Why Don’t They Take Their Medication?

By Corinna Santa Ana

3 min read

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

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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.

Cost concerns

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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Diane Talbert Moderator & Contributor
Hello <inline-mention username="Corinna Cornejo" user-id="3541819"/> , This is such a great article and right on point. It covered everything I have thought about over the past 40 years. Thanks for sharing these tips so that others can see that there is always a way out. Diane, Team Member
Corinna Santa Ana Moderator & Contributor
Glad to hear this post resonated with you <inline-mention username="Diane Talbert" user-id="3607879"/>. We really need to move away from labeling people "good" or "bad" when their diabetes care doesn't go as expected and get to the reason behind it.
Diane Talbert Moderator & Contributor
Hello <inline-mention username="Corinna Cornejo" user-id="3541819"/>, You nailed it right on the head. My husband and I both have T2D. People do label us. Now for me; I know why I have it. I used to eat all kinds of junk and didn't know what a gym was. I take pills now, but my husband has to take insulin. The weird part is that we all thought my husband was in excellent health. He worked out every day, had muscles for days, had no weight issues, and ate healthy foods. The doctors just said that genetics played a part in this for him. This is my favorite line in your article - "each person's experience is unique and can change over time". This is so true. Take care, Diane - Team Member
CommunityMember5b06e8 Member
I have to take so many"supporting" drugs because of diabetes. Only 3 out of 6 drugs I'm taking are directly diabetes related. The others are statins, cholesterol, etc. It's too much drugs to take IMO.
1. GabbyFormica Community Admin
 <inline-mention username="CommunityMember5b06e8" user-id="6760182"/>, We hear you, that is a lot to manage. That's not even considering any side effects! How do you keep yourself organized? Gabby (team member)
Corinna Santa Ana Moderator & Contributor
<inline-mention username="CommunityMember5b06e8" user-id="6760182"/> Managing a lot of different medications can be challenging. One thing I've done in the past is asked my doctor to review my prescriptions to make sure that everything I'm taking is still needed and my best option. Have you thought of doing this?
Trinette Stanford, LLC, RN, FNP-C, CDCES Moderator
<inline-mention username="CommunityMember5b06e8" user-id="6760182"/> I understand your frustration about all of the medicines not related to diabetes. But they really are related- like distant cousins. Diabetes causes inflammation in blood vessels. The response can be plaque build up in the vessels. Plaque can break off and act like a blood clot. It can block blood going to the heart (heart attack) or brain (stroke). So in order to decrease the risk of these occurrences, you take a statin to lower the plaque formation in the vessel. The diabetes medicine's goal is to lower your blood sugar and keep it controlled. This will diminish inflammation and keep your system operating smoothly. Other things to consider is family history. Any history of stroke or heart attack, especially before the age of 50 in first degree relatives. As <inline-mention username="Corinna Cornejo" user-id="3541819"/> points out, ask for a medication review and explanation. If unable to meet with your provider, set up an appointment with a diabetes educator. They can review your medications and labs to put everything into perspective. Hope this explanation helps. @Trinette Stanford, community moderator
CommunityMemberc5cf8e Member
Great article . I miss medication half of the year. Medicare’s donut hole makes my medication unaffordable. 
1. Lori.Foster Community Admin
 It breaks my heart to hear that, <inline-mention username="CommunityMemberc5cf8e" user-id="3538904"/>. No one should have to go without medication because they can't afford it. Are you aware of the changes to come to Medicare in 2025? The Inflation Reduction Act puts a yearly cap of $2,000 a year on out-of-pocket prescription costs. That's still a lot, but at least there will be a limit. I hope that helps you. Gentle hugs. - Lori (Team Member)
CommunityMemberc5cf8e Member
Thank you.
SweetEnough Member
I’m glad that the word ‘compliance’ has not been used in this article. I can’t think of many other words that cause an instant barrier in people that are being admonished to take their meds. In the UK most National Health Trusts have stopped free prescription of test strips for non insulin medicated T2 diabetics and this means that that T2s cannot monitor their blood glucose so are flying blind. Monitoring bgs is the best navigational tool we have. If people don’t take their meds regularly then they’ll get a sharp reminder if they are monitoring their bgs daily. I’m all in favour of the blunt approach where people that are not taking their diabetes meds are told “if you don’t take your meds you will die a painful lingering death with possible blindness, amputations, kidney damage and neuropathy.” I don’t have to pay directly for my meds (paid all my life with National Health subscriptions) but if I had to pay directly I’d know that living was my number one priority. As regards side effects, management of diabetes has always been a case of balancing the pros and cons. Meds can usually be changed to something with less side effects. Complex medication regimens can be managed with special pill dispensers and so on. But really the bottom line is that when people see how high their bgs rise when not taking their meds that will be the trigger for them to take action. There will be others that won’t change and there’s nothing that can be done about that. 
1. Lori.Foster Community Admin
 Hi <inline-mention username="SweetEnough" user-id="4506842"/>. It really can be a wakeup call when people develop irreversible damage from Type 2 diabetes. It is so important that doctors take the time to educate newly diagnosed patients about their diabetes, the medications, and the dietary and lifestyle changes that can help, and then refer them to people who can help even more, like dieticians. But our healthcare system isn't set up for that. Most doctors can't invest that kind of time in each patient. It's a shame because addressing some of these fears and misconceptions could save lives. Thanks so much for your insight. Wishing you the best. - Lori (Team Member)