Research quantifies non-adherence to diabetes therapies

In spite of Type 2 diabetes’ ranking as the seventh-leading cause of death in the U.S., many patients fail to adhere to the therapies that could improve their symptoms.

Now, scientists are better quantifying that cause-and-effect relationship and searching for answers to that non-adherance.

The chronic disease is characterized by insulin resistance and the progressive dysfunction of the insulin-producing beta-cells in the pancreas that produce them. That commonly causes elevated blood glucose, lipid and blood pressure levels that can result in long-term vascular complications. Poor diabetes management can increase patients’ danger of stroke, foot ulcers necessitating amputations and/or blindness, as well as poor wound healing.

Some 27 percent of people in the U.S. 65 and older have the disease while another 50 percent are pre-diabetic. Analysts believe 17.2 million people nationwide will be afflicted by 2025. When last measured in 2012, Type 2 diabetes (TD2) was estimated to cost the U.S. healthcare system $176 billion annually.

Because patients are typically heavily involved in treating their own symptoms via insulin injections or oral therapies, it’s long been understood they play a primary role in controlling the severity of their illness. But recent research in six different countries zeroes in on that impact, indicating that 4–15 percent of diabetes-related costs are linked to patients not adhering to or persisting with therapies.

Conducted in the U.S., the UK, Germany, Brazil, Mexico and Saudi Arabia, the study by the IMS Institute for Healthcare Informatics suggests identifying and profiling patients who need assistance and improving access to education materials tailored to their needs. It also recommends maximizing digital technology for self-management; educating more on diet, exercise and the use of glucose-lowering machines; and facilitating collaboration between affected patients, healthcare and government leaders, nonprofits and the private sector.

Other points made in the study:

  • Among the U.S. Medicare population, an estimated 46 percent of patients were achieving “sub-optimal” adherence and persistence regarding their therapies when studied in 2014. That lack of adherence caused an estimated 17 percent spike in the HbA1c levels in patients, which are used to diagnose and monitor diabetes.
  • T2D-related complications are slated to cost U.S. Medicare almost $100 billion annually between 2015 and 2025. As much as $4 billion of that is driven by complications of those struggling to adhere in full to recommended therapies.
  • Recent research found those with lower activation levels cost 21 percent more than highly activated patients (although the study included other diseases besides T2D).
  • The U.S. healthcare system is shifting from the traditional “fee-for-service” reimbursement model toward one that is value based. That means metrics are increasingly being used to measure how well patients are self-treating their T2D and providing financial incentives (through shared savings programs) for better adherence. The most common metrics are HEDIS (the Healthcare Effectiveness Data and Information Set) and Medicare star ratings.
  • Because effective use of medication also reduces healthcare costs, the Medicare Medication Therapy Management (MTM) program was established to improve outcomes. Under its guidelines, a pharmacist or other healthcare professional is offered financial incentives to provide a comprehensive medication review for people with multiple chronic health conditions (including T2D) to ensure they’re taking the right medications, and that they understand why. Detailed action plans are established in cases where problems or barriers are identified.
  • Federal and state-level lawmakers in the U.S. are working to embed more patient activation into legislation to reduce healthcare costs and improve quality. For example, the Affordable Care Act identifies patient engagement as integral to accountable care organizations and patient-centered medical homes.
  • The reasons T2D patients don’t adhere to their recommended therapies need further study.

“(Patient) activation is the sum of personal circumstances, attitudes, behaviors and motivations, which are themselves influenced by a variety of stakeholders,” the study concludes. “As a result, it is critical to not only quantify (patient) activation but also identify its associated underlying causes. This will enable healthcare providers to address an individual’s specific support and information needs and develop a customized, patient-centric approach that positively impacts T2D therapy adherence and persistence.”

Contact Artcraft Health for a consultation on better therapy education.