjusted odds ratios (aOR) and their 95%

confidence interval (CI) were used to present the strength of association.

Of the 230 study patients, 64.8% had medication non-adherence. Factors associated with medication non-adherence included religion (aOR 2.68, 95% CI 1.10, 6.48) self- management (aOR 8.41, 95% CI 1.13, 62.72) combination of oral anti-diabetic drug and Insulin (aOR 7.16, 95% CI 1.35, 38.13) frequency twice daily (aOR 4.44, 95% CI 1.51, 13.06) frequency three times daily (aOR 13.80, 95% CI 3.19, 59.78) and num- ber of tablets per day (aOR 2.28, 95% CI 1.16, 4.51)

The high prevalence of medication non-adherence among the study group needs corrective mea- sures. These may include assessment of medication adherence and modify treatment for each case espe- cially in Muslim patient with medication adherence.

Keywords: Type 2 diabetes mellitus, medication adherence, prevalence

¿Ÿ¡‘À≈—ß·≈–‡Àμÿº≈

∫“À«“π ‚√§‡√◊ÈÕ√—ß∑’ˇªìπªí≠À“ “∏“√≥ ÿ¢∑—Ë«‚≈°·≈–

∫—Ëπ∑Õπ§ÿ≥¿“æ™’«‘μ¢ÕߺŸâªÉ«¬ ªí®®ÿ∫—𧫓¡™ÿ°¢Õß‚√§π’È

¡’·π«‚π⡇æ‘Ë¡ Ÿß¢÷Èπ∑—Èß„πª√–‡∑»∑’Ëæ—≤π“·≈â« ·≈–ª√–‡∑»∑’Ë

°”≈—ßæ—≤π“ ´÷Ëß√«¡∑—Èߪ√–‡∑»‰∑¬ ‚√§‡∫“À«“π‡ªìπ‚√§∑’Ë μâÕß„™â‡«≈“„π°“√√—°…“π“πÀ√◊Õμ≈Õ¥™’«‘μ^(1,2) ‡æ◊ËÕ§«∫§ÿ¡

√–¥—∫πÈ”μ“≈„π‡≈◊Õ¥„ÀâÕ¬Ÿà„π¿“«–ª°μ‘À√◊Õ„°≈⇧’¬ßª°μ‘„Àâ

¡“°∑’Ë ÿ¥ ∑—Èßπ’ȇæ◊ËÕ≈¥§«“¡æ‘°“√·≈–ªÑÕß°—π‚√§·∑√°´âÕπ μà“ßÊ ®“°‡∫“À«“𠇙àπ ‚√§·∑√°´âÕπ∑’Ëμ“ ‰μ √–∫∫À—«„®

·≈–À≈Õ¥‡≈◊Õ¥^(3,4)

ºŸâªÉ«¬‚√§‡∫“À«“π‚¥¬‡©æ“–‚√§‡∫“À«“π™π‘¥∑’Ë 2 (T2DM)  à«π„À≠à‰¥â√—∫°“√√—°…“‚¥¬°“√„™â¬“À≈“¬√“¬°“√

·≈–μàÕ‡π◊ËÕßμ≈Õ¥™’«‘μ ‡æ◊ËÕ√—°…“‚√§·≈–ªÑÕß°—π¿“«–

·∑√°´âÕπ∑’ËÕ“®‡°‘¥¢÷Èπ ¥—ßπ—Èπ ªí≠À“∑’ˉ¡à “¡“√∂∫√‘À“√¬“

‡∫“À«“π„Àâ∂Ÿ°μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —Ëß®÷߇ªìπªí≠À“∑’Ë ”§—≠

ªí≠À“Àπ÷ËߢÕß°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬ ´÷ËßμâÕ߉¥â√—∫°“√ª√–‡¡‘π

