Odegard and Gray conducted a study to characterize adherence and medication management barriers for adults with poorly controlled (those with A1c 9% or above) type 2 diabetes mellitus (DM) and to identify specific adherence characteristics associated with poor diabetes control. The study was part of a cross-sectional analysis of baseline data from a randomized, controlled diabetes intervention conducted in University of Washington (UW) Medicine Clinics in the greater Seattle area. The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months. Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Questionnaire. Specific adherence characteristics associated with poor diabetes control (A1c >9%) were identified using multivariate regression analysis. Seventy-seven subjects (mean A1c, 10.4%; mean duration of DM, 7 years) were studied. The most common adherence challenges included paying for medications (34%), remembering doses (31%), reading prescription labels (21%), and obtaining refills (21%). Taking more than two doses of DM medication daily and difficulty reading the DM medication prescription label were significantly associated with higher hemoglobin A1c. Self-reported adherence was unrelated to A1c control.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROFESSIONAL: The authors identified several variables related to medication adherence, as well as two related to higher hemoglobin A1c. They concluded that their findings highlight the importance of identifying potential challenges to medication adherence for those with DM, and providing support to minimize or resolve these barriers to control.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Not being able to read the instructions or taking more that two doses of a diabetes drug or could lead you not to be compliant to medication instructions. Be certain you know what you should do before leaving your health care provider’s office. Taking more than one dose of a drug each day can be managed by buying an inexpensive pill container at your local drug store. It will have certain times of the day marked when you need to take your drug. Even then, however, it is hard to remember to take all your drugs at the correct time. Do the best you can and avoid becoming guilty if you miss a dose. Take the next one as scheduled!

PS Odegard, SL Gray. Barriers to medication adherence in poorly controlled diabetes mellitus. Diabetes Education, 2008;34:692-697.