Diabetic Patients and Medication Adherence: How Pharmacists Can Improve Compliance
After three months of falling off her diet more days than she stayed on target, Kayla stepped on the scale in her doctor’s office and learned she had only dropped three of the expected 10 pounds. When blood tests revealed her glucose was still too high, her doctor prescribed metformin. She took the first round but didn’t refill the prescription, blissfully unaware that her actions increased the risk of complications from uncontrolled diabetes.
Kayla’s not alone—at least 30 percent of patients with diabetes don’t adhere to their treatment regimen. Compounding pharmacists are positioned to significantly improve medication adherence and compliance, and boost their bottom line in the process.
Non-Compliance in Diabetic Patients
There’s no doubt that it’s hard for patients with diabetes to stick with required changes in their diet and to follow an exercise program, but it turns out that many find it just as challenging to consistently take medications. Overall adherence to a treatment plan is estimated to be around 50 percent, but statistics vary from 30 percent to 80 percent due to variables such as patients who adhere to only one part of a multimodal regimen. Non-compliance is linked to an increased risk of cardiovascular disease, kidney disease and all-cause mortality.1 These statistics highlight the depth of the problem:
- Most patients with type 2 diabetes fail to control blood glucose with diet and exercise, so they ultimately need medication.
- Only 40 percent of patients taking oral glucose-lowering medication persisted after 24 months.
- In type 2 diabetics taking insulin, 25 percent never refilled their prescription.2
- Reasons cited for nonadherence include medication side effects, complexity of treatment regimen and cost.
- Diabetes is the 7th most common cause of death in the U.S.3
Pharmaceutical Options That Make a Difference in Medication Adherence
Lack of adherence is especially distressing considering that complications can be prevented or delayed with proper treatment. Compounding pharmacists can intervene to help patients overcome barriers related to medications.
Inhaled Insulin: Patients have a new option that may improve compliance over injectable insulin—rapid-acting inhaled insulin. Afrezza was approved by the FDA in October 2015 for adults with type 1 or type 2 diabetes.4 Onset of action is 15 to 30 minutes, it reaches peak at 53 minutes and lasts for about 2.7 hours. The most common adverse effects include hypoglycemia, cough, throat pain and headache.
Formulary Issues: Compounding pharmacists can offer options to reduce the complexity of the medication regimen. After a brief counseling session to target the issues, some solutions to consider include:
- Patients with diabetes often take multiple medications such as oral diabetes meds, anti-hypertensives and lipid-lowering medications. If the prescription and dosage allow, combining multiple meds into one dose will increase compliance.
- For some patients, formulating a liquid rather than a pill may make meds easier to take.
- Diabetic patients with neuropathy or skin ulcers can add topical medications to the treatment regimen. Tailored formulations with the appropriate combination of meds improve efficacy and support compliance thanks to streamlined treatment.
- Talk to these patients about the different topical and transdermal options for healing wounds, relieving pain, and improving circulation and skin hydration, including meds such as verapamil, capsaicin, lidocaine and ketoprofen.
Future Options: Oral insulin product ORMD-0801 for type 1 and type 2 diabetes is currently in phase II clinical trials, while ORMD-0901—an oral glucagon-like peptide-1—is in phase I. Telling patients more options are in the works may encourage them to adhere with current meds longer.
Outreach to Improve Compliance
Each patient has their own reason for lack of compliance. While it may feel like you’re pushing too hard or stepping into their personal business, compounding pharmacists should never underestimate their role and their ability to influence outcomes.
- Studies show that when pharmacists engage patients with diabetes, medication adherence and clinical outcomes are improved.
One important cause of noncompliance—cost of medications—is a topic often avoided by patients. The key is to reach out and make a connection with patient when they fill the first prescription. Following up with a phone call can be helpful, especially if they don’t come back for a refill.
Tips for Counseling Diabetic Patients:
- Always discuss adverse effects. In a survey, 72 percent of patients reported experiencing at least one problem in the two weeks prior to the survey. The most common concerns were hypoglycemia, gastrointestinal problems, weight gain, headache and fluid retention.5
- Counseling about side effects is the perfect way to start a discussion. Patients may not know there are different classes of diabetes meds and that simply making a change may relieve problems.
- Noncompliance often includes failure to keep doctor’s appointments. You can intervene to screen for side effects and offer guidance about the risks of noncompliance. Encourage patients to see their doctor; even offer support in scheduling an appointment.
- Implement appointment-based medication synchronization, then actively enroll patients. Seventy-four percent of those who enrolled reported improved compliance.
- Be prepared with handouts that cover the complications of untreated diabetes, increased risk for chronic diseases, and the role of diet, exercise and medications to prevent negative outcomes. Be sure to include info on foot care.
- About 50 percent of people with diabetes take supplements they believe will lower blood glucose, such as cinnamon, chromium and magnesium.6 They may want to replace meds, prefer natural treatment, or hope to lower medication costs. Talk with them about supplement effectiveness and interactions with medications.
- Reach out to diabetic patients buying decongestants, cough syrup and other over-the-counter products known to raise blood glucose.
Everyone Wins When Pharmacists Reach Out
Pharmacists are among the most accessible—and trusted—health care professionals many patients encounter. The thing to remember is that most patients don’t know the extent to which compounding pharmacists can help improve their health. For individuals with diabetes, your role is vital because taking a proactive approach keeps them on track with life-saving treatments. And remember that patients aren’t the only ones who benefit: surveys show that your bottom line also improves, as sales increase in tandem with better medication adherence.
Pharmaceutica North America provides the bulk pharmaceuticals and custom compounding kits needed to meet the treatment goals of your patients with diabetes. Please contact us today to discuss how our high-quality ingredients and delivery systems can support your unique compounding pharmacy.
- “The Impact of Treatment Non-Compliance on Mortality in People With Type 1 Diabetes,” November 2012, http://www.jdcjournal.com/article/S1056-8727(12)00286-3/abstract ↩
- “Adherence to Therapies in Patients With Type 2 Diabetes,” December 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889324/ ↩
- “Leading Causes of Death,” September 2015, http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm ↩
- “Inhaled Insulin: Controlling A1C Without a Needle,” October 2015, http://www.uspharmacist.com/content/s/381/c/57442/ ↩
- “Improving Adherence,” 2015, http://www.ncpa.co/images/Improving-Adherence-Infographic-Online2.png ↩
- “Taking Diabetes Drugs With Nutritional Supplements,” November 2011, http://www.todaysdietitian.com/newarchives/110211p32.shtml ↩