Currently Viewing:
Supplements Utilizing Advances in Diabetes and Targeting Medication Adherence to Enhance Clinical Outcomes and M
Economic Impact of and Treatment Options for Type 2 Diabetes
Jan D. Hirsch, BSPharm, PhD, and Candis M. Morello, PharmD, CDE
Overview of the Cardiovascular Benefit With Diabetic Agents and Novel Combination Products for Type 2 Diabetes
Candis M. Morello, PharmD, CDE
Currently Reading
Strategies for Addressing the Cost of Nonadherence in Diabetes
Candis M. Morello, PharmD, CDE, and Jan D. Hirsch, BSPharm, PhD
Utilizing Advances in Diabetes and Targeting Medication Adherence to Enhance Clinical Outcomes and Manage Costs for Type 2 Diabetes Posttest

Strategies for Addressing the Cost of Nonadherence in Diabetes

Candis M. Morello, PharmD, CDE, and Jan D. Hirsch, BSPharm, PhD
Conclusion
Diabetes is a chronic, progressive, and costly disease, one that is dependent on self-management behaviors and a patient-centered collaborative model of care for effective long-term management. Medication nonadherence poses a significant barrier to effective management of diabetes, with issues for patients. While studies have demonstrated that treatment adherence is associated with improved glycemic control, almost 60% of patients with diabetes fail to reach their glycemic goals. Understanding the factors associated with nonadherence may help develop patient-, provider-, and system-focused strategies to help increase the rates of medication adherence, reduce complications associated with uncontrolled diabetes, and lower the overall cost of management. Treatment advances and improvements in delivery systems, along with innovative technologies, can also be used to help patients overcome some of the challenges associated with the management of diabetes. 

Author affiliations: Dr Hirsch is a professor of clinical pharmacy, chair, division of clinical pharmacy, and executive director, Partners in Medication Therapy, at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California, San Diego, and also a clinical pharmacist specialist at Veterans Affairs of San Diego Healthcare System in San Diego, CA; Dr Morello is a professor of clinical pharmacy and associate dean for student affairs at the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California, La Jolla, CA, and a clinical pharmacist specialist at the Veterans Affairs San Diego Healthcare System in San Diego, CA.

Funding source: This activity is supported by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Inc; Lilly USA, LLC; and Merck Sharp & Dohme Corp.

Author disclosures: Drs Morello and Hirsch have no relevant financial relationships with commercial interests to disclose.

Author information: Acquisition of data (CMM); analysis and interpretation of data (CMM); concept and design (CMM, JDH); critical revision of the manuscript for important intellectual content (JDH); drafting of manuscript (CMM, JDH).

Address correspondence to: candismorello@ucsd.edu or anhirsch@ucsd.edu.

