Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review Mail-order pharmacy use and medication adherence among Medicare Part D beneficiaries with diabetes Impact of family support improvement behaviors on anti diabetic medication adherence and cognition in type 2 diabetic patients Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus. Correlates of Medication Nonadherence Among Latinos With Type 2 Diabetes The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: A randomized pilot study. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia Challenges and lessons learned in the development and implementation of a couples-focused telephone intervention for adults with type 2 diabetes: the Diabetes Support Project Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes. Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-Americans and Latinos with Diabetes SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored Symptoms of depression prospectively predict poorer self-care in patients with Type 2 diabetes. Adherence to Preventive Medications Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER. Two Randomized Controlled Pilot Trials of Social Forces to Improve Statin Adherence among Patients with Diabetes The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia. Medication adherence survey of drugs useful in prevention of dementia of Alzheimer's type among Indian patients. Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes
Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration Abstract Objective : To examine medication adherence among Medicare Part D beneficiaries initiating oral anti-diabetic medications and explore whether there is any association of using mail-order pharmacy ( vs. retail pharmacy ) with better adherence in this patient population . Research design and methods : Using administrative pharmacy cl aims data , we conducted a retrospective cohort study on Medicare Part D beneficiaries who newly initiated oral anti-diabetic treatment between July 1 , 2008 and December 31 , 2008 . Mail-order pharmacy users were matched to retail pharmacy users via propensity scoring , controlling for patient demographic and clinical characteristics . Adherence with oral anti-diabetic medications during the benefit year of 2009 was assessed using the proportion of days covered ( PDC ) . Comparison of medication adherence between the mail-order pharmacy group and retail pharmacy group was conducted in the propensity matched sample using the paired t-tests and McNemar ’s tests . Results : A total of 22,546 patients who initiated oral anti-diabetic medications were identified .  The average PDC was 0.60 and only 41.6 % of the study population attained good adherence ( defined as PDC ≥ 0.8 ) with oral anti-diabetic medications during calendar year 2009 . The matched sample included 1361 patients in each of the mail-order and retail pharmacy cohorts . Compared with the retail pharmacy group , mail-order pharmacy users demonstrated a significantly higher PDC ( 0.68 vs. 0.61 ; P < 0.001 ) throughout the benefit year . More patients in the mail-order pharmacy group ( 49.7 % ) attained good adherence with their oral anti-diabetic medications compared to 42.8 % in the retail pharmacy group ( P < 0.001 ) . Limitations : The study was subject to limitations inherent in retrospective cl aims data base analysis . Conclusions : Adherence with oral anti-diabetic medications among Medicare Part D beneficiaries is suboptimal . Patients using mail-order pharmacy had better adherence to oral anti-diabetic medications than those who used retail pharmacies . However , the causal relationship between mail-order pharmacy use and adherence should be further examined in a r and omized study setting Background Glycaemic control is the main goal of treatment for type 2 diabetic patients . Hyperglycaemia may result in cognitive decline . More family support may increase medication adherence and decrease glycaemic level . The purpose of this study was to determine the impact of family support improvement behavior on anti diabetic medication adherence and cognition in type 2 diabetic patients . Method The r and omized control trial study was conducted on 91 patients from an outpatient diabetes clinic . They were r and omly divided to intervention ( n = 45 ) and control  ( n = 46 ) group . Data on the patients ’ demographic information and their family gathered using a question naire , For two groups Morisky Medication Adherence Scale ( MMAS ) , drug administration part of  Diabetes Social Support Question naire – family version ( DSSQ ) , Number Connection Test ( NCT ) were applied and hemoglobin A1C was measured two times in the onset of study and three months later for control group and before and after intervention for intervention group . The key family members of the intervention group were taught according to their educational needs in small groups . Result In intervention group mean of NCT score was significantly decreased after intervention ( P = 0.006 ) however in the control group there was no significant difference after three months . In intervention group a significant correlation