Medication education key to successful adherence in patients with diabetes

"Counseling can be more effective if pharmacists recognize that individual patients are each motivated to adhere to their drug regimens in different ways," said Candis M. Morello, PharmD, associate professor of clinical pharmacy at UCSD's Skaggs School of Pharmacy. "By understanding these differences, and knowing what actually works for individual patients, pharmacists can provide a very important service."

Diabetes is a complex disorder, typically requiring multiple medications to achieve control of the patient's blood sugar levels. Medication adherence -taking medications as instructed at the right time of day, frequency and dosage -- is a significant factor for a patient's successful management of their disease. Therefore, knowing which methods diabetes patients and caregivers report help for improving adherence can provides valuable knowledge to make counseling opportunities more effective.

Morello and colleagues surveyed more than 1200 individuals over age 18, most of whom (about 75%) had type 2 diabetes. Nearly half of this number took only oral medications, and the vast majority (86.8%) of the patients with diabetes reported taking medications two or more times per day.

Their goal was to determine methods that patients and their caregivers have used to improve medication adherence, assess the perceived helpfulness of such methods and identify motivating factors or medication characteristics that might help patients stick to their regimen.

Taking medications as part of a daily routine and utilizing pill boxes were the most frequently reported helpful methods to improve adherence. The three most motivating factors that patients identified were their knowledge that diabetes medications work effectively to lower blood glucose, understanding how they could manage side effects of their medications and a better understanding of the drugs' benefits.

Conversely, non-adherence involved not only a patient's forgetfulness, but also such factors as inability to afford a prescription or adverse reactions to a drug such as weight gain or nausea. As a result, health care providers might deem such regimens unsuccessful and prescribe even more or different drugs.

"To empower patients to overcome medication adherence barriers, we conclude that pharmacists are well-positioned to provide more proactive and thorough counseling sessions to include education of how diabetes drugs work and why they are so important," said Morello. She added that while seemingly simple tools such as using a 7-day pill box may improve a patient's adherence, improvement is often very patient-specific.

"Pharmacists should incorporate an assessment of individual variances into their counseling sessions…and patients should know that their pharmacist is an excellent resource for medication education and advice."