TAKING YOUR DIABETES MEDICATION: Why Adherence Is Crucial

According to advocacy group the National Council for Patient Information and Education (NCPIE), up to one-third of patient prescriptions don’t actually ever get filled. Further, it says about 50 percent of the two billion prescriptions that are filled in this country each year is not taken correctly.

Taking prescribed medication may seem like a simple, straightforward proposition, but non-adherence–the failure of a patient to take the correct drugs on time and in the prescribed manner and dosages as directed– is an all-too-common problem that can lead to serious consequences. This is particularly true in patients with chronic conditions such as diabetes, which in and of itself is a challenging disease to manage successfully. In fact, recent research has found medication nonadherence results in 2.5 times an increased risk of hospitalization for patients with diabetes.

Non-adherence happens in many forms:

  • Failure to get a first prescription filled
  • Taking the wrong amount of medicine (more or less than prescribed)
  • Taking a dose at the wrong time (this is particularly a problem with diabetes medications)
  • Discontinuing a medication prematurely (i.e.,without completing the prescribed regimen)

Non-adherence is sometimes intentional. Perhaps the drug is too expensive...and we all know the rising cost of prescription medications can be a barrier. Perhaps the patient is not knowledgeable about the purpose of the medication, not convinced of its effectiveness or is concerned about side effects. Or he/she may fear needles or have difficulty following a multilayered medication regimen such as those that can accompanya diagnosis of diabetes.

Non-adherence can be unintentional. The patient is willing to take the medication, but a variety of life scenarios and external factors prevent him or her from taking the medication consistently. The scenarios can range from demanding work or family schedules and obligations to those that are related to healthcare systems: long waiting times at clinics or pharmacies, office visit time limitations or long time lapses between doctor appointments. Even the lack of some sort of “reminder system” can stand in the way.

Let’s look at some situations that you might recognize.

You go to the pharmacy to pick up your prescription and the bill comes to a few more added zeros than you expected. The mortgage is due and you know a large bill for car repair is coming in the mail next week. You are tempted take only half the pills, as getting through to the clinic to discuss alternatives just takes too much time and you’re wondering, “what will they think of me?” It is just easier to cut the dose… and then you wonder why those blood sugars are not budging.

You thought you heard your healthcare clinician tell you to take the new pill twice a day…or was it four times as indicated on the bottle? Better to go with twice a day as you thought you heard, rather than call to check this out. After all , the pharmacist was not at your appointment! So why is the blood pressure not coming down?

Yikes! This drug has to be injected. I sure do not remember anyone telling me about injections! And look at those syringes--they are a mile long! Goodness, not for me…I just think I will skip this. After all, the web said I don’t need this if I just drink more water and eat more vegetables. Maybe I will take a few extra pills of the ones I picked up three months ago. But why do I not feel so good--nauseated and with the runs? Maybe I should not be doing this on my own?

One of the best ways to help overcome any challenges with medication adherence is to cultivate a strong relationship with your doctor or other healthcare professional involved in your care in which you feel comfortable asking questions and expressing concerns about your medication plan. If you are having difficulty maintaining your diabetes medication regimen, make a written list of questions prior to your appointment. Here is a helpful starter list:

  • What is the name of the medication?
  • What is its purpose in helping to treat my disease?
  • How fast does it work?
  • How will I know that it’s working?
  • If I miss a dose, what should I do?
  • Can the medication(s) be taken with other medications and/or foods?
  • What are the common side effects or adverse effects with the medication?
  • Are there any other options to this medication?

The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality has a helpful question builder at: http://www.ahrq.gov/legacy/questions/qb/default.aspx.

Additional resources may be useful in providing the extra support needed to help you adhere to your medication routine, with options ranging from something as simple as a seven-day pill holder to mobile phone text message reminders and online tracking tools. For some helpful, diabetes-specific tools, visit http://www.scriptyourfuture.org/tools/ and click on the Diabetes tab.

There’s no denying that diabetes management is a complex undertaking that can touch almost every aspect of a person’s daily life. Successful outcomes require cooperation and collaboration between patients, their specialists, primary care providers and other healthcare professionals, even friends, relatives and colleagues. Taking advantage of all of the resources available and necessary for medication non-adherence will not only help protect you against future illness or serious health complications, but also create a better quality of life.

Dr. Sethu Reddy is the Chief of Adult Diabetes at the Joslin Diabetes Center, Boston, affiliated with Harvard Medical School. He has experience with medication non-adherence from both a professional and personal perspective and understands the challenge that individuals face in managing their chronic conditions. He has been involved with national and international initiatives focused on improving adherence, particularly in diabetes.