A