was noted between DSSQ scores and MMAS scores after intervention(r = 0.67 , P < 0.001 ) but , there was no significant correlation in the control group . Conclusion Family support instruction based on the educational needs of family members , may improve medication adherence through direct effect and cognitive status with indirect effect AIMS Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control ( PGC ) in a cohort of patients with type 2 diabetes mellitus in Germany . METHODS Baseline data of the DIANA- study , a prospect i ve cohort study of type 2 diabetes mellitus patients in South-West Germany , were analysed . Information on medication adherence and factors related to PGC was obtained by self-administered question naire . PGC was defined as HbA(1c)≥7.5 % . Bivariate and multivariate analyses using log-binomial regression were employed to assess overall and gender-specific associations of non-adherence and PGC . RESULTS 624 men and 518 women were included in the analyses . In total , 147 men ( 24 % ) and 114 women ( 23 % ) reported non-adherence to medication . In men , PGC was found in 37 % of the participants reporting non-adherence and in 19 % reporting adherence ( adjusted prevalence ratio (PR)=1.90 , 95%-CI : 1.46 - 2.49 ) . In women , PGC was found in 19 % of the participants reporting non-adherence and in 18 % reporting adherence ( adjusted PR=0.97 , 95%-CI : 0.65 - 1.46 ) . CONCLUSIONS Our results show gender-specific differences in the association of adherence and PGC . This underlines the need for efforts to improve glycaemic control in patients with type 2 diabetes mellitus with a particular focus on men Purpose The purpose of this study is to assess factors related to diabetes medication nonadherence in a sample of predominantly Spanish-speaking Mexican-origin adults residing along the US-Mexico border . Methods As part of a r and omized controlled trial , 302 patients r and omly sample d from a clinic roster completed a baseline interview .  Medication nonadherence was assessed with the  Morisky Medication Adherence Scale .  Consistent with the framework proposed by Venturini et al , four factors were examined : patient-related attributes , drug regimen characteristics and complexity , health status , and patient-provider interaction characteristics . Results Sixty percent of the patients were classified as nonadherent . Men , those who engaged in diabetes control behaviors less frequently , and individuals with depression were more likely to be classified as nonadherent . Among those who were Spanish-dominant , education and self-rated health also were significantly and negatively related to medication adherence ; patients with a high school education or greater and those who more positively rated their health were more likely to be classified as nonadherent compared to those with less than a high school education and those who rated their health as poor . Conclusions Results reflect potentially higher medication nonadherence rates for Latinos with type 2 diabetes living in rural communities along the US-Mexico border . Additionally , this study supports the need to address strategies to support medication adherence , including addressing depression , for diabetes control . Strategies to promote adherence among Latino men are sorely needed , as are strategies to address forgetfulness and carelessness regarding diabetes medicine taking BACKGROUND Inadequate medication adherence reduces optimal health outcomes and can lead to increased costs , particularly in patients with diabetes . Efforts to improve adherence have result ed in limited effects ; approaches leveraging mobile technology have emerged , but their focus has mainly been limited to simple reminder messages . OBJECTIVE The purpose of this pilot study was to test the effectiveness of tailored text messages focusing on improving medication adherence and health beliefs in adults with diabetes . METHODS Adults aged 21 - 64 , with uncontrolled diabetes , and taking at least one anti-diabetic medication were recruited and r and omized into 2 study arms : daily tailored text messaging for 90 days or st and ard care . Comparing baseline and endpoint survey responses , changes in theory-driven health beliefs and attitudes were assessed . The impact on medication adherence was evaluated using pharmacy cl aims by calculating the percent of days covered ( PDC ) . RESULTS A total of 75 subjects were consented , and 48 were r and omized .  Mean PDC at baseline were comparable between cohorts ( 84.4 % and 87.1 % , respectively ) . Declines in adherence were observed in both groups over time but no significant differences were observed between groups or from baseline to the end of the active study period . Unadjusted tests suggested that perceived benefits and competence might have improved in the intervention arm . CONCLUSIONS Tailoring mobile phone text messages is a novel way to address medication nonadherence and health beliefs ; further investigation to this combined technique is needed to better underst and its impact on behavior change in adults with diabetes Background : Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia . Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved . Aims : The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia . Patients and Method : The study consists of two phases . A cross-sectional review of r and omly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview , with pre tested adherence and self management and monitoring tool question er of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic . Result : Oral hypoglycemic agent were prescribed for 351(91.4 ) of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6 % ) . About 312 ( 88.9 % ) patients on oral hypoglycemic agent were on mono therapy , the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3 % ) and metformine 80(25.7 % ) . Only 41.8 % of the patient had adequate glycemic control . The main external factors for non adherence were lack of finance ( 37.1 % ) followed by perceived side effect of drug 29.2 % . Only 6.5 % patient who missed their medications disclosed to physician during consultation . The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied . Conclusion : Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine . While the current prescribing strategy do not achieve glycemic control on majority of the patient . This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management ABSTRACT Type 2 diabetes ( T2DM ) studies report that marital/family support relates to glycemic control , adherence , and quality of life . Yet , there are few reports on couples-focused interventions . This study aims to describe the challenges faced and lessons learned in the implementation of a theoretically based , couples intervention .  Three hundred fifty couples ( one partner has T2DM in poor glycemic control ) are r and omized to a couples intervention , individual intervention , or enhanced usual care .  All contacts are by telephone to increase reach . The medical ( e.g. , glycemic control ) , psychosocial ( e.g. , diabetes distress ) , and behavioral ( e.g. , regimen adherence ) outcomes were measured . Challenges in recruitment , assessment , and intervention with couples are described , with suggestions about how to address them . Findings concerning the efficacy and cost-effectiveness of the couples intervention , its effect on partners , and possible mechanisms of demonstrated changes , are anticipated in 2013 . Interventionists need specific skills to work with couples to promote communal coping and increase the likelihood of an efficacious couples intervention PURPOSE The purpose of this study is to characterize the adherence and medication management barriers for adults with poorly controlled type 2 diabetes mellitus ( DM ) ( those with A1c 9 % or above ) and to identify specific adherence characteristics associated with poor diabetes control . METHODS This was a cross-sectional analysis of baseline data from a r and omized , controlled diabetes intervention conducted in University of Washington ( UW ) Medicine Clinics in the greater Seattle , Washington , area . The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months . Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Question naire . Specific adherence characteristics associated with poor diabetes control ( A1c > 9 % ) were identified using multivariate regression analysis . RESULTS Seventy-seven subjects ( mean A1c , 10.4 % ; mean duration of DM , 7 years ) were studied . The most common adherence challenges included paying for medications ( 34 % ) , remembering doses ( 31 % ) , reading prescription labels ( 21 % ) , and obtaining refills ( 21 % ) . Taking more than 2 doses of DM medication daily ( beta = .78 , SE = 0.32 , P = .02 ) and difficulty reading the DM medication prescription label ( beta = .76 , SE = 0.37 , P = .04 ) were significantly associated with higher hemoglobin A1c . Self-reported adherence was not related to A1c control . CONCLUSIONS In this study , we identified 2 factors that were associated with poorer A1c control . These findings highlight the importance of identifying potential challenges to medication adherence for those with DM and providing support to minimize or resolve these barriers to control We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design . One hundred and sixty-four participants with poorly controlled diabetes from two setting s were r and omized using computer-generated list into control ( n = 82 ) and intervention ( n = 82 ) groups , of which 151 completed the study . Monthly interventions over 12 weeks addressed the self-care practice s of diet , physical activity , medication adherence and self-monitoring of blood glucose ( SMBG ) . These self-care practice s were assessed at Weeks 0 and 12 using pre- and post- question naires in both groups together with glycated haemoglobin A1c ( HbA1c ) and diabetes knowledge . In the intention-to-treat analysis ( n = 164 ) , the intervention group improved their SMBG ( P = < 0.001 ) , physical activity ( P = 0.001 ) , HbA1c ( P = 0.03 ) , diabetes knowledge ( P = < 0.001 ) and medication adherence . At Week 12 , HbA1c difference adjusted for SMBG frequency , medication adherence and weight change remained significant ( P = 0.03 ) compared with control group . For within group comparisons , diabetes knowledge ( P = < 0.001 ) , HbA1c level ( P = < 0.001 ) , SMBG ( P = < 0.001 ) and medication adherence ( P = 0.008 ) improved from baseline in the intervention group . In the control group , only diabetes knowledge improved ( P = < 0.001 ) . These findings can contribute to the development of self-management diabetes education in Malaysia Background Adherence to prescribed medications is a key dimension of healthcare quality . The aim of this large population -based study was to evaluate self-reported medication adherence and to identify factors linked with poor adherence in patients with type 2 diabetes in France . Methodology The ENTRED study 2007 , a French national survey of people treated for diabetes , was based on a representative sample of patients who cl aim ed reimbursement for oral hypoglycaemic agents and /or insulin at least three times between August 2006 and July 2007 , and who were r and omly selected from the data base of the two main National Health Insurance Systems . Medication adherence was determined using a six-item self-administered question naire . A multinomial polychotomous logistic regression model was used to identify factors associated with medication adherence in the 3,637 persons with type 2 diabetes . Principal Findings Thirty nine percent of patients reported good medication adherence , 49 % medium adherence and 12 % poor adherence . The factors significantly associated with poor adherence in multivariate analysis were socio-demographic factors : age < 45 years , non-European geographical origin , financial difficulties and being professionally active ; disease and therapy-related factors : HbA1c>8 % and existing diabetes complications ; and health care-related factors : difficulties for taking medication alone , decision making by the patient only , poor acceptability of medical recommendations , lack of family or social support , need for information on treatment , reporting no confidence in the future , need for medical support and follow-up by a specialist physician . Conclusions In a country with a high level of access to healthcare , our study demonstrated a substantial low level of medication adherence in type 2 diabetic patients . Better identification of those with poor adherence and individualised suitable recommendations remain essential for better healthcare management WHAT IS KNOWN AND OBJECTIVE There is little evidence from well- design ed r and omized controlled trials of the impact of community pharmacist intervention on the clinical management of patients with type 2 diabetes . It is also not known how sustainable any observed effects on glycaemic control are , over time . This study was initiated to address both these issues . METHODS A 6-month , r and omized , controlled parallel-group trial in 66 community pharmacies was conducted in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 135 ) or a predefined pharmacist intervention ( n = 153 ) . The intervention mainly focused on correct medication use , medication adherence and healthy lifestyle promotion . Primary outcome was glycaemic control , as measured by fasting plasma glucose and HbA1c . Sustainability of changes in glycaemic control was assessed by additional glucose measurements 18 months after the end of the study . RESULTS AND DISCUSSION The intervention significantly reduced HbA1c ( between-group difference : 0·5 % , P = 0.009 ) . The largest impact on HbA1c was observed when pharmacotherapy changes ( i.e. , type and /or dose of hypoglycaemic agents ) initiated by the physician were sustained with pharmaceutical care : HbA1c was reduced by 1·05 % in the intervention group , whose medication was changed , compared with a reduction of 0·02 % in the therapy-modification only , group . It was also found that the diabetes education program result ed in improved self-management and better knowledge of diabetes . Eighteen months after the end of the formal study period , the mean HbA1c of the intervention group did not differ significantly from the control group ( 7·4 % vs. 7·2 % ) . WHAT IS NEW AND CONCLUSION This study provides new evidence , from a r and omized controlled trial , of the beneficial  effect of community pharmacist intervention in the clinical management of type 2 diabetic patients . However , questions remain about the sustainability of the observed improvements Background Given the increasing prevalence of diabetes and the lack of patients reaching recommended therapeutic goals , novel models of team-based care are emerging . These teams typically include a combination of physicians , nurses , case managers , pharmacists , and community-based peer health promoters ( HPs ) . Recent evidence supports the role of pharmacists in diabetes management to improve glycemic control , as they offer expertise in medication management with the ability to collaboratively intensify therapy . However , few studies of pharmacy-based models of care have focused on low income , minority population s that are most in need of intervention . Alternatively , HP interventions have focused largely upon low income minority groups , addressing their unique psychosocial and environmental challenges in diabetes self-care . This study will evaluate the impact of HPs as a complement to pharmacist management in a r and omized controlled trial . Methods / Design The primary aim of this r and omized trial is to evaluate the effectiveness of clinical pharmacists and HPs on diabetes behaviors ( including healthy eating , physical activity , and medication adherence ) , hemoglobin A1c , blood pressure , and LDL-cholesterol levels .  