Type 2 diabetes medication adherence did not improve from 2017 to 2019 in US
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Adherence to type 2 diabetes medications did not significantly change from 2017 to 2019, and forgetfulness was the most common reason given for not taking medication as recommended, according to study findings.
“The Medication Adherence Reasons Scale provided an estimate of the extent of nonadherence with type 2 diabetes in a nationwide sample in the United States,” Elizabeth J. Unni, PhD, MBA, chair of the department of social, behavioral and administrative sciences at Touro College of Pharmacy in New York, and colleagues wrote in a study published in Nutrition, Metabolism and Cardiovascular Diseases. “Over time, little improvement in adherence with type 2 diabetes medicines was found, regardless of better awareness and interventions including extensive diabetes education. The future focus for interventions to increase type 2 diabetes adherence should be to provide individualized, nonadherence reasons-based interventions.”
Researchers analyzed data from adults responding to the U.S. National Health and Wellness Survey from 2017 to 2019. Those who self-reported having type 2 diabetes and taking a daily prescription medication to treat their diabetes were included. Respondents completed the Medication Adherence Reasons Scale, which included a global item assessing the extent and frequency of medication nonadherence and 19 items measuring specific reasons for nonadherence. Participants also completed the SF-36 to measure mental and physical quality of life and the Work Productivity and Activity Impairment questionnaire to measure work productivity loss.
Responses were obtained from 2,983 participants in 2017, 5,416 in 2018 and 5,268 in 2019. The rate of overall diabetes medication nonadherence was 25.11% in 2017, 20.88% in 2018 and 26.84% in 2019. Nonadherence rates during the 7 days before responding to the survey increased each year from 11.67% in 2017 to 18.94% in 2018 and 19.02% in 2019. Adherence was higher for those taking insulin therapies compared with noninsulin medications in all 3 years. The mean number of days missing medication was similar across all 3 years, at 2.76 days in 2017, 2.33 days in 2018 and 2.62 days in 2019.
Both the adherent and nonadherent groups had a similar percentage of participants with overweight or obesity in 2017 and 2018. In 2019, adherent participants had a higher proportion of overweight or obesity than those who reported not taking medications as directed. Those who were adherent also took fewer steps to lose weight across all 3 years, though there was no significant difference in exercise days between the groups.
Adherent participants reported drinking and smoking less, had better control of HbA1c levels and reported less neuropathic pain than participants reporting nonadherence. Those who were adherent had better mental and physical quality of life scores, less activity impairment and less work productivity loss.
In all 3 years, the most common reason for nonadherence was “simply missing the medicine.” The second most common reason was “missing the medicine due to busy schedule/change in schedule” in 2017 and 2018, and “concerns about long-term effects of medicines” in 2019.
The top reason for missing medicine for more days over the past week was “concerns about long-term effects” in 2017, “did not have money to pay for the medicine” in 2018, and “not sure how to take medicine” in 2019.
“Since belief-based reasons caused the most days missed, patient education should still be a high priority,” the researchers wrote. “Payers and pharmaceutical companies can develop population-based interventions to address the concerns about long term effects from medications or to develop patient assistance programs to tackle cost issues.”
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