Adhering to a healthy regimen— including regularly taking their medications—can be difficult for diabetes patients, according to experts.
A study published in the Diabetes Care, which appeared recently in a Cardiometabolic Health Congress blog, showed that poor adherence statistics ranged from 25% to 91%, with a mean of 37.8%.
Some might be hampered by behavioral issues, remarked David Marrero, PhD, director of the UA Center for Border Health Disparities at the University of Arizona Health Sciences. “If all I had to do was tell people they shouldn’t eat so much, we wouldn’t have an obesity problem. Diabetics have to say to themselves: ‘if I do that, this happens, and what will be the outcome over here?’” says Marrero. “A lot of calculations are involved, and not everyone’s good at that.”
Another impediment could be illness, like diabetes distress; a reaction to the burden of therapy, he says. “Therapy’s not a single behavior; it’s multilayered and complex. You have to think about things like diet and exercise, so it can be challenging for a lot of people.”
Physicians can help patients deal with various challenges by regularly questioning them in the clinic about their level of adherence, says Sethu Reddy, MD, chair of Medicine, CMU College of Medicine, in Mt. Pleasant and Saginaw, Michigan, and former chief of adult diabetes at the Joslin Diabetes Center in Harvard, Massachusetts. In fact, based on the assumption patients don’t regularly take their medications, Reddy provides what he called a safe, forgiving office environment. “If I come out sounding very accusatory and negative, it could be counterproductive.”
By the same token, most patients don’t want to see their doctor angry and might be tempted to tell them what they want to hear instead of the truth, he said. But it’s better to be honest, so a physician and patient can come up with ways to improve adherence, Reddy says.
For example, he encourages some patients to keep extra pills in places such as their office, so if they forgot to take them at home and are due for a dose, it’s there in their office.
Physician/patient communication works optimally when they devise solutions together, a process known as shared decision making, says Reddy. “The old approach is that a doctor gives a patient a prescription and that’s it.” Today, doctors talk to patients about their condition and ask them if they’re able to take a certain medication every day, he says. Patients have to be involved in the decision making and “buy in” to the need for the medication so that they’re engaged and more likely to follow instructions, according to Ready.
Conversations help physicians pinpoint stressors, such as economic issues, that might persuade them against taking certain medications because they can’t afford them, says Marrero. “You need analytics to determine what challenges a patient’s facing and decide whether it’s a correctable problem.”
Modern technology, like smartphones, also can help improve adherence, by providing those diabetes patients who need it a reminder to take their meds, according to Reddy.
The availability of smartphone health apps has expanded quickly, with a recent study showing 160 medication adherence-specific health apps.
Mail order pharmacies are another way to help ease a patient’s ability to adhere, he says. “Patients would have a guaranteed supply with no excuse of running out of meds.”
Some pharmacies provide a patient’s monthly medications in convenient blister packs, Reddy adds.
Of course, there are those patients who might need something more drastic to compel them to be more adherent—like a friend or relative with diabetes recently experiencing a diabetes related-complication, Reddy says. “Some don’t take their medications because they’re not having any symptoms; but once someone they know does—or if they develop tingling/burning in their feet—their concern for their diabetes increases and one becomes more adherent to taking their medications,” he says.
With that being said, some patients simply are more predisposed than others to adhere, according to Reddy. “Patients have different personalities; some don’t conform; others are more obsessive about religiously following orders,” he says.
Perhaps more will get the message, given how much nonadherence can put at stake financially.
A review in the Annals of Internal Medicine, estimated nonadherence causes nearly 125,000 deaths, 10% of hospitalizations and costs the healthcare system between $100 billion to $289 billion yearly.
Chuck Green has covered healthcare for more than 10 years.