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Managing Diabetes

Taking Your Medicine

Introduction

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.

What is meant by ‘compliance’?

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.

What aspects of compliance are important?

There may be a lack of compliance with several aspects of diabetes care all of which may contribute to problems with care.

  • diet
  • exercise
  • testing blood glucose
  • taking your tablets
  • insulin injections
  • smoking cessation

What influences compliance?

A variety of factors may affect compliance in diabetes.

  • overall mood and well-being. Clearly depression and poor motivation would have a negative impact on compliance
  • peer pressure
  • knowledge about diabetes. People who are well educated about their disease are more likely to understand the benefits of taking their tablets
  • social factors
  • ability to exercise may be impaired due to obesity, angina or peripheral vascular disease
  • nicotine addiction and peer pressure – continued smoking
  • teenagers are known to be particularly non-compliant
  • presence of complications

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.

What is the scale of the problem?

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.

How can compliance be improved?

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
Consultant Diabetologist
West Suffolk Diabetes Service
January 2005