Diabetes is somewhat unique among the diseases of the 21st century, even though it’s been known for thousands of years. Although both Type 1 and Type 2 diabetes are potentially fatal, most patients can live a very long life with proper care, treatment and lifestyle changes.
Its name is derived from the Greek words for “sweet-smelling urine,” and the distinctive polyuria — frequent urination with increased volume — observed by ancient civilizations. Its prevalence has increased substantially over the centuries because of the increasing number of people who are obese and social factors. Diabetes is now the seventh leading cause of death globally, responsible for more than four million deaths in 2019.
Managing diabetes isn’t easy and very much depends on the individual patient’s social determinants of health and compliance with the plan of care. Monitoring weight, blood sugar, lipid levels, hemoglobin A1C numbers, paying attention to diet, and taking multiple medications are all part of a typical day for the 34 million Americans living with the disease. The struggle is real, but so are the risks of severe health complications when patients don’t adhere to their medication regimens and healthy lifestyle recommendations. Blindness, chronic renal disease, peripheral neuropathies, cardiovascular disease, and strokes are some of the most serious consequences of uncontrolled diabetes.
There is still no cure. But today it’s clear that strict management of diabetes can make a huge difference in reducing the risk of complications and improving the chances of extended longevity. Recently, newer classes of oral drugs and injectables, and innovative delivery of insulin have shown very promising results, particularly reducing long-term vascular complications. Looking to the future, advances in potential new treatments are on the horizon, including stem-cell-derived pancreatic beta cells, which have shown functional success in limited studies, especially for Type 1 diabetes.
Yet, according to the Association of Diabetes Care & Education Specialists, half of all people with a chronic disease such as diabetes do not take their medications as prescribed. More than 20% of all new prescriptions are never filled, and approximately 30% of people with diabetes report missing at least one dose of oral hypoglycemics per month.
Why are so many people putting their health at risk by neglecting to take their medicine? Study respondents cited unclear instructions, forgetfulness, procrastination, perceived ineffectiveness and unpleasant side effects. But perhaps the most important factor is cost. A 2017 study published in Diabetes Care said people with diabetes pay almost $5,000 a year (or more than $400 a month) for medication.
Fortunately, new technologies with advanced integration into electronic health record (EHR) system offer important opportunities to promote medication adherence.
When clinicians prescribe medications, they typically don’t know how much the co-pay will be. Patients usually don’t know either until they arrive at the pharmacy — where they may suffer sticker shock and walk away without their medicine.
A study in the Annals of Internal Medicine cited cost as the most significant factor in prescription abandonment, with patients 3.4 times more likely to abandon prescriptions that cost between $40 and $50 compared with medications with no copayment. As costs rose, so did abandonment rates.
What if clinicians could see what a medication would cost the patient before placing the order? New e-prescribing solutions make that possible — within seconds and with patients present — by giving clinicians visibility into relevant information concerning insurance benefits and formulary design, including copays, out-of-pocket costs, and therapeutically equivalent alternatives.
After a patient leaves the office, clinicians can “continue the conversation” using auto-generated messaging. For example, when they prescribe medication, their e-prescribing solution can send the patient a secure text message linking to online information, such as the medication’s intended benefits and possible side effects.
Ready access to educational material like this may minimize patient confusion about why they need medication and how it could improve their condition.
This same technology can send patients links to cost-saving coupons for prescribed drugs, reducing some of the financial barriers to medication adherence. For people with diabetes, the potential benefit is significant: An average of more than $600 a year on their diabetes medications, according to a DrFirst analysis of nearly 800,000 prescriptions written for more than 350,000 patients over eight months in 2020.
Sometimes patients forget to pick up their prescriptions or postpone their trip to the pharmacy. With today’s busy schedules, that is understandable. We all need a reminder now and then.
Fortunately, some e-prescribing tools can send automatic text messages that give patients a friendly nudge to pick up a prescription or have it refilled and offer medication education and discount coupons. For chronic care patients, maintaining their medication regimen is vitally important to their health. Reminders delivered directly to their smartphones could make a crucial difference in supporting diabetes patients throughout the course of their care.
By adopting solutions like these that help reduce or eliminate financial, educational, and behavioral barriers, you have the opportunity to enhance your patients’ health, satisfaction, and outcomes.
Thomas E. Sullivan, M.D., is a cardiologist with more than 40 years of practice and the chief strategic officer for DrFirst, a health technology company.