Therapeutic Adherence and Glycemic Control in the Population with Diabetes in Ceuta (Spain), a Multicultural City: A Cross-Sectional Study

Abstract

Diabetes mellitus constitutes a significant global public health problem. It is a chronic disease characterized by persistent hyperglycemia, which is a consequence of inadequate insulin secretion, deficient insulin action, or a combination of both factors. A crucial component in the effective management of this pathology is therapeutic adherence, as it helps prevent complications, improve patient quality of life, reduce associated mortality, and decrease the need for hospitalization. In this context, it is crucial to implement a comprehensive care model that offers continuous support and a multidisciplinary approach. Primary care should be central, coordinating the entire care process. Understanding the clinical and social characteristics of people with diabetes is key to guiding more effective interventions. Objective: The objective of this study was to describe the sociodemographic and anthropometric characteristics, degree of metabolic control, and treatment adherence in patients with diabetes mellitus enrolled in primary care programs in Ceuta. Materials and Methods: This was a descriptive, observational, and cross-sectional study conducted during the second half of 2024. The study population included individuals enrolled in the primary care diabetes program in Ceuta. We analyzed sociodemographic variables with a self-administered questionnaire, the level of therapeutic adherence using the MMAS-8 scale, and glycemic control through glycosylated hemoglobin (HbA1c) values. Results: The sample consisted of 370 individuals, with 50.3% being men. The average age was 62.82 years (SD = 13.46). A significant portion of participants, 61.07%, had no formal education or had only received primary education. Additionally, 84.9% of the participants had at least one other associated chronic pathology. Regarding adherence, 36.8% of the patients showed a high level, and for all patients, the mean HbA1c value was 7.5% (SD = 1.55). Furthermore, our analysis revealed statistically significant associations between cultural background and both therapeutic adherence (weak positive correlation: r = 0.213, p ≤ 0.001; multivariate significance: sig: <0.001; Exp(B) = 2.448) and glycemic control (multivariate significance: sig: <0.001; Exp(B) = 2.686). Conclusions: We observed high treatment adherence in the study population, with HbA1c values within the limits recommended by the World Health Organization for older adults. Furthermore, a relationship between cultural background and both treatment adherence and glycemic control was identified. This suggests a need for further research into these and other social determinants, like study level or monthly income, in future studies.