·≈–·°â‰¢ ‡π◊ËÕß®“°ªí≠À“¥—ß°≈à“«¡—°‰¡à‰¥â√—∫§«“¡ π„® ∂Ÿ°

ª≈àÕ¬„Àâ°≈“¬‡ªìπªí≠À“‡√◊ÈÕ√—ß‚¥¬‰¡à‰¥â√—∫°“√·°â‰¢  àߺ≈

°√–∑∫μàÕª√– ‘∑∏‘¿“æ„π°“√√—°…“ ‡°‘¥°“√ ‘Èπ‡ª≈◊Õ߬“

·≈–∑’Ë ”§—≠∑”„À⺟âªÉ«¬‡ ’ˬßμàÕ°“√ªÉ«¬·≈–쓬®“°¿“«–

·∑√°´âÕπ‡æ‘Ë¡¢÷Èπ

‚√ß欓∫“≈ÀπÕß®‘° ®—ß«—¥ªíμμ“π’ ‡ªìπ‚√ß欓∫“≈

™ÿ¡™π¢π“¥ 30 ‡μ’¬ß ‚√§‡∫“À«“π‡ªìπ‚√§∑’Ëæ∫¡“°‡ªìπÕ—π¥—∫

2 ¢Õß‚√ß欓∫“≈·≈–¡’·π«‚πâ¡®–¡’ºŸâªÉ«¬‡æ‘Ë¡¡“°¢÷Èπ∑ÿ°ªï

∑’˺à“π¡“ ‡¿ —™°√®à“¬¬“æ√âÕ¡„À⧔·π–𔇰’ˬ«°—∫°“√„™â¬“

∑’˺ŸâªÉ«¬‰¥â√—∫ ‚¥¬‰¡à‰¥âª√–‡¡‘π°“√„™â¬“¢ÕߺŸâªÉ«¬„π§√—Èß∑’Ë ºà“π¡“Õ¬à“ß®√‘ß®—ß ®“°°“√≈Õߪ√–‡¡‘π°“√„™â¬“ æ∫ºŸâªÉ«¬

∫“ß√“¬‰¥â√—∫¬“ Metformin ´÷ËßμâÕß√—∫ª√–∑“π«—π≈– 3 §√—Èß

·μຟâªÉ«¬√—∫ª√–∑“π‡æ’¬ß«—π≈–§√—Èß §◊Õ¡◊ÈÕ‡¬Áπ ¡“π“π°«à“ 6

‡¥◊Õπ ‡π◊ËÕß®“°μâÕß∑”ß“π‡ªî¥√â“πμ⡬”„πª√–‡∑»¡“‡≈‡´’¬

´÷Ëß∑”ß“π‡«≈“ª√–¡“≥ 15.00 - 04.00 π. ¥—ßπ—ÈπºŸâªÉ«¬®÷߉¡à  “¡“√∂∫√‘À“√¬“„π¡◊ÈÕ‡™â“·≈–‡∑’ˬßμ“¡∑’Ë·æ∑¬å —Ë߉¥â ‡æ√“–

‡«≈“¥—ß°≈à“«‡ªìπ‡«≈“æ—°ºàÕπ ®“°‡Àμÿ°“√≥套߰≈à“«ºŸâ«‘®—¬®÷ß

 π„®∑’Ë®–»÷°…“§«“¡™ÿ° ·≈–ªí®®—¬∑’Ë¡’º≈μàÕ§«“¡≈⡇À≈«

„π°“√∫√‘À“√¬“‡∫“À«“π¢ÕߺŸâªÉ«¬‡∫“À«“π™π‘¥∑’Ë 2 „π Õ”‡¿ÕÀπÕß®‘° ®—ßÀ«—¥ªíμμ“π’ ‡æ◊ËÕ„™â‡ªìπ·π«∑“ß„π°“√·°â ªí≠À“°“√∫√‘À“√¬“‡∫“À«“π„ÀⷰຟâªÉ«¬μàÕ‰ª

«—μ∂ÿª√– ß§å

‡æ◊ËÕÀ“§«“¡™ÿ°·≈–ªí®®—¬∑’Ë¡’º≈μàÕ§«“¡≈⡇À≈«„π°“√

∫√‘À“√¬“‡∫“À«“π¢ÕߺŸâªÉ«¬‡∫“À«“π™π‘¥∑’Ë 2

«‘∏’¥”‡π‘π°“√

°“√»÷°…“§√—Èßπ’ȇªìπ°“√»÷°…“·∫∫¿“§μ—¥¢«“ß„πºŸâªÉ«¬

‡∫“À«“π™π‘¥∑’Ë 2 ∑ÿ°√“¬´÷Ëß¡“√—∫∫√‘°“√μ√«®√—°…“‚¥¬

·æ∑¬å·≈–æ∫‡¿ —™°√∑’˧≈‘π‘°‡∫“À«“π ‚√ß欓∫“≈ÀπÕß®‘°

®—ßÀ«—¥ªíμμ“π’ √–À«à“ß«—π∑’Ë 1  ‘ßÀ“§¡ 2556 ∂÷ß«—π∑’Ë 31

∏—𫓧¡ 2556 ºŸâªÉ«¬∑’Ë√—°…“‡∫“À«“π‚¥¬‰¡àμâÕß„™â¬“

μ“∫Õ¥À√◊ÕºŸâ∑’Ë∫Õ°°“√„™â¬“„π§√—Èß∑’˺à“π¡“‰¡à‰¥â¥â«¬μ—«‡Õß À√◊Õ≠“μ‘®–∂Ÿ°æ‘®“√≥“μ—¥ÕÕ°®“°°“√»÷°…“ ºŸâ«‘®—¬√«∫√«¡