A total of 300 minority patients with uncontrolled diabetes from the University of Illinois Medical Center ambulatory network in Chicago will be r and omized to either pharmacist management alone , or pharmacist management plus HP support . After one year , the pharmacist-only group will be intensified by the addition of HP support and maintenance will be assessed by phasing out HP support from the pharmacist plus HP group ( crossover design ) . Outcomes will be evaluated at baseline , 6 , 12 , and 24 months . In addition , program and healthcare utilization data will be incorporated into cost and cost-effectiveness evaluations of pharmacist management with and without HP support . Discussion The study will evaluate an innovative , integrated approach to chronic disease management in minorities with poorly controlled diabetes . The approach is comprised of clinic-based pharmacists and community-based health promoters collaborating together . They will target patient-level factors ( e.g. , lack of adherence to lifestyle modification and medications ) and provider-level factors ( e.g. , clinical inertia ) that contribute to poor clinical outcomes in diabetes . Importantly , the study design and analytic approach will help determine the differential and combined impact of adherence to lifestyle changes , medication , and intensification on clinical outcomes .Trial registration Clinical Trials.gov identifier : BACKGROUND Poor adherence to oral antidiabetics has a negative influence on glycaemic control in type 2 diabetes patients .  Real Time Medication Monitoring ( RTMM ) combines real time monitoring of patients ' medication use with SMS reminders sent only if patients forget their medication , aim ing to improve adherence . This study aim ed to investigate the effect of these SMS reminders on adherence to oral antidiabetics in patients using RTMM  and investigate patients ' experiences with RTMM . METHODS Data were collected in a RCT involving 104 type 2 diabetes patients with suboptimal adherence to oral antidiabetics . Fifty-six patients were r and omised to receive SMS reminders if they forgot their medication , 48 patients received no reminders . Primary outcome measure was adherence to oral antidiabetics registered with RTMM , measured as : ( 1 ) days without dosing ; ( 2 ) missed doses ; ( 3 ) doses taken within predefined st and ardized time windows . Patients ' experiences were assessed with written question naires . RESULTS Over the six-month study period , patients receiving SMS reminders took significantly more doses within predefined time windows than patients receiving no reminders : 50 % vs. 39 % within a 1-h window ( p=0.003 ) up to 81 % vs. 70 % within a 4-h window ( p=0.007 ) . Reminded patients tended to miss doses less frequently than patients not reminded ( 15 % vs. 19 % , p=0.065 ) . Days without dosing were not significantly different between the groups . The majority of patients reported positive experiences with RTMM and SMS reminders . CONCLUSION RTMM with SMS reminders improves adherence of type 2 diabetes patients , especially the precision with which patients follow their prescribed regimen , and is well accepted by patients . TRIAL REGISTRATION Netherl and s Trial Register NTR1882 AIMS To examine prospect ively the association of depression symptoms with subsequent self-care and medication adherence in patients with Type 2 diabetes mellitus . METHODS Two hundred and eight primary care patients with Type 2 diabetes completed the Harvard Department of Psychiatry/National Depression Screening Day Scale ( H AND S ) and the Summary of Diabetes Self-Care Activities ( SDSCA )  at baseline and at follow-up , an average of 9 months later . They also self-reported  medication adherence at baseline and at a follow-up . RESULTS Baseline H AND S scores ranged from 0 to 27 , with a mean score of 5.15 + /- 4.99 . In separate linear regression models that adjusted for baseline self-care , patients with higher levels of depressive symptoms at baseline reported significantly lower adherence to general diet recommendations and specific recommendations for consumption of fruits and vegetables and spacing of carbohydrates ; less exercise ;  and poorer foot care at follow-up ( beta ranging from -0.12 to -0.23 ; P < 0.05 ) . Similarly , each one-point increase in baseline H AND S score was associated with a 1.08-fold increase in the odds of non-adherence to prescribed medication at follow-up ( 95 % confidence interval 1.001 , 1.158 , P = 0.047 ) . Increases in depression scores over time also predicted poorer adherence to aspects of diet and