Diabetes medication adherence is a significant public health issue in the United States, affecting millions of individuals and posing substantial healthcare challenges. Preventable complications of uncontrolled diabetes are costly to our healthcare system; the total direct and indirect cost of diabetes was $412.9 billion in 2022. These medical costs have increased by over 35% in the last 10 years. Approximately one of every four healthcare dollars spent in the U.S. can be attributed to people diagnosed with diabetes. Vulnerable and underserved communities may bear an even higher cost burden.
Medication adherence is a cornerstone of effective diabetes management, yet it remains a significant challenge. A systematic review and meta-analysis published in 2023 found that only 54% of patients with type 2 diabetes were adherent. Non-adherence is associated with poorer outcomes, progression of disease, and disease complications.
Factors Influencing Diabetes Medication Adherence
- Patient Beliefs and Perceptions: Patients’ beliefs about their medications and the perceived benefits versus side effects play a significant role in adherence. Addressing these beliefs through patient education and counseling can improve adherence rates.
- Complexity of Medication Regimens: Complex regimens overwhelm patients, leading to non-adherence. Simplifying regimens, when possible, will enhance adherence.
- Cost of Medications: High medication costs are a barrier for many patients. Exploring cost-effective alternatives and assisting patients in navigating insurance coverage will alleviate this burden.
Additional evidence-based criteria that impact diabetes medication adherence include:
| Factor | Description |
| Perceived Support | – Family providing support and cues for adherence – Healthcare providers’ encouragement of adherence and healthy lifestyle behavior – Patient perception of feeling heard and trusting provider – Clear communication from healthcare provider – Healthcare provider explaining importance of adherence – Healthcare provider exploring patient culture and beliefs about medications and disease |
| Importance of Routine | – Creating a behavioral habit strengthens adherence |
| Lack of Knowledge | – Not knowing purpose of medication – Lack of knowledge about disease processes – Not understanding dangers of not taking medication – Health literacy |
| Issues Related to Medication | – Concerns about adverse effects – Perceived treatment efficacy – Occurrence and/or fear of moderate to sever hypoglycemia – Misprioritization of medication by conditions perceived as more critical than diabetes medication – Polypharmacy/complex regimens – Complexity of medication delivery devices – Cost |
| Mental Health | – Depression can negatively impact adherence |
| Social Determinants of Health | – Factors impacting access to care, food insecurity, income, insurance, social support, etc. |
Improving Medication Adherence in Patients with Diabetes
The keys to diabetes medication adherence are asking patients about potential barriers and medication beliefs in a nonjudgmental manner, identifying and understanding each patient’s unique barriers, and working collaboratively across the care team to overcome those barriers. Some probing questions to ask about adherence include:
- “Medications can be difficult to take every day. How often do you skip one?”
- “It is common for people to experience some side effects from medicine. What side effects are you experiencing?”
- “Medications can be expensive for many people, even with insurance. What concerns do you have about paying for your medication?”
Other evidence-based strategies to improve adherence include:
- Individual Counseling and Education
- Discussing self-efficacy, self-management, adherence, and overcoming potential barriers
- Education, skills training, and problem-solving from providers, pharmacists, health coaches, case managers, etc.
- Motivational interviewing
- Health Technologies
- Use of telemedicine, internet, mobile phones, and adherence apps
- Phone Interventions
- Use of phone or text reminders for refills
- Point-of-Care Testing
- Intervene on lab results while patient is still present in office
- Reducing Pill Burden and Complexity
- Use once daily dosing options when feasible
- Reassess each medication for ongoing indication
- Use generic fixed dose combinations when available
- Use mail order when available for chronic medications
- Use pill boxes
- Match medication administration to schedule and lifestyle
- Use pharmacy medication synchronization programs to enable patients to refill all medications at once
- Use 90-day quantities
- Ensuring First Fills of New Medication
- Monitor claims data where available
- Follow-up with patients after new medication initiation
At CHESS Health Solutions, our pharmacists practice population health by holistically considering patients’ medication therapy management while collaborating across the care team. This cooperative, patient-centric approach helps to address barriers to medication adherence and reinforces the importance of education and regular touch points to prevent complications and improve outcomes.
REFERENCES: Medication Adherence: Truth and Consequences, Effective Interventions to Improve Medication Adherence in Type 2 Diabetes, Social Determinants of Health and Diabetes, Poor Medication Adherence in Type 2 Diabetes, Factors Influencing Medication Adherence Among Adults Living with Diabetes and Comorbidities
About the Author
