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Diabetes study offers medication adherence options

Mar. 20, 2014, 10:28 AM

Knowing when to take a medication — and what to do if a dose is missed — could greatly improve adherence to diabetes medications and glycemic control among adults with type 2 diabetes, according to a Vanderbilt study published in the journal Diabetes Care.

Study author Chandra Osborn, Ph.D., MPH, assistant professor of Medicine and Biomedical Informatics, said it is estimated that one in three diabetes patients don’t take their medications as prescribed and that rate increases significantly among low-income, racial/ethnic minorities.

Chandra Osborn, Ph.D., MPH

“There are a whole host of barriers that get in the way of being compliant with taking medications,” Osborn said. “The factors that we looked at — knowledge of your regimen, how motivated you are to take your medications and how confident you are that you can do it across situations — account for 40 percent of the variability in medication compliance.”

Osborn and co-author Lindsay Satterwhite Mayberry, Ph.D., M.S., postdoctoral research fellow in the Department of Medicine, used the Information-Motivation-Behavior Skills (IMB) model of adherence in a sample of 314 low-income, diverse adults with type 2 diabetes to see if it could successfully explain adherence and inform future intervention efforts.

“We found that adherence was related to knowing how and when to take a medication and how to handle a missed dose,” Mayberry said.

“I think that comes up for patients a lot; ‘if I forget a dose and I don’t know if I am supposed to double it, I don’t know if I am supposed to wait until the next dose, so I just don’t take it.’”
Mayberry said missed dose recommendations depend on the medication and should be discussed with a qualified health care provider.

Concerns related to patients’ motivation to take diabetes medications included believing medications don’t keep diabetes in control and fear of side effects such as weight gain.

Other barriers to adherence included poor planning for how to maintain medication adherence during trips when schedules are disrupted and when out in public.

“A lot of our attention has been focused on how do we promote physical activity and good nutrition for these patients, and so this paper is really all about putting the focus on medication adherence and how do we start doing that better,” Osborn said.

“There needs to be conversations between providers and patients on what to do when doses are missed. There also needs to be a way of understanding what these beliefs are that patients have around the fear associated with taking insulin and the belief that if they take certain medications they are going to gain weight.”

The research was funded with support from the Vanderbilt Clinical Translational Scientist Award (UL1-TR-000445) from the National Center for Advancing Translational Sciences. Mayberry was supported by a National Research and Service Award (F32-DK-097880) from the National Institute of Diabetes and Digestive and Kidney Diseases, and Osborn was supported by a Career Development Award (K01-DK-087894) from the National Institute of Diabetes and Digestive and Kidney Diseases.

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