exercise . CONCLUSIONS Depressive symptoms predict subsequent non-adherence to important aspects of self-care in patients with Type 2 diabetes , even after controlling for baseline self-care . Although the relationship between symptoms of depression and poorer diabetes self-care is consistent , it is not large , and interventions may need to address depression and self-care skills simultaneously in order to maximize effects on diabetes outcomes OBJECTIVE —To evaluate barriers to and strategies for medication adherence and predictors of adherence and the primary outcome in the Diabetes Prevention Program ( DPP ) . RESEARCH DESIGN AND METHODS —Within a r and omized , controlled primary prevention study for type 2 diabetes , we collected data on study medication adherence , its predictors , and health outcomes in 27 clinical centers across mainl and U.S. and Hawaii . Medication arm participants included 2,155 adults with impaired glucose tolerance r and omly assigned to either metformin or matched placebo treatment arms .  Structured interviews were used to promote medication adherence and to collect data regarding adherence . Adherence was measured by pill count . The primary DPP outcome of type 2 diabetes was assessed by fasting plasma glucose and oral glucose tolerance test . RESULTS —Older age-groups were more adherent than the youngest group ( P = 0.01 ) in the metformin group . The most frequently reported barrier to adherence was “ forgetting ” ( 22 % ) . Women reported more adverse effects of metformin ( 15 vs. 10 % , P = 0.002 ) in the metformin group . Odds of nonadherence increased as participants reported more than one barrier ( odds ratio 19.1 , P < 0.001 ) . Odds of adherence increased as participants reported multiple strategies to take medication ( 2.69 , P < 0.0001 ) . There was a 38.2 % risk reduction for developing diabetes for those adherent to metformin compared with those adherent to placebo ( P < 0.0003 ) . CONCLUSIONS —DPP medication adherence results are unique in primary prevention for a chronic disease in a large multiethnic sample . Our finding that adherence was associated with risk reduction for diabetes supports the development of brief interventions in clinical setting s where medication adherence is a challenge Background Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated . Aim To identify predictors of higher success of an intervention aim ed to increase adherence to a Mediterranean diet ( MeDiet ) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease : the PREDIMED ( PREvención con DIeta MEDiterránea ) trial . C and i date predictors included demographic and socioeconomic characteristics , cardiovascular risk factors , and baseline dietary habits . Methods A total of 1,048 asymptomatic subjects aged 55–80 years allocated to the active intervention groups ( subjects in the control group were excluded ) . Participants ’ characteristics were assessed at baseline among subjects . Dietary changes were evaluated after 12 months . Main outcome measures were : attained changes in five dietary goals : increases in ( 1 ) fruit consumption , ( 2 ) vegetable consumption , ( 3 ) monounsaturated fatty acid (MUFA)/saturated fatty acid ( SFA ) ratio , and decreases in ( 4 ) sweets and pastries consumption , ( 5 ) and meat consumption . Univariate and multivariate logistic regression analyses were used to examine associations between the c and i date predictors and likelihood of attaining optimum dietary change ( improved adherence to a MeDiet  ) . Results Among men , positive changes toward better compliance with the MeDiet  were more frequent among non-diabetics , and among those with worse dietary habits at baseline ( higher consumption of meat , higher SFA intake , lower consumption of fruit and vegetables ) . Among women , marital status ( married ) and worse baseline dietary habits ( high in meats , low in fruits and vegetables ) were the strongest predictors of success in improving adherence to the MeDiet . Conclusions Some participant characteristics ( marital status and baseline dietary habits ) could contribute to predicting the likelihood of achieving dietary goals in interventions aim ed to improve adherence to a MeDiet , and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling OBJECTIVE Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors , medication non-adherence , and poor glycemic control that may predispose patients to premature death . African American women , in whom diabetes is more common and social support is often insufficient , may be at particularly high risk . The objective of this study was to examine the impact of lowering diabetes-related emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes ( T2D ) . DESIGN Post-hoc analysis of prospect i ve , r and omized , controlled trial . SETTING Rural communities in the southeastern United States . PATIENTS 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0 ) . PRIMARY INDEPENDENT VARIABLE Diabetes-related distress . MAIN OUTCOME MEASURES Changes from baseline to 12-month follow-up in diabetes-related distress , and associated changes in medication adherence , self-care