الفهرس 
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Abstract
Diabetes is a chronic and life-threatening disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. (1) Uncontrolled blood sugar level can lead to chronic hyperglycemia. This can result then in short and long-term complications, many of which, if not prevented and left untreated, can be fatal. All have the potential to reduce the quality of life of people with diabetes and their families. (8)
Egypt is in the world’s top 10 in terms of the highest number of people with diabetes in 2003 (3.9 million) and highest projected number of people with diabetes in 2025 (7.8 million).(6) According to the IDF in 2012, the total adult population with diabetes became 7.5 millions with a prevalence of 15.27%. The number of deaths due to diabetes was 84,546. The mean healthcare expenditure per person with diabetes was $ 136.25/year. (8)
Diabetes has a strong economic impact on the healthcare sector, the individual and family, and society. The cost of diabetes care refers to the cost element that is attributable to diabetes itself or to the complications of diabetes; it clearly includes the costs of hospital admissions and other healthcare episodes for diabetic ketoacidosis, hypoglycemia and other direct results of diabetes or its therapy. (9)
Reducing the cost burden is possible by increasing the effectiveness of management and treatment for those who already have diabetes and by implementing primary prevention measures for those who are at high risk of developing type 2 diabetes.
In the context of health care, compliance has been defined as the extent to which the patient’s actual history of drug administration corresponds to the prescribed regimen.(13)
Poor adherence to the treatment for diabetes results in avoidable suffering for the patients and excess costs to the health system. Adherence is a primary determinant of the effectiveness of treatment (24, 25) because poor adherence attenuates optimum clinical benefit (26, 27). Good adherence improves the effectiveness of interventions aimed at promoting healthy lifestyles, such as diet modification, increased physical activity, and of the pharmacological-based risk-reduction interventions. (24, 28, 29, 30)
In addition to their positive impact on the health status of patients with chronic illnesses, higher rates of adherence confer economic benefits. The combined health and economic burden of diabetes is huge and increasing. Hospitalization costs, which include the treatment of long-term complications such as heart disease, account for 30–65% of the overall costs of the disease – the largest proportion of costs. The direct costs of complications attributable to poor control of diabetes are 3–4 times higher than those of good control.
To understand the problem of treatment adherence and assess the effectiveness of interventions to improve adherence, it needs to be accurately measured. (39)
Non-adherence is the most common cause of non-response to treatment which is interpreted as treatment or drug failure; it may also affect the psychological well-being of a patient. (34) Failure of medical treatment may lead the clinician to decide on alternate therapies or a change in dose schedule. This may in turn lead to the elimination of the use of potentially effective medications, or may expose the patient to risks of adverse effect of drugs. The patient on the other hand, may turn to other clinicians for cure. This results in an increase of disease related medical costs.
Non adherence may be intentional that means patients deciding not to take the medication or unintentional when patients forget or are unable to take their medication.(64) Adherence is simultaneously influenced by several factors and studies over the past three decades have identified a number of these factors affecting medication adherence.(62, 63) The World Health Organization in 2003 suggested that medication adherence can be determined by interplay of five sets of factors, termed as “dimensions” which are social and economic, health care system, condition-related, therapy-related, and patient-related factors.(9)