Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors - PubMed (original) (raw)

Review

. 2016 Jul 22:10:1299-307.

doi: 10.2147/PPA.S106821. eCollection 2016.

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Review

Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors

William H Polonsky et al. Patient Prefer Adherence. 2016.

Abstract

At least 45% of patients with type 2 diabetes (T2D) fail to achieve adequate glycemic control (HbA1c <7%). One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals), patient demographic factors (eg, young age, low education level, and low income level), critical patient beliefs about their medications (eg, perceived treatment inefficacy), and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia). Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative medication beliefs of patients. Solutions to these problems would require behavioral innovations as well as new methods and modes of drug delivery.

Keywords: HbA1c; glycemic control; hypoglycemia; medication adherence; psychosocial; type 2 diabetes.

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Figures

Figure 1

Figure 1

Prevalence of diagnosed diabetes among adults ≥20 years old from the NHANES of 1988–1994 and 1999–2010. Note: Data from a previous study. Abbreviations: NHANES, National Health and Nutrition Examination Survey; BMI, body mass index.

Figure 2

Figure 2

Percentage of patients discontinuing therapy (>60 days without drug) with oral hypoglycemic drugs during a 1-year follow-up of patients initiating therapy. Note: Data from a previous study. Abbreviation: TZD, thiazolidinedione.

Figure 3

Figure 3

Percentage of patients with low, medium, or high adherence to antidiabetic medication based on the MMAS score according to the occurrence of recent hypoglycemic episodes. Notes: *P<0.05 vs never hypoglycemia. Data from a previous study. Abbreviation: MMAS, Morisky Medication Adherence Scale.

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