Bucking the Trend: Getting Patients to Take Steps to Control Diabetes

The diabetes epidemic is quickly turning into a perfect storm. According to findings presented at the 71st American Diabetes Association (ADA) meeting, held last month in San Diego, California, the rate of diabetes is rapidly climbing, and despite being awareness of the risks associated with the disease, patients are not taking action to prevent or control diabetes.

Each year, roughly 6 million people worldwide develop diabetes; of those, more than 90% have type 2 diabetes. “The increasing prevalence of obesity—fueled by excessive calorie intake, suboptimum dietary quality, and sedentary lifestyles—is driving this epidemic,” wrote Frank Hu, MD, PhD, of Harvard School of Public Health, in a commentary published in The Lancet. “Obesity is a prominent risk factor for type 2 diabetes, and with global obesity rates rising, the ensuing burden of type 2 diabetes looks set to worsen.”

The easy answer, it would seem, is to focus on prevention. Results of the ACTID trial, presented at the ADA meeting, show that dietary advice given in a primary care setting can prevent a decline in glucose control in adults with type 2 diabetes.

The problem is despite the fact that adults are aware of the risks and dangers of diabetes, that knowledge doesn’t seem to translate into action. In fact, a large national sampling found that the vast majority of respondents said they know obesity contributes to chronic disease and that type 2 diabetes is as dangerous to health as type 1 diabetes. However, only 57.3% of patients at high risk of developing type 2 diabetes said they were even "considering" a plan to lose weight, an online article stated. And although 75% of high-risk individuals said they tried to keep from gaining weight and 70% said they tried to lose weight, only 34% were able to maintain their desired weight, and just 32.6% were able to follow a prescribed eating plan.

The statistics on exercise were even more alarming. According to the article, of the roughly 63% of study participants whose physicians suggested they exercise more, just 13% said they were physically active. In addition, 67% of these high-risk individuals said they performed little or no exercise.

Medication Nonadherence

And the problem isn’t limited to those who are at risk for diabetes.

Another key factor in the diabetes epidemic, according to a study presented by John R. White Jr., PharmD, is medication non-adherence among those who have been diagnosed with the condition.

In the United States, between a third and half of all patients with diabetes are not taking medications as directed. Nonadherence causes 69% of medication-related hospitalizations versus 33% in those who are adherent. Specific to diabetes, mortality increases to 12.1% from 6.7%, the risk of hospitalization goes up to 30% from 13%, and the average annual cost nearly doubles, to $16,498 from $8,886, White said during an ADA symposium.

Factors contributing most to nonadherence include complexity of the regimen, side effects, poor provider-patient relationship, the patient’s lack of belief in the benefit of treatment, and cost or insurance reimbursement, he noted. Earlier research had found 38% adherence with tid dosing versus 79% adherence with qd dosing, and a different study of 37,431 Medicaid type 2 diabetes patients found 15% adherence for monotherapy versus less than 5% with combination therapy.

“Part of the problem in diabetes is that it is a complex metabolic disease that exists often in the presence of other conditions,” said White, adding that providers “have to be cognizant of all these other factors that may contribute to adherence problems.”

He outlined a number of steps that health care professionals can take to help improve medication adherence in patients with diabetes:

• Identify patients with poor adherence.
• Emphasize the value of the treatment regimen.
• Elicit patients’ feelings and listen to their concerns.
• Reinforce desirable behavior.
• Incorporate other communication methods for improving the provider-patient relationship.
• Provide simple, clear instructions to patients, simplifying the regimen when possible (eg, qd versus tid).
• Consider medications with better side effect profiles.
• Seek help from family members or friends.

Finally, although the problem may seem daunting, it is critical that pharmacists, physicians, and all health care professionals emphasize the importance of prevention, screening, and early intervention.

For more information on how to help prevent or manage diabetes, click on the links below.

• Diabetes Management: The Role of the Pharmacist (CE activity)
• Cardiovascular Disease Risk Associated With Diabetes
• Controlling Diabetes: Teaching Patients to Take Charge