Treatment Compliance Among People With Type 2 Diabetes in Rural Tamil Nadu, India: Prevalence, Associated Factors, and a Comparison of Public and Private Care.

BACKGROUND: Treatment compliance determines whether therapy for type 2 diabetes succeeds in practice, yet it is poorly characterized in rural India, where free public services and fee-charging private services operate side by side. We estimated the prevalence of treatment compliance, identified its independent correlates, and compared compliance between government and private facilities in a rural community of Tamil Nadu. METHODS: In this community-based cross-sectional study, 220 adults with type 2 diabetes on treatment for at least three months were selected by simple random sampling. Compliance was measured with the nine-item Hill-Bone Medication Adherence Scale and dichotomized at the sample median. Independent correlates were identified by binary logistic regression, and the most recent fasting and post-prandial blood glucose values were retrieved as an objective correlate. Associations were tested with the chi-squared and Fisher exact tests and the Mann-Whitney U test, with p < 0.05 considered significant. RESULTS: Only 34.1% of participants were compliant. Compliant patients had markedly lower fasting glucose (143 vs. 181 mg/dL) and post-prandial glucose (236 vs. 295 mg/dL; both p < 0.001). In multivariable analysis, only a diabetes duration exceeding 10 years independently predicted compliance (adjusted odds ratio 3.39, 95% confidence interval (CI) 1.55-7.40; p = 0.002); the univariate associations with age and travel time did not persist after adjustment. Compliance was almost identical in government and private facilities (34.4% vs. 33.7%; p = 0.907), even though 24.5% of private-care users reported being unable to afford treatment, and it was unrelated to sex, education, occupation, or socioeconomic class. CONCLUSIONS: Two-thirds of rural adults with type 2 diabetes were non-compliant, and non-compliance was mirrored in significantly worse glycemic control. Public and private care achieved equal compliance despite an unequal cost burden, and only longer disease experience distinguished compliant patients. Duration-sensitive adherence support that engages the recently diagnosed, delivered across both care streams, is needed.