Improving diabetics' medication adherence

The lack of patient adherence to taking medication can be a source of frustration for physicians no matter what conditions these individuals are suffering from, but it is a particularly prevalent and concerning phenomenon among those with diabetes.

"Boosting adherence rates could improve millions of Americans' quality of life."

According to the American Diabetes Association, nearly 26 million children and adults in the United States currently suffer from diabetes. If current trends continue, one in three Americans will have the disease by 2050. Given that diabetes is so common, coming up with a method to boost adherence rates could improve millions of Americans' quality of life - but as many physicians know only too well, this is considerably easier said than done.

What type of diabetic adheres to medication regimens?
Research published in Issue 773 of Diabetes in Control revealed an adherence rate of 69 percent among the more than 200,000 patients who participated in the study. Factors that contributed to adherence included:

  • Age (older patients were more likely to be adherent)
  • High income and education levels
  • Use of mail order pharmacies
  • Familiarity with diabetes therapy
  • High total number of medications (both for diabetes and other afflictions)
  • Low out-of-pocket costs

Meanwhile, aspects that lowered the likelihood of adherence were identified as:

  • Age (younger patients were less likely to be adherent)
  • Low income and education levels
  • Use of retail pharmacies
  • Newness to diabetes therapy
  • Low total number of medications and perception of being generally healthy
  • High out-of-pocket costs

The price of insulin… and of non-adherence
Pharmacy Times cited a separate study of the relationship between the lack of generic insulin and low patient adherence that appeared in the March 2015 edition of The New England Journal of Medicine.

According to Jeremy Greene and Kevin Riggs, two internist-researchers from Johns Hopkins University who co-authored the study, uninsured patients and individuals whose insurance coverage does not extend to prescription drugs must pay as much as $400 per month for insulin.

"When people can't afford it, they often stop taking it altogether," said Riggs, noting that the effects of non-adherence include blindness, gangrene, kidney failure and loss of limbs.

Insulin is costly - but so is not taking it.Insulin is costly - but so is not taking it.

4 ways to boost medication adherence
Patients' failure to take their diabetes medication is a prevalent problem that can have sobering results. So, how can healthcare providers improve adherence rates?

  1. Implementing shared medical appointments: In instances when physicians' motivational efforts have fallen flat, peer input can prove invaluable. "Patients will often be a little firmer with each other than we're sometimes comfortable being," said Molly Cooke, former president of the American College of Physicians and a practicing internist, as quoted by Medical Economics.
  2. Adhering to a team model: To maximize patient education and professional accountability, some practices bring in specialists like social workers and nutritionists to complement the care administered by the primary physician. "Everybody has a piece in the care," noted Jeanne Marconi of the Norwalk, Connecticut-based Center for Advanced Pediatrics, which adheres to this model.
  3. Pointing to online resources: Physicians may want to encourage patients to take advantage of online resources, such as those provided by the American Diabetes Association. According to the Pew Research Center, patients with chronic conditions like diabetes are more likely than their healthy counterparts to seek out healthcare information using Internet searches.
  4. Advocating the use of wearable devices: Wearable devices such as Fitbit allow patients to monitor their health wherever and whenever they wish, as well as engage with a virtual community that may help keep them on track in terms of taking medication.