Patient Therapy and Health System-related Factors Influencing Antiglycemic Drug Utilization among Patients with Diabetes in Nasarawa State, Nigeria

Abstract

Aims: The study aimed to identify and characterise the patient, therapy, and health system-related factors influencing the utilisation of antiglycaemic agents among patients with diabetes attending selected health facilities in Nasarawa State, Nigeria. Study Design: A descriptive cross-sectional mixed-methods study. Place and Duration of Study: General Hospitals in Nasarawa Eggon, Wamba, Obi, Doma, Garaku, and Keffi, Nasarawa State, Nigeria, drawing on a registered patient population accumulated between 2021 and 2025, with primary data collection conducted in 2025–2026. Methodology: A structured, closed-ended questionnaire covering socio-demographic characteristics and factors affecting antiglycaemic drug utilisation was administered to 300 registered diabetes patients selected from a sampling frame of 3,235 registered patients using the Krejcie and Morgan sample size table and a purposive sampling technique; 295 questionnaires (98.3%) were valid for analysis. This was complemented by two Focus Group Discussions (FGDs) involving 41 participants comprising patients with diabetes and healthcare providers (doctors, nurses, and pharmacists) across the study facilities, exploring patient-, therapy-, health system-, socioeconomic-, and disease-related barriers to drug utilisation. Data were summarised descriptively as frequencies and percentages; FGD data were analysed thematically. Results: Among the 295 respondents with valid questionnaires, 231 (77.0%) reported prior knowledge of factors affecting antiglycaemic drug utilisation. The leading patient-related behavioural factors were smoking/alcohol consumption (56.7%), poor glycaemic control (26.7%), lack of physical exercise (23.7%), and inadequate fruit/vegetable intake (14.7%). Rational antiglycaemic drug use was reported to have had a positive effect by 176 respondents (58.7%), primarily through improved insulin sensitivity (67.0%), blood glucose control (20.3%), and reduced complication risk (11.0%). FGDs identified therapy-related barriers (prolonged treatment duration, regimen complexity), health system-related barriers (facility accessibility, quality of patient-provider communication), and socioeconomic barriers (low income, unemployment, weak family support) as compounding patient-related knowledge and behavioural factors. Reduced cardiovascular risk (59.7%) and improved quality of life (31.7%) were the most frequently reported outcomes of adherent antiglycaemic therapy. Conclusion: Antiglycaemic drug utilisation in this rural Nigerian setting is shaped by an interlocking set of patient-related behavioural and knowledge factors, therapy-related burdens, and health system and socioeconomic constraints, rather than any single determinant. Interventions that combine lifestyle counselling, regimen simplification where clinically appropriate, and strengthening of facility-level accessibility and communication are likely to yield greater gains in rational antiglycaemic drug utilisation than patient-focused education alone.