¢âÕ¡Ÿ≈®“°„∫ —Ë߬“„∫·√°¢Õß°“√»÷°…“´÷Ëߪ√–°Õ∫¥â«¬¢âÕ¡Ÿ≈

æ◊Èπ∞“π §◊Õ Õ“¬ÿ ‡æ» »“ π“ ·≈–πÈ”Àπ—°¡«≈°“¬ ¢âÕ¡Ÿ≈‚√§

√à«¡´÷Ëߪ√–°Õ∫¥â«¬‚√§§«“¡¥—π‚≈À‘μ Ÿß ‚√§‰¢¡—π„π‡≈◊Õ¥ Ÿß

·≈–‚√§‰μ‡√◊ÈÕ√—ß æ‘®“√≥“°“√¡’‚√§√à«¡®“°√“¬°“√¬“∑’Ë ºŸâªÉ«¬‰¥â√—∫ À“°ºŸâªÉ«¬‰¥â√—∫¬“≈¥§«“¡¥—π‚≈À‘μ ®–∂◊Õ«à“¡’

‚√§§«“¡¥—π‚≈À‘μ Ÿß À“°‰¥â√—∫¬“≈¥‰¢¡—π„π‡≈◊Õ¥ ®–∂◊Õ«à“

¡’‚√§‰¢¡—π„π‡≈◊Õ¥ Ÿß  à«π‚√§‰μ‡√◊ÈÕ√—ߥŸ®“°°“√√–∫ÿμ—«

ºŸâªÉ«¬∫π„∫ —Ë߬“ ·≈–¢âÕ¡Ÿ≈‡°’ˬ«°—∫°“√„™â¬“‡∫“À«“π ´÷Ëß ª√–°Õ∫¥â«¬√Ÿª·∫∫¢Õ߬“‡∫“À«“π∑’Ë„™â §«“¡∂’Ë ·≈–®”π«π

‡¡Á¥¬“∑’Ë√—∫ª√–∑“π„π·μà≈–«—π  ”À√—∫¬“√—°…“‡∫“À«“π∑’Ë

»÷°…“¡’ 3 √“¬°“√§◊Õ Glipizide, Metformin ·≈– Insulin Mixed Pen

ª√–‡¡‘𧫓¡ “¡“√∂„π°“√∫√‘À“√¬“‡∫“À«“π‚¥¬

ºŸâ«‘®—¬´÷Ë߇ªìπ‡¿ —™°√ª√–®”§≈‘π‘° ª√–‡¡‘πºŸâªÉ«¬¿“¬À≈—ß°“√

æ∫·æ∑¬å ‚¥¬„À⺟âªÉ«¬¥Ÿμ—«Õ¬à“߬“ ·≈â«∫Õ°«‘∏’°“√„™â¬“

‡∫“À«“π∑’˺à“π¡“ ºŸâ«‘®—¬®–μ√«® Õ∫§«“¡∂Ÿ°μâÕߢÕß°“√

∫√‘À“√¬“®“°„∫ —Ë߬“„π§√—Èß∑’˺à“π¡“®“°‚ª√·°√¡ Hos-XP

‡

À“°ºŸâªÉ«¬∫Õ°¢π“¥¢Õ߬“ §«“¡∂’Ë ‡«≈“„π°“√„™â¬“∂Ÿ°μâÕß μ√ßμ“¡∑’Ë·æ∑¬å —Ëß ·≈–„™â¬“Õ¬à“ß ¡Ë”‡ ¡Õ ®–∂◊Õ«à“ “¡“√∂

∫√‘À“√¬“‡∫“À«“π‰¥â (Adherence)  à«πºŸâªÉ«¬∑’ˉ¡à “¡“√∂

∫Õ°‰¥â∂Ÿ°μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —Ëß À√◊Õ„™â¬“‰¡à ¡Ë”‡ ¡Õ§◊Õ

¢“¥¬“¡“°°«à“ 3 §√—Èß ®–∂◊Õ«à“‰¡à “¡“√∂∫√‘À“√¬“‡∫“À«“π

䴉 (Non-Adherence)

«‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬„™â‚ª√·°√¡ R ‚¥¬π”‡ πÕ¢âÕ¡Ÿ≈„π

