Patient education
Treatment adherence in type 2 diabetes

Diabetes is a largely self-managed condition, requiring the majority of patients to make significant lifestyle changes and adhere to medication prescriptions. It is well-recognised that clinical outcomes are strongly dependent on the patient’s daily self-care behaviours, including diet, exercise and medication taking.

Poor self-care – often referred to as non-compliance or non-adherence - is common in type 2 diabetes and an important barrier to achieving optimal metabolic control. Adherence is generally defined as the extent to which patients’ behaviour in terms of medication taking, following diets, or executing life-style changes coincides with medical or health advice. Some authors have questioned the usefulness of the adherence concept, suggesting ‘something completely different is needed’. Whatever the term, it is important to understand that non-adherence may be intentional or unintentional. Indeed, “forgetfulness” is a frequently reported reason for poor adherence to medication prescriptions. Research across different medical conditions has identified various risk factors for low adherence, notably patient-related factors (e.g. dysfunctional beliefs, negative emotions) and poor patient-provider communication.

Reliably measuring adherence presents us with complex methodological issues, with most studies relying on self-report measures, pertaining to a broad spectrum of health behaviours, ranging from keeping appointments to medication taking. Adherence in one health behaviour does not necessarily translate to other health behaviours.
Medication adherence typically is not higher than 50% and tends to be lower in case of multiple medications as is often the case in type 2 diabetes. Although overall self-management education has shown to have beneficial effects on psychosocial outcomes and glycaemic control, surprisingly few studies have studied ways to specifically enhance medication adherence in diabetes.

Recent reviews have identified different types of such adherence promoting interventions with mixed results. New effective ways to assist patients in adhering to their treatment regimen are sought. These would certainly need to include strategies to help improve patient-provider communication.