1.        Avoidable costs in US health care. QuintilesIMS website. www.imshealth.com/files/web/IMSH%20Institute/Reports/Avoidable_Costs_in%20_US_Healthcare/IHII_AvoidableCosts_2013.pdf. Published 2013. Accessed July 18, 2017.
2.        Blackburn DF, Swidrovich J, Lemstra M. Non-adherence in type 2 diabetes: practical considerations for interpreting the literature. Patient Prefer Adherence. 2013;7:183-189. doi: 10.2147/PPA.S30613.
3.        American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(suppl 1):S1-S135.
4.        Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218-1224.
5.        Ali MK, Bullard KM, Gregg EW. Achievement of goals in U.S. diabetes care, 1990-2010. N Engl J Med. 2013;369(3):287-288. doi: 10.1056/NEJMc1306652.
6.        Fu AZ, Sheehan JJ. Treatment intensification for patients with type 2 diabetes and poor glycaemic control. Diabetes Obes Metab. 2016;18(9):892-898. doi: 10.1111/dom.12683.
7.        Asche C, LaFleur J, Conner C. A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clin Ther. 2011;33(1):74-109. doi: 10.1016/j.clinthera.2011.01.019.
8.        Boye KS, Curtis SE, Lage MJ, Garcia-Perez LE. Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database. Patient Prefer Adherence. 2016;10:1573-1581. doi: 10.2147/PPA.S107543.
9.        Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy. 2014;7:35-44. doi: 10.2147/RMHP.S19801.
10.      Jaam M, Awaisu A, Ibrahim MIM, Kheir N. A holistic conceptual framework model to describe medication adherence in and guide intervention in diabetes mellitus. Res Social Admin Pharm. 2017. pii: S1551-7411(17)30472-2. doi: 10.1016/j.sapharm.2017.05.003.
11.      Morello CM, Hirsch JD, Lee KC. Navigating complex patients using an innovative tool: the MTM Spider Web. J Am Pharma Assoc (2003). 2013;53(5):530-538. doi: 10.1331/JAPhA.2013.12244.
12.      Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93(1):1-9. doi: 10.1016/j.diabres.2011.02.002.
13.      Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger P-M. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med. 2012;29(5):682-689. doi: 10.1111/j.1464-5491.2012.03605.x.
14.      Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Social factors and barriers to self-care adherence in Hispanic men and women with diabetes. Patient Educ Couns. 2015;98(6):805-810. doi: 10.1016/j.pec.2015.03.001.
15.      Farmer A, Kinmonth AL, Sutton S. Measuring beliefs about taking hypoglycaemic medication among people with type 2 diabetes. Diabet Med. 2006;23(3):265-270. doi: 10.1111/j.1464-5491.2005.01778.x.
16.      Farsaei S, Radfar M, Heydari Z, Abbasi F, Qorbani M. Insulin adherence in patients with diabetes: risk factors for injection omission. Prim Care Diabetes. 2014;8(4):338-345. doi: 10.1016/j.pcd.2014.03.001.
17.      Rabin DL, Jetty A, Petterson S, Saqr Z, Froehlich A. Among low-income respondents with diabetes, high-deductible versus no-deductible insurance sharply reduces medical service use. Diabetes Care. 2017;40(2):239-245. doi: 10.2337/dc16-1579.
18.      Watanabe JH, Singh RF, Morello CM, Bounthavong M, Hirsch JD. Are Medicare and Medicare-Medicaid insulin users different? comparisons in a nationally representative claims database. Paper presented at: American Diabetes Association 75th Scientific Sessions; June 5-9, 2015; Boston, MA.
19.      Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166(17):1836-1841.
20.      Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004;27(9):2149-2153.
21.      Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43(6):521-530.
22.      Zeng F, An JJ, Scully R, Barrington C, Patel BV, Nichol MB. The impact of value-based benefit design on adherence to diabetes medications: a propensity score-weighted difference in difference evaluation. Value Health. 2010;13(6):846-852. doi: 10.1111/j.1524-4733.2010.00730.x.
23.      Patel MR, Piette JD, Resnicow K, Kowalski-Dobson T, Heisler M. Social determinants of health, cost-related nonadherence, and cost-reducing behaviors among adults with diabetes: findings from the National Health Interview Survey. Med Care. 2016;54(8):796-803. doi: 10.1097/MLR.0000000000000565.
24.      Libby AM, Fish DN, Hosokawa PW, et al. Patient-level medication regimen complexity across populations with chronic disease. Clin Ther. 2013;35(4):385-398.e1. doi: 10.1016/j.clinthera.2013.02.019.
25.      Delamater AM. Improving patient adherence. Clin Diabetes. 2006;24(2):71-77. doi: 10.2337/diaclin.24.2.71.
26.      Marzec LN, Maddox TM. Medication adherence in patients with diabetes and dyslipidemia: associated factors and strategies for improvement. Curr Cardiol Rep. 2013;15(11):418. doi: 10.1007/s11886-013-0418-7.
27.      Sirey JA, Greenfield A, Weinberger MI, Bruce ML. Medication beliefs and self-reported adherence among community-dwelling older adults. Clin Ther. 2013;35(2):153-160. doi: 10.1016/j.clinthera.2013.01.001.
28.      Morello CM, Chynoweth M, Kim H, Singh RF, Hirsch JD. Strategies to improve medication adherence reported by diabetes patients and caregivers: results of a Taking Control of Your Diabetes survey. Annals Pharmacother. 2011;45(2):145-153. doi: 10.1345/aph.1P322.
29.      Larkin AT, Hoffman C, Stevens A, Douglas A, Bloomgarden Z. Determinants of adherence to diabetes treatment. J Diabetes. 2015;7(6):864-871. doi: 10.1111/1753-0407.12264.
30.      Meece J. Improving medication adherence among patients with type 2 diabetes. J Pharm Pract. 2014;27(2):187-194. doi: 10.1177/0897190013513803.
31.      Brennan TA, Dollear TJ, Hu M, et al. An integrated pharmacy-based program improved medication prescription and adherence rates in diabetes patients. Health Aff (Millwood). 2012;31(1):120-129. doi: 10.1377/hlthaff.2011.0931.
32.      American College of Clinical Pharmacy; McBane, SE, Dopp AL, Abe A, et al. Collaborative drug therapy management and comprehensive medication management, 2015. Pharmacotherapy. 2015;35(4):e39-e50. doi:10.1002/phar.1563.
33.      Viswanathan M, Kahwati LC, Golin CE, et al. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(1):76-87. doi: 10.1001/jamainternmed.2014.5841.
34.      Grabner M, Chu J, Raparla S, Quimbo R, Zhou S, Conoshenti J. Clinical and economic outcomes among patients with diabetes mellitus initiating insulin glargine pen versus vial. Postgrad Med. 2013;125(3):204-213. doi: 10.3810/pgm.2013.05.2656.
35.      Xie L, Zhou S, Wei W, Gill J, Pan C, Baser O. Does pen help? a real-world outcomes study of switching from vial to disposable pen among insulin glargine-treated patients with type 2 diabetes mellitus. Diabetes Technol Ther. 2013;15(3):230-236. doi: 10.1089/dia.2012.0253.
36.      Cuddihy RM, Borgman SK. Considerations for diabetes: treatment with insulin pen devices. Am J Ther. 2013;20(6):694-702. doi: 10.1097/MJT.0b013e318217a5e3.
37.      Pearson TL. Practical aspects of insulin pen devices. J Diabetes Sci Technol. 2010;4(3):522-531. doi: 10.1177/193229681000400304.
38.      Insulin pumps. American Diabetes Association website. www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-pumps.html. Updated June 29, 2015. Accessed July 5, 2017.
39.      Reznik Y, Cohen O, Aronson R, et al; OpT2mise Study Group. Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial. Lancet. 2014;384(9950):1265-1272. doi: 10.1016/S0140-6736(14)61037-0.
40.      Bangalore S, Kamalakkannan G, Parkar S, Messerli FH. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007;120(8):713-719. doi: 10.1016/j.amjmed.2006.08.033.
41.      Nau DP. Recommendations for improving adherence to type 2 diabetes mellitus therapy--focus on optimizing oral and non-insulin therapies. Am J Manag Care. 2012;18(3 suppl):S49-S54.
42.      Pan F, Chernew ME, Fendrick AM. Impact of fixed-dose combination drugs on adherence to prescription medications. J Gen Intern Med. 2008;23(5):611-614. doi: 10.1007/s11606-008-0544-x.
43.      Medication Therapy Management programs for complex health needs. Medicare.gov website. www.medicare.gov/part-d/coverage/medication-therapy-management/medication-therapy-programs.html. Accessed May 27, 2017.
PDF
 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up