√Ÿª¢Õß°“√·®°·®ß§«“¡∂’Ë √âÕ¬≈– §à“‡©≈’ˬ ·≈– à«π‡∫’ˬß

‡∫π¡“μ√∞“π  ”À√—∫°“√«‘‡§√“–ÀåÀ“§«“¡ —¡æ—π∏å√–À«à“ß ªí®®—¬μà“ßÊ °—∫§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“π „™â ∂‘μ‘

multiple logistic regression analysis ‚¥¬§—¥‡≈◊Õ°

μ—«·ª√‡¢â“ ¡°“√¥â«¬«‘∏’ stepwise ·≈–°”À𥧫“¡‡™◊ËÕ¡—Ëπ

∑“ß ∂‘μ‘∑’Ë p-value<0.05

º≈°“√»÷°…“

°≈ÿà¡μ—«Õ¬à“ß à«π„À≠à‡ªìπ‡æ»À≠‘ß π—∫∂◊Õ»“ π“Õ‘ ≈“¡

¡’πÈ”Àπ—°‡°‘π‡°≥±å¡“μ√∞“π (BMI>23 °°./¡.²) √âÕ¬≈– 94.3

¡’‚√§√à«¡ ‚¥¬‚√§√à«¡∑’Ëæ∫¡“°∑’Ë ÿ¥§◊Õ ‰¢¡—π„π‡≈◊Õ¥ Ÿß

√Õß≈ß¡“§◊Õ§«“¡¥—π‚≈À‘μ Ÿß  à«π‚√§‰μ‡√◊ÈÕ√—ßæ∫√âÕ¬≈– 20.4 ºŸâªÉ«¬ à«π„À≠à∫√‘À“√¬“¥â«¬μπ‡Õß ª√–¡“≥§√÷ËßÀπ÷ËߢÕß ºŸâªÉ«¬∑—ÈßÀ¡¥„™â Glipizide √à«¡°—∫ Metformin ‡æ◊ËÕ√—°…“

‚√§‡∫“À«“π (μ“√“ß∑’Ë 1)

ºŸâªÉ«¬√âÕ¬≈– 64.8 ‰¡à “¡“√∂∫√‘À“√¬“‡∫“À«“π„Àâ∂Ÿ°

μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —Ëß (Non-Adherence) ‚¥¬ºŸâªÉ«¬°≈ÿà¡

π’È¡’ —¥ à«π¢ÕߺŸâ∑’Ëπ—∫∂◊Õ»“ π“Õ‘ ≈“¡ ∫√‘À“√¬“¥â«¬μπ‡Õß

·≈–„™â Glipizide √à«¡°—∫ Metformin ¡“°°«à“ºŸâªÉ«¬Õ’°°≈ÿà¡

(μ“√“ß∑’Ë 2)

®“°°“√«‘‡§√“–Àå¥â«¬ multiple logistic regression

‡æ◊ËÕÀ“ªí®®—¬∑’Ë¡’§«“¡ —¡æ—π∏å°—∫§«“¡≈⡇À≈«„π°“√∫√‘À“√

¬“‡∫“À«“π¢ÕߺŸâªÉ«¬‡∫“À«“π™π‘¥∑’Ë 2 æ∫«à“»“ π“ °“√

∫√‘À“√¬“‡∫“À«“π¥â«¬μπ‡Õß °“√„™â¬“‡¡Á¥√à«¡°—∫ Insulin

§«“¡∂’Ë„π°“√„™â¬“ ·≈–®”π«π‡¡Á¥¬“∑’Ë„™â„π·μà≈–«—π ¡’§«“¡

 —¡æ—π∏å°—∫§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“πÕ¬à“ß¡’π—¬

 ”§—≠∑“ß ∂‘μ‘ (μ“√“ß∑’Ë 3)

μ“√“ß∑’Ë 1 ¢âÕ¡Ÿ≈∑—Ë«‰ª¢Õß°≈ÿà¡μ—«Õ¬à“ß

¢âÕ¡Ÿ≈∑—Ë«‰ª ®”π«π (√“¬) √âÕ¬≈–

√«¡∑—ÈßÀ¡¥ 230 100.0

Õ“¬ÿ (ªï)

§à“‡©≈’ˬ _±  à«π‡∫’ˬ߇∫π¡“μ√∞“π 59.8 _± 11.1

§à“μË” ÿ¥ - §à“ Ÿß ÿ¥ 28 - 96

‡æ»

