Dr. Kailash Tripathi talks about adherence to therapy for Diabetes control - Zee News

Adherence to therapy for diabetes control

The degree to which a patient is committed to taking medication, adhering to a diet, making lifestyle changes, and aligning with accepted advice from a healthcare provider is known as adherence to therapy. When type 2 diabetes mellitus manifests, patients are initially urged to maintain a healthy diet and exercise routine. This is followed by early medication, which typically consists of one or more pills and may subsequently include injections.

Despite the advantages of therapy, studies have shown that less than 50% of patients meet the suggested blood glucose targets, which may be related to lower adherence to treatments. High blood sugar levels and chronic consequences thereby raise difficulties of life and premature death, as well as the price of healthcare services.1

Why may one fail to adhere to the treatment suggested?

The causes of nonadherence are complex and challenging to pinpoint. Age, knowledge of the condition, duration of treatment, the complexity of the dosing regimen, need to take multiple pills, psychological considerations, the safety of medicines, and cost are a few.

Adherence rates are usually reduced for patients with chronic conditions like diabetes than those with acute conditions; the decline in adherence is most rapid after the first six months of therapy. Such reduced adherence results in poor health outcomes and significantly impacts healthcare costs.2 Adherence to diet and exercise substantially improves health.3

The cost of medications can be a reason for a lack of adherence. According to a study, 34% of patients said that not taking their prescriptions as prescribed was due to the cost.3

The factors influencing adherence to exercise include overuse, injuries and lack of motivation, and whether the activity is routinely monitored. Regarding diet, patients expressed a dislike for foods included in meal plans.

Consequences of poor adherence

Skipping meals may increase the chances of binging on food that isn't good for diabetes, and as a result, the patient starts to feel hungry and irritated, the mind becomes foggy and lacks clarity, and one could also gain weight. Not adhering to diet will also lead to medication imbalances causing gastrointestinal side effects.

Poor adherence to medications makes diabetes control difficult, which may increase the chances of complications like kidney damage, eye damage, amputation, heart disease, stroke, etc.4

Another long-term consequence of poor adherence is increased health-related expenses linked to type 2 diabetes. WHO emphasizes that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments”2

What to do if it is challenging to stick to the treatment or lifestyle changes suggested?

One has to discuss it very openly with the doctor. The doctor may help reduce the complexity of the medicines that are being taken, educate and persuade to stick to the treatment regimen, suggest alternate options, and prescribe cost-effective medicines. One can also use mobile apps, calendars and reminders that help to follow the treatment recommended.

References:

García-Pérez LE, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther. 2013 Dec;4(2):175-94.  World Health Organization: Adherence to long-term therapies. Evidence for action. Geneva: World Health Organization; 2003 American Diabetes Association Standards of medical care in diabetes: 2013. Diabetes Care. 2013;36(Suppl 1):S11–S66. Odegard PS, Gray SL. Barriers to medication adherence in poorly controlled diabetes mellitus. Diabetes Educ. 2008;34:692–697Tiv M, Viel J-F, Mauny F, et al. Medication adherence in type 2 diabetes: the ENTRED study 2007, a French population-based study. PLoS ONE. 2012;7:e32412.

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