activities , self-efficacy , and glycemic control ( A1C ) . RESULTS Patients with a reduction in diabetes-related distress ( n=79 ) had significantly greater improvement in A1C , medication adherence , self-care activities , and self-efficacy compared with those in whom diabetes distress worsened or was unchanged ( n=50 ) . Changes in distress were also significantly and inversely correlated with improvements in medication adherence , self-care activities , and self-efficacy . CONCLUSIONS Among rural African American women , reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy , self-care behaviors , and medication adherence ABSTRACT Background Medication nonadherence is an important obstacle to cardiovascular disease management . Objective To improve adherence through real-time feedback based on theories of how social forces influence behavior . Design Two r and omized controlled pilot trials called PROMOTE and SUPPORT . Participants stored statin medication in wireless-enabled pill bottles that transmitted adherence data to research ers . Participants Adults with diabetes and a history of low statin adherence based on pharmacy refills ( i.e. , Medication Possession Ratio [ MPR ] < 80 % in the pre-r and omization screening period).InterventionIn  PROMOTE , each participant was r and omized to 1 ) weekly messages in which that participant ’s statin adherence was compared to that of other participants ( comparison ) , 2 ) weekly summaries of that participant ’s statin adherence ( summary ) , or 3 ) control . In SUPPORT , each participant identified another person ( the Medication Adherence Partner [ MAP ] ) to receive reports about that participant ’s adherence , and was r and omized to 1 ) daily reports to MAP , 2 ) weekly reports to MAP , 3 ) reports to MAP only if dose was missed , or 4 ) control . Main Outcomes MeasureAdherence measured by pill bottle . Key Results Among 45,000 health plan members contacted by mail , < 1 % joined the trial . Participants had low baseline MPRs ( median = 60 % , IQR 41–72 % ) but high pill-bottle adherence ( 90 % in PROMOTE , 92 % in SUPPORT ) during the trial . In PROMOTE ( n = 201 ) and SUPPORT ( n = 200 ) , no intervention demonstrated significantly better adherence vs. control . In a subgroup of PROMOTE participants with the lowest pre- study MPR , pill-bottle-measured adherence in the comparison arm ( 89 % ) was higher than the control ( 86 % ) and summary ( 76 % ) arms , but differences were non-significant ( p = 0.10 ) . Conclusions Interventions based on social forces did not improve medication adherence vs. control over a 3-month period . Given the low percentage of invited individuals who enrolled , the studies may have attracted participants who required little encouragement to improve adherence other than study participation BACKGROUND Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients . OBJECTIVE This study aims to evaluate whether a pharmacist-led medication therapy management , compared to the usual care , could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus . METHODS A prospect i ve r and omized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30 , 2016 . Patients in the control group ( n=65 ) received the usual care while patients in the intervention group ( n=62 ) received a personalized pharmacotherapeutic care plan and diabetes education . The two groups were compared by repeated measure ANOVA at 3 and 6-months with medication adherence ( using Morisky medication adherence scale ) and number of hospital admissions as the main outcome variables . RESULTS A total of 127 patients were included in the study . A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group ( increased from 9.2 % at baseline to 61 % at 6 month ) compared with the control group ( increased from 13.2 % at baseline ( to 30.2 % at 6 month ; p-value<0.01 ) . Furthermore , at the 6-month follow-up , only 23 patients in MTM group with poorly controlled blood glucose levels result ed in hospital admissions compared to 48 patients in non-MTM group , result ing in a 52.1 % fewer hospital admissions ( p < 0.001 ) . CONCLUSIONS The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus . Hence , policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally . In Malaysian healthcare system , pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic ( DMTAC ) . This study aim ed to assess the clinical outcomes of patients managed by pharmacists ( DMTAC ) , in a Malaysian hospital setting . This was an open labelled r and omised study . Type 2 diabetes patients with HbA1c ≥8 % were recruited and arbitrarily divided into the intervention group ( usual care plus DMTAC ) and the non-intervention group ( usual care only ) . Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits . Improvements in lab results were compared longitudinally ( pre and post analysis ) between the groups . Data analysis was done using PASW 18 ® version . A total of 76 patients were enrolled , with 39 patients in the intervention group and 37 patients in the non-intervention group . Mean HbA1c ( -0.90 % vs. -0.08 % , p=0.011 ) and fasting blood glucose levels ( -3.45 mmol.l vs. + 0.79 mmol/l , p=0.002 ) reduced significantly between the intervention group vs. non-intervention group . Total cholesterol and low-density lipoprotein cholesterol ( LDL-C ) were also significantly reduced in the intervention group ( TC -0.34 mmol/l , p=0.018 ) ( LDL -0.45 mmol/l , p=0.001 ) . In conclusion , pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients BACKGROUND Good medication adherence is the cornerstone of therapeutic success . Alzheimer 's disease ( AD ) is the most common type of dementia and most patients are old and on multiple drugs , and good compliance therefore is even more important in this population . Dementia of Alzheimer 's type ( DAT ) at present is yet to find a cure . Anticholinesterases and N-methyl-D-aspartate blockers are specific anti-AD therapies available . Hypertension , diabetes , and dyslipidemia can contribute to cognitive worsening . Keeping hypertension , diabetes , and dyslipidemia in control can therefore possibly prevent further cognitive decline . METHODS Patients with subjective memory complaints ( n = 75 ) were chosen r and omly . Upon thorough neurological diagnostic work up for dementia , those with mild cognitive impairment/ question able dementia ( Clinical Dementia Rating = 0.5 ) or those with AD were recruited in this study ( n = 67 ) . Those with hypertension , diabetes , and deranged lipid profile were further interviewed if they were able to take medicines regularly or not . An attempt was made to know causes of non-compliance . RESULTS Forty-one percent of patients were not taking the drugs that have potential to prevent cardiovascular complications or ability to slow down cognitive decline in AD on regular basis . The lack of awareness , ignorance , medicines being " too expensive , " and the pressure of taking medicines regularly were cited as the reasons for non-compliance . Being illiterate and having low education contributed majorly to poor compliance in this study . CONCLUSION Compliance to drugs that have potential or real ability to slow down cognitive decline is low in elderly people with DAT Background : Diabetes mellitus ( DM ) requires continuous medical care , patients ’ self-management , education , and adherence to prescribed medication to reduce the risk of long-term complications . The aim of this study was to assess the benefits of an education program on diabetes , patient self-management , adherence to medication , anxiety , depression and glycemic control in type 2 diabetics in Saudi Arabia . Material s and Methods : This was a prospect i ve study , conducted among 104 diabetic patients at a major tertiary hospital in Riyadh , Saudi Arabia , between May 2011 and October 2012 .  Education material s given to diabetic patients included pamphlets/h and outs written in Arabic , the national language . Special videotapes about DM were made and distributed to all participants . In addition , specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged . Patients were interviewed using a structured interview schedule both during the baseline , and after 6 months of the program . The interview schedule included , socio-demographics , clinical characteristics , diabetes self-management , adherence to medication , anxiety , and depression . Glycemic control was considered poor , if hemoglobin A1c ( HbA1c ) was ≥ 7 % . Results : The mean age of the study population was 57.3 ± 14.4 years . Seventy one were males ( 68.3 % ) and 33 ( 31.7 % ) were females . After six months of the diabetes education program , there were significant improvements in patients ’ dietary plan ( P = 0.0001 ) , physical exercise ( P = 0.0001 ) , self-monitoring of blood glucose ( SMBG ) ( P = 0.0001 ) , HbA1c ( P = 0.04 ) , adherence to medication ( P = 0.007 ) , and depression ( P = 0.03 ) . Conclusions : Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan , physical exercise , SMBG , adherence to medication , HbA1c and depression
The review found that multifaceted interventions , addressing several non-adherence factors , were comparatively more effective in improving medication adherence and glycaemic target in patients with T2D than single strategies .
However , interventions with similar components and those addressing similar non-adherence factors demonstrated mixed results , making it difficult to conclude on effective intervention strategies to promote adherence .
Educational strategies have remained the most popular intervention strategy , followed by behavioural , with affective components becoming more common in recent years .
There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications .
BACKGROUND Poor adherence to anti-diabetic medications contributes to suboptimal glycaemic control in patients with type 2 diabetes ( T2D ) .
A range of interventions have been developed to promote anti-diabetic medication adherence .
However , there has been very little focus on the characteristics of these interventions and how effectively they address factors that predict non-adherence .
In this systematic review we assessed the characteristics of interventions that aim ed to promote adherence to anti-diabetic medications .