˭ԧ 162 70.4

™“¬ 68 29.6

»“ π“

æÿ∑∏ 40 17.4

Õ‘ ≈“¡ 190 82.6

§«“¡Àπ“·πàπ¡«≈°“¬ (°°./¡.²)

< 23 65 28.3

> 23 165 71.7

§à“‡©≈’ˬ _±  à«π‡∫’ˬ߇∫π¡“μ√∞“π 25.5 _± 4.5

§à“μË” ÿ¥ - §à“ Ÿß ÿ¥ 13.6 - 43.5

‚√§§«“¡¥—π‚≈À‘μ Ÿß

‰¡à¡’ 49 21.3

¡’ 181 78.7

‚√§‰¢¡—π„π‡≈◊Õ¥ Ÿß

‰¡à¡’ 40 17.4

¡’ 190 82.6

‚√§‰μ‡√◊ÈÕ√—ß (chronic kidney disease)

‰¡à¡’ 183 79.6

¡’ 47 20.4

°“√∫√‘À“√¬“‡Õß

‰¡à„™à 9 3.9

㪈 221 96.1

√Ÿª·∫∫¬“∑’ˉ¥â√—∫

„™â¬“‡¥’ˬ« 91 39.6

Glipizide + Metformin 120 52.2

„™â¬“‡¡Á¥√à«¡°—∫¬“©’¥ 19 8.3

§«“¡∂’Ë„π°“√„™â¬“μàÕ«—π (§√—Èß)

1 33 14.3

2 133 57.8

3 64 27.8

®”π«π‡¡Á¥¬“μàÕ«—π (‡¡Á¥)

< 3.5 116 50.4

3.5-7 45 19.6

> 7 69 30.0

μ“√“ß∑’Ë 2 ®”π«π·≈–√âÕ¬≈–¢ÕߺŸâªÉ«¬·μà≈–°≈ÿà¡·¬°μ“¡μ—«·ª√Õ‘ √–μà“ßÊ

Non-Adherence Adherence

ªí®®—¬ p-value

®”π«π (√âÕ¬≈–) ®”π«π (√âÕ¬≈–)

√«¡∑—ÈßÀ¡¥ (√“¬) 149 81

Õ“¬ÿ (ªï) 0.04

mean (SD) 58.7 (10.5) 61.8 (12)

‡æ» 0.639

™“¬ 42 (28.2) 26 (32.1)

˭ԧ 107 (71.8) 55 (67.9)

»“ π“ 0.049

æÿ∑∏ 20 (13.4) 20 (24.7)

Õ‘ ≈“¡ 129 (86.6) 61 (75.3)

BMI (kg/m²) 0.178

< 23 47 (31.5) 18 (22.2)

≥ 23 102 (68.5) 63 (77.8)

°“√∫√‘À“√¬“¥â«¬μπ‡Õß 0.01

‰¡à„™à 2 (1.3) 7 (8.6)

㪈 147 (98.7) 74 (91.4)

‚√§§«“¡¥—π‚≈À‘μ Ÿß 0.799

‰¡à¡’ 33 (22.1) 16 (19.8)

¡’ 116 (77.9) 65 (80.2)

‚√§‰¢¡—π„π‡≈◊Õ¥ Ÿß 0.214

‰¡à¡’ 22 (14.8) 18 (22.2)

¡’ 127 (85.2) 63 (77.8)

‚√§‰μ‡√◊ÈÕ√—ß (CKD) 0.177

‰¡à¡’ 123 (82.6) 60 (74.1)

¡’ 26 (17.4) 21 (25.9)

√Ÿª·∫∫¬“∑’ˉ¥â√—∫ < 0.001

„™â¬“‡¥’ˬ« 35 (23.5) 56 (69.1)

Glipizide + Metformin 97 (65.1) 23 (28.4)

„™â¬“‡¡Á¥√à«¡°—∫ Insulin 17 (11.4) 2 (2.5)

§«“¡∂’Ë„π°“√„™â¬“ < 0.001

1 §√—Èß 6 (4) 27 (33.3)

2 §√—Èß 85 (57.1) 48 (59.3)

3 §√—Èß 58 (38.9) 6 (7.4)

®”π«π‡¡Á¥¬“μàÕ«—π < 0.001

«‘®“√≥å

®“°°“√»÷°…“π’È æ∫ºŸâªÉ«¬∑’ˉ¡à “¡“√∂∫√‘À“√¬“‡∫“À«“π

„Àâ∂Ÿ°μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —Ëß¡“°∂÷ß√âÕ¬≈– 64.8 ´÷Ëß¡“°°«à“

