Improving Medication Adherence in Type 2 Diabetes

Jasmine D. Gonzalvo, PharmD, and Dhiren Patel, PharmD, discuss ways to help patients with type 2 diabetes mellitus overcome barriers to medication adherence.

Jasmine D. Gonzalvo, PharmD: Counseling people on good medication adherence is not something that I do specifically. Rather, what I do is ask questions about it. Let’s say somebody is not taking their diabetes medication every day, I might say, “Well, tell me what makes it difficult for you to take your medication every day.” For example, if they say, “I don’t want to,” then we’re going to have a longer conversation about, “Why don’t you want to?” We’ll figure out specifically what those barriers are for individual people, rather than me guessing at what they might feel or saying, “Oh, maybe you should just use a pillbox” or, “Set an alarm to remember to take you medications.”

Oftentimes, it’s not an actual barrier that’s in place for someone not taking their medications. The best analogy that I like to use is flossing. When we talk about medication adherence, it’s analogous to flossing. Oftentimes, I talk to my students: “How many of you floss?” I usually get about 25% out of a good audience. Then I ask, “But how many of you know that it’s important to floss?” and 100% of the students raise their hands. I think that’s really analogous to medication adherence.

It’s not that people don’t know it’s important to take their medication. There are a hundred million other factors that come into play for why people don’t take their medications. That’s what I really do to dive deep with individual patients. I ask, “Well, what is it? What is your specific barrier?” It can be so many things. But oftentimes, it comes from an emotional place or a not understanding place or a misunderstanding place, where they don’t know why it’s beneficial to take a medication. Those are the longer conversations that I appreciate having with patients versus just giving tips or giving a medication adherence speech.

Dhiren Patel, PharmD: Adherence to insulin therapy has a lot of different factors that can drive the success or the failure of it. A lot of it comes from, as a pharmacist, being able to properly educate patients regarding its use, how it works, and what the side effects are, and making sure that you’re very up-front with the patient in disclosing any of those risks that might be associated with it. The 2 that come to mind are hypoglycemia—low blood sugars—and weight gain. We know that they come along with insulin, but there are various ways you can minimize them through appropriate counseling and making sure the administration of it is correct and at the right time.

With some of the newer generation basal insulins, we’ve seen improve hypoglycemia profiles. We’ve seen no additional weight gain. So, these are all attractive features. If not communicated to the patient, they don’t realize that, and they think that all insulin is the same. I would say some of the side effects end up being the biggest predictors of if a patient is going to be adherent to therapy or not. If you can tackle them in the beginning, I think that will set that patient up for success down the line.

Jasmine D. Gonzalvo, PharmD: Simplifying a medication regimen for patients is pretty much always desirable. We want somebody to have less of a pill burden, for example. If it’s affordable and if it’s covered by insurance, of course I make it a priority to minimize the number of pills that somebody would have to take. Using a lesser number of injections with insulin would be ideal for a patient. I think it’s pretty easy to understand that it’s better to take less injections than more injections, or less pills than more pills. Any time we can do that, especially as pharmacists, decrease the pill burden or decrease the number of medications or injections, I think that’s going to be supportive of someone taking their medications as prescribed.