Trouble reading may contribute to poor glycemic control

At least two factors were linked to poor HbA1c levels in patients with diabetes.

Taking diabetes medication doses more than twice a day and having trouble reading the medication prescription label were factors associated with poorly controlled diabetes, according to a recent study.

Researchers from the University of Washington in Seattle conducted a cross-sectional analysis of data from a randomized, controlled diabetes intervention trial. The mean duration of diabetes for 77 patients was seven years; mean HbA1c was 10.4%.

“The hope is that the study findings help provide some practical tips for those working the front lines of diabetes care,” Peggy Soule Odegard, PharmD, CDE, associate professor of pharmacy, told Endocrine Today. “We wanted to reach the audience of diabetes care clinicians because the tips are practical and can be implemented at the diabetes care visit.”

Dosage and labeling problematic

Paying for medications (34%), remembering doses (31%), reading prescription labels (21%) and obtaining refills (21%) were the most common adherence challenges, according to the researchers.

The two factors that were associated with higher HbA1c levels were taking .two doses of diabetes medication per day (P=.02) and difficulty reading the medication prescription label (P=.04). Self-reported adherence was not linked to HbA1c control, according to the researchers.

“It is of particular interest that both of these factors are modifiable risks to medication adherence, in that medication regimens can be simplified in many cases to taking no more than two doses daily, and prescription labels can be produced in a larger size font or reprinted on large paper for the visually impaired,” the researchers wrote.

“These findings highlight the importance of identifying potential challenges to medication adherence for those with diabetes mellitus and providing support to minimize or resolve these barriers to control.” – by Christen Haigh

Diabetes Educ. 2008;34:692-697.

Diabetes Educ. 2008;34:692-697.

As many clinicians are aware, polypharmacy, the use of 5 or more medications in a regimen, is a risk factor for non-adherence. It is important for clinicians and educators to simplify and explain medication therapy(s) to patients. In addition, it is critical to assess the patient’s interpretation or understanding of their medication regimen. What a clinician says or what is written on a prescription label, and what a patient hears or reads may be different.

It is important for clinicians and educators to assess a patients understanding and review their utilization of medications at every visit. In addition, simplifying or minimizing multiple daily dosing of medications; as well as, the use of combination therapies, may improve adherence. The use of a multidiscipline team with optimal communication can improve patient care.

It is important to empower patients to take an active role in the management of their diabetes. Taking medication is one of the AADE 7 self care behaviors. If a patient comprehends the importance of their treatment plan and can identify barriers, as well as, suggest solutions to adherence upon initiation of their treatment plan, they are more likely to follow through and receive maximum benefit of the therapy.

Key questions to ask patients to assess their adherence are the following:

Q. What are you taking this medication for?
Assesses their understanding of the medication and how it helps their condition and potential for self discontinuation.

Q. How and when do you currently take your medication?
Assesses their adherence to therapy and if they are getting maximum benefit from their therapy.

Q. What have you noticed different since you started this medication?
Assesses adverse effects and potential adherence concerns.

Q. What situations interfere with you taking your medication as prescribed?
Assesses barriers to adherence and provides opportunity for open dialog to allow patient to identify solutions.

– Susan Cornell, BS, PharmD, CDE, CDM

Assistant Professor, Department of Pharmacy Practice, Midwestern University, Chicago