∑’ˇ§¬√“¬ß“π®“°À≈“¬Ê ª√–‡∑»∑’˺à“π¡“^(3-22) ∑’Ëæ∫ºŸâªÉ«¬

πâÕ¬°«à“√âÕ¬≈– 20 ∑’ˉ¡à “¡“√∂∫√‘À“√¬“‡∫“À«“π„Àâμ√ß μ“¡∑’Ë·æ∑¬å —Ëß ‡™àπ °“√»÷°…“®“°ª√–‡∑»Ω√—Ë߇»  æ∫ºŸâªÉ«¬

∑’ˉ¡à “¡“√∂∫√‘À“√¬“‡∫“À«“π„Àâ∂Ÿ°μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —Ëß

‡æ’¬ß√âÕ¬≈– 12 §«“¡·μ°μà“ßπ’ÈÕ“®‡°‘¥®“°®”π«π°≈ÿà¡μ—«Õ¬à“ß

√–¬–‡«≈“„π°“√»÷°…“ »“ π“ §«“¡‡™◊ËÕ «—≤π∏√√¡·≈–«‘∏’

°“√ª√–‡¡‘𧫓¡ “¡“√∂„π°“√∫√‘À“√¬“‡∫“À«“π °“√»÷°…“

„πÕ¥’μ à«π„À≠à®–ª√–‡¡‘π‚¥¬°“√„™â·∫∫ Õ∫∂“¡ À√◊Õ°“√

μ√«® Õ∫°“√¡“μ“¡π—¥‡æ◊ËÕ√—∫¬“  à«π°“√»÷°…“π’Ȫ√–‡¡‘π

‚¥¬„À⺟âªÉ«¬¥Ÿμ—«Õ¬à“߬“æ√âÕ¡∫Õ°«‘∏’°“√„™â¬“∑’˺à“π¡“„Àâ

‡¿ —™°√ª√–®”§≈‘π‘°‡∫“À«“π´÷Ë߇ªìπºŸâ«‘®—¬øíß ‡∑’¬∫§«“¡∂Ÿ°

μâÕߢÕß°“√∫Õ°°—∫„∫ —Ë߬“¢ÕߺŸâªÉ«¬„πÕ¥’μ®“°‚ª√·°√¡

HOS XP ‡Àμÿº≈∑’ˇ≈◊Õ°«‘∏’π’ȇæ√“–ºŸâªÉ«¬ à«π„À≠àÕà“π·≈–

‡¢’¬π¿“…“‰∑¬‰¡à‰¥â ºŸâªÉ«¬‰¡à𔬓‡À≈◊Õ¡“§◊π∑’Ë‚√ß欓∫“≈

·≈–ªí®®ÿ∫—π¬—߉¡à¡’«‘∏’°“√ª√–‡¡‘π∑’ˇªìπ¡“μ√∞“π “°≈

 à«πªí®®—¬∑’Ë¡’º≈μàÕ§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“π

„Àâ∂Ÿ°μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —ËßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘쑧◊Õ

»“ π“Õ‘ ≈“¡ °“√∫√‘À“√¬“¥â«¬μπ‡Õß √Ÿª·∫∫¬“∑’ˉ¥â√—∫

§«“¡∂’Ë„π°“√„™â¬“ ·≈–®”π«π‡¡Á¥¬“μàÕ«—π ´÷Ëß Õ¥§≈âÕß°—∫

°“√»÷°…“À≈“¬©∫—∫∑’˺à“π¡“(5,6,12-13)

 à«πÕ“¬ÿ ‡æ»·≈–‚√§

√à«¡‰¡à¡’§«“¡ —¡æ—π∏å°—∫§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“

‡∫“À«“π„Àâ∂Ÿ°μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —Ëß ´÷Ë߉¡à Õ¥§≈âÕß°—∫

°“√»÷°…“∑’˺à“π¡“⁽⁵⁾

 “‡Àμÿ¢Õߧ«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“π„Àâ∂Ÿ°

μâÕßμ√ßμ“¡∑’Ë·æ∑¬å —Ëß∑’Ëæ∫¡“°∑’Ë ÿ¥§◊Õ°“√¡’«‘∂’™’«‘μ∑’ˉ¡à‡Õ◊ÈÕ μàÕ°“√„™â¬“μ“¡·æ∑¬å —Ëß ‡™àπ ºŸâ∑’ËμâÕß∑”ß“πμÕπ°≈“ߧ◊π

