Why Don’t They Take Their Medication?
Former Surgeon General C. Everett Koop famously said, "Drugs don't work in patients who don't take them."
Taking medications as prescribed (medication adherence) and taking them consistently (medication persistence) are sources of concern for people with chronic health conditions and their healthcare providers. For people with type 2 diabetes, missing meds puts people directly at higher risk of emergency room visits and developing health complications.
With such serious consequences at stake, what kind of problem-solving can people with type 2 diabetes and their healthcare providers do together to encourage medication adherence and persistence? When barriers are eliminated, people with type 2 diabetes can enjoy a better quality of life.
Understanding the impact of missing medications on type 2 diabetes
For people with type 2 diabetes, missing medications directly affects their health. Not taking diabetes medicine as prescribed makes it harder to keep blood glucose levels in target range. Blood glucose levels can go up or become volatile.1
Over time, these poorly managed glucose levels lead to higher A1c levels. A higher A1c means an increased risk of developing serious health complications. The likelihood of emergency room or hospital stays also increases with a higher A1c.1
Medication adherence by the numbers
A substantial number of people with type 2 diabetes miss taking their medications at some time or another. Studies report that anywhere from 38 percent to 93 percent of patients with type 2 diabetes haven't taken their medication as prescribed. The number varies so widely because different studies use different ways to measure adherence.1
Whatever the actual number is, it's clear that the health of a significant number of people with type 2 diabetes has been put in jeopardy, frustrating both patients and healthcare providers.
Recognizing barriers to medication adherence and persistence
Rarely is the case that the person simply refuses to take their medications. 1 or more barriers are usually present and disrupt the person's ability to take their medications as prescribed.
The most commonly reported barriers to taking medicines as prescribed are:1
- Concerns about out-of-pocket cost
- How complicated and/or convenient it is to take the medication as prescribed
- Fear of hypoglycemia and other side effects
- Beliefs about the medication, especially related to long-term effects
- Perceptions about medication effectiveness
- Trust level with healthcare provider
Each of these barriers can result from circumstances particular to the individual. To effectively remove any barrier to medication adherence and medication persistence, you have to consider and address each unique situation.
Concerns about out-of-pocket costs, for example, can grow out of many different sources. While the aspect that might come to mind is limited insurance coverage, that's not the only source that can drive this concern. Whether additional supplies, like test strips or syringes, also need to be purchased can be a concern. Traveling to a pharmacy or getting mail-order prescriptions also affects worries about the cost of time and money.
Confusing and complex medication regimens
The complexity of medication regimens can lead to overwhelm and missing meds. Often, people managing type 2 diabetes take more than 1 medication. Each additional medicine adds complexity to the person's daily care routine.
Some medications need to be taken several times per day. Injections require needles or syringes and (maybe) a discrete place to take an injection. There can be a lot of details to keep in mind.
Even with excellent organization skills and lots of reminders, the best-laid plans can (and do) come undone. Something as common as traveling across time zones or changing work shifts can bring chaos to already complex medication routines.
Fear of side effects
Not understanding how a particular medication works can also make people hesitant to take their prescriptions. People can be fearful of potential side effects from a medication, like experiencing extremely low blood glucose levels or developing kidney damage over time.
Sometimes, when people don't feel any difference after taking a medication, they assume that the medicine isn't working and think they don't need to take it anymore. Addressing these barriers requires uncovering the reason behind the person's hesitancy and addressing it directly.
Problem-solve to address barriers at the source
Any barrier can be effectively removed by uncovering and addressing a barrier's particular source. There is no single source or barrier to medication adherence or persistence. Each person's experience is unique and can change over time.
A strong starting point is cultivating clear, honest, and open communication between the person with type 2 diabetes and their healthcare providers. Discussing why medications are being missed, without pre-judgment, provides a solid base to work from. This environment makes it possible to solve problems without blame or shame.
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