Taking medications module

Pharmacological therapy is highly efficacious in improving glycaemic control (reducing HbA1c by 0.5% to 2% depending on the agent used) and has demonstrated benefits in reducing the micro and macro vascular complications of diabetes. Despite the efficacy of diabetes medications, adherence is poor ranging from 36% to 85% adherence for oral diabetes medications. People with type 2 diabetes are likely to be on a range of medications and complex regimens. Significantly worse clinical outcomes have been reported for individuals not adhering to diabetes and related medication regimens versus those who adhere, including higher HbA1c, higher all cause hospitalisation and all cause mortality.¹

Common factors leading to non-adherence include: fears (of the disease worsening, hypoglycaemia, weight gain); knowledge and skill; self efficacy; health beliefs; depression; lack of confidence in the immediate or future benefit of taking the medication; remembering doses and refills; complexity of the regimen (more than one medication, splitting tablets); frequency of dosing (2 or more times per day results in poorer adherence); cost; adverse effects.¹

Possible strategies for addressing barriers to adherence include: use of standard questionnaires to explore patient beliefs; mailed medication reminder 10 days before due refill date; unit dose packaging (blister packs). Cue-dose training (linking medication with daily activities) has been shown to improve initial adherence but not sustain adherence.¹ Diabetes care providers need to assess challenges faced by individuals with respect to mediation taking and develop strategies to address these.