·≈–æ—°ºàÕπ„π‡«≈“°≈“ß«—π À√◊ÕºŸâ∑’Ë¡’Õ“™’æª√–¡ßμâÕßÕÕ°

‡√◊Õ‰ª∑–‡≈·μà‡™â“ ®÷߉¡à “¡“√∂∫√‘À“√¬“„Àâ∂Ÿ°μâÕßμ√ßμ“¡∑’Ë

·æ∑¬å —Ë߉¥â √Õß≈ß¡“§◊Õ§«“¡‡™◊ËÕ∑’˺‘¥ ‡™àπºŸâªÉ«¬∫“ß√“¬‡™◊ËÕ

«à“Õ“À“√∫“ß™π‘¥ ‡™àπ·μß‚¡ À√◊Õ¬“∑’ˉ¥â√—∫®“°·À≈àßÕ◊Ëπ®–¡’

ªØ‘°‘√‘¬“°—∫¬“‡∫“À«“π

ªí≠À“§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“π„Àâ∂Ÿ°μâÕß μ√ßμ“¡∑’Ë·æ∑¬å —Ëß æ∫¡“°„π°≈ÿà¡μ—«Õ¬à“ß´÷Ëߧ«√‰¥â√—∫°“√

·°â‰¢Õ¬à“߇√àߥà«π ¥—ßπ—Èπ°“√ª√–‡¡‘π°“√„™â¬“¢ÕߺŸâªÉ«¬‚¥¬

‡©æ“–ºŸâ∑’Ëπ—∫∂◊Õ»“ π“Õ‘ ≈“¡´÷Ëß∫√‘À“√¬“¥â«¬μπ‡Õß·≈–°“√

μ“√“ß∑’Ë 3 ªí®®—¬∑’Ë¡’§«“¡ —¡æ—π∏å°—∫§«“¡≈⡇À≈«„π°“√∫√‘À“√¬“‡∫“À«“π¢ÕߺŸâªÉ«¬‡∫“À«“π™π‘¥∑’Ë 2

ªí®®—¬ Adjusted OR 95% CI p-value

Õ“¬ÿ (ªï) 1.01 0.98 - 1.05 0.448

‡æ» (™“¬/À≠‘ß) 0.47 0.22 - 1.03 0.061

»“ π“ (Õ‘ ≈“¡/æÿ∑∏) 2.68 1.10 - 6.48 0.029

BMI (‡°‘π‡°≥±å/μ“¡‡°≥±å) 0.45 0.21 - 1.00 0.051

§«“¡¥—π‚≈À‘μ Ÿß (¡’/‰¡à¡’) 0.98 0.40 - 2.40 0.961

‰¢¡—π„π‡≈◊Õ¥ Ÿß (¡’/‰¡à¡’) 1.30 0.54 - 3.13 0.563

‚√§‰μ‡√◊ÈÕ√—ß (¡’/‰¡à¡’) 1.87 0.73 - 4.76 0.189

°“√∫√‘À“√¬“¥â«¬μπ‡Õß („™à/‰¡à„™à) 8.41 1.13 - 62.72 0.038

√Ÿª·∫∫¬“∑’ˉ¥â√—∫ (Glipizide+Metformin/¬“‡¥’ˬ«) 1.42 0.48 - 4.18 0.529

(¬“‡¡Á¥√à«¡°—∫ Insulin/¬“‡¥’ˬ«) 7.16 1.35 - 38.13 0.021

§«“¡∂’Ë„π°“√„™â¬“ (2 §√—Èß/1 §√—Èß) 4.44 1.51 - 13.06 0.007

(3 §√—Èß/1 §√—Èß) 13.80 3.19 - 59.78 < 0.001

®”π«π‡¡Á¥¬“∑’Ë√—∫ª√–∑“π„π·μà≈–«—π 2.28 1.16 - 4.51 0.017

ª√—∫‡ª≈’ˬπ«‘∏’°“√√—°…“„Àâ∂Ÿ°μâÕß ‡À¡“– ¡°—∫ºŸâªÉ«¬·μà≈–

√“¬®÷߇ªìπ ‘Ëß ”§—≠∑’Ë®–™à«¬‡æ‘Ë¡§«“¡ “¡“√∂„π°“√∫√‘À“√

¬“‡∫“À«“π

°‘μμ‘°√√¡ª√–°“»

¢Õ¢Õ∫§ÿ≥ 𓬷æ∑¬å«‘∑¬“  «— ¥‘«ÿ≤‘æß»å ∑’ˉ¥â°√ÿ≥“

„À⧔ª√÷°…“·π–π”„π°“√‡¢’¬π√“¬ß“π«‘®—¬ ¢Õ¢Õ∫§ÿ≥

ºŸâªÉ«¬‚√§‡∫“À«“π·≈–∑’¡ß“πª√–®”§≈‘π‘°‡∫“À«“π∑ÿ°∑à“π∑’Ë

„À⧫“¡√à«¡¡◊Õ ®π∑”„Àâ°“√«‘®—¬§√—Èßπ’È ”‡√Á®≈ÿ≈à«ß≈ߥ⫬¥’

10. Catalan VS, Couture JA, Lelorier J. Predictors of persistence of use with the novel anti-diabetic agent acarbose. Arch Intern Med 2001;161:1106-12.

