OBJECTIVES: The cost of diabetes mellitus has continued to increase over the years largely due to increase in prevalence of western lifestyle and treatment non-adherence. This study focused on cost of managing patients with poor glycemic control in ambulatory settings.

METHODS: This was a retrospective and prospective study among type 2 diabetes mellitus patients attending two tertiary healthcare facilities in Southwest Nigeria between June 2016 and July 2018. A semi-structured questionnaire was interviewer-administered to the patients. Information retrieved included; socio-demographics and other clinical parameters. Treatment non-adherence was assessed using glycated hemoglobin (HbA1c). Ninety-five patients, with HbA1c<7%, were assigned to controlled group and 106 patients, with HbA1c≥7% were assigned to uncontrolled group. A six-month educational intervention was provided for the uncontrolled group which focused largely on resolving non-adherence to recommended treatment (medications, diet and physical exercise). Direct cost (out-of-pocket) estimated for medications, transportation, consultation and laboratory investigations was calculated for six-month retrospective data and six-month post-intervention management for both groups. Data was evaluated for both groups using paired t-test with p<0.05.

RESULTS: Patients’ mean age was 62.9±11.64years, while average monthly income was $183.2±249.0. Mean HbA1c of controlled group before and after intervention was 6.13±0.55% and 6.14±0.81% respectively, (p=0.88; t=-1.56). Mean HbA1c of uncontrolled group before and after intervention was 8.67±1.52% and 7.81±2.00% respectively (p=0.00; t=4.12). Average six-month pre-intervention cost of management for control and uncontrolled groups were $293.0±127.7 and $330.5±120.7, respectively. The cost reduced to $292.0±135.5 (p=0.93; t=1.122) among the controlled group and increased to $346.3±160.8 (p=0.155; t=-0.432) among the uncontrolled group after intervention.

CONCLUSIONS: Educational intervention on treatment non-adherence led to significant improvement in glycemic control of the uncontrolled group with an insignificant increase in cost of management. Thus, the need for consistent treatment adherence among patients in order to reduce the burden of the disease