Research over the past two decades has produced many advances in the treatment of diabetes. These interventions have been shown to reduce the risk of complications and premature death.
As a direct result of this new evidence, the number of tablets people with type 2 diabetes are required to take has increased substantially. ‘Polypharmacy’ or the prescription of multiple drugs presents a major problem for patients and health professionals.
Compliance with regard to managing type 2 diabetes is a broad term used to describe how likely people are to take their medication. Diabetes is a chronic illness which has major implications for lifestyle. It is not surprising that persisting with treatment and lifestyle changes (diet and exercise) is often difficult.
There may be a lack of compliance with several aspects of diabetes care all of which may contribute to problems with care.
A variety of factors may affect compliance in diabetes.
Many people find reasons for non-compliance such as lack of time or forgetfulness.
There are sometimes more serious underlying reasons for not taking insulin such as a desire to lose weight.
There is some evidence that increasing the number of tablets or treatments is linked to poor compliance.
Non-compliance with oral hypoglycemic drugs (blood sugar lowering tablets) is a central issue in patients with type 2 diabetes, as it reduces the efficacy of treatment. It also adds considerably to the cost of care in the NHS.
A study of 90 patients with Type 1 diabetes in Scotland showed a significant number took less insulin than prescribed. 90% of episodes of Diabetic Ketoacidosis were associated with poor compliance.
Combination tablets may offer a way of reducing the number of tablets one has to swallow. Examples of combination preparations include AvandaMet (Rosiglitazone+Metformin) and Coversyl Plus (Perindopril + Indapamide).
Diabetes education and self management is widely considered to be the best way of improving compliance and the concept of patient ‘empowerment’ is now gaining widespread recognition. Having a good understanding of the potential benefits of treatment is a strong motivator to comply with your medication.
Dr Nishan Wijenaike
West Suffolk Diabetes Service