11. Chiechanowski PS, Katon WJ, Russo JE. Depression and diabetes.

Arch Intern Med 2000;160:3278-85.

12. Dailey G, Kim MS, Lian JF. Patient compliance and persistence with anti-hyperglycemic drug regimens: evaluation of a Medicaid patient population with type 2 diabetes mellitus. ClinTher 2001;

23:1311-20.

13. Dezii CM, Kawabata H, Tran M. Effects of once daily and twice- daily dosing on adherence with prescribed glipizide oral therapy for type 2 diabetes. South Med J 2002;95:68-71.

14. Donnan PT, MacDonald TM, Morris AD for the DARTS/MEMO collaboration. Adherence to prescribed oral hypoglycemic medica- tion in a population of patients with type 2 diabetes: a retrospec- tive cohort study. Diabet Med 2002;19:279-84.

15. Evans JM, Donnan PT, Morris AD. Adherence to oral hypoglyce- mic agents prior to insulin therapy in type 2 diabetes. Diabet Med 2002;19:685-8.

16. Melikian C, White J, Vanderplas A, Dezii CM, Chang E. Adher- ence to oral anti-diabetic therapy in a managed care organization:

a comparison of mono-therapy, combination therapy, and fixed- dose combination therapy. ClinTher 2002;24:460-7.

17. Morningstar BA, Sketris IS, Kephart GC, Sclar DA. Variation in pharmacy prescription refill adherence measures by type of oral anti-hyperglycemic drug therapy in seniors in Nova Scotia, Canada.

J Clin Pharm Ther 2002;27:213-20.

18. Rajagopalan R, Joyce A, Smith D, Ollendorf D, Murray FT.

Medication compliance in type 2 diabetes patients: retrospective data analysis (Abstract). Value Health 2003;6:328.

19. Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care 2002;25:1015-21.

20. Sclar DA, Robison LM, Skaer TL, Dickson WM, Kozma CM, Reeder CE. Sulfonylurea pharmacotherapy regimen adherence in a Medicaid population: influence of age, gender, and race. Diabetes Educator 1999;25:531-2.

21. Spoelstra JA, Stolk RP, Heerdink ER, et al. Refill compliance in type 2 diabetes mellitus: a predictor of switching to insulin therapy?

Pharmacoepidemiol Drug Saf 2003;12:121-7.

22. Venturini F, Nichol MB, Sung JC, Bailey KL, Cody M, McCombs JS. Compliance with sulfonylureas in a health maintenance organi- zation: a pharmacy record-based study. Ann Pharmacother 1999;

33:281-8.

‡Õ° “√Õâ“ßÕ‘ß

1. Nathan D, Buse J, Davidson M, et al. Medical management of hyperglycemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy. Diabetologia 2009;

52:17-30.

2. Funnell M, Brown T, Childs B, et al. National standards for diabetes self-management education. Diabetes Care 2009;32:S87.

3. Selvin E, Wattanakit K, Steffes MW, et al. HbA1c and peripheral arterial disease in diabetes: the atherosclerosis risk in communities study. Diabetes Care 2006;29:877-22.

4. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of meta- bolic syndrome among US adults. Diabetes Care 2004;27:2444-9.

5. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of meta- bolic syndrome among US adults. Diabetes Care 2004;27:2444-9.

6. Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence 2013;

17;7:525-30.

7. Farsaei S, Sabzghabaee AM, Zargarzadeh AH, AminiM. Adher- ence to glyburide and metformin and associated factors in type 2 diabetes in Isfahan, Iran. Iran J Pharm Res 2011;10:933-9.

8. Boccuzzi SJ, Wogen J, Fox J, Sung JCY, Shah AB, Kim J.

Utilization of oral hypoglycemic agents in a drug-insured U.S.

population. Diabetes Care 2001;24:1411-5.

9. Brown JB, Nichol GA, Glauber HS, Bakst A. Ten-year follow-up of anti-diabetic drug use, nonadherence, and mortality in a defined population with type-2 diabetes. ClinTher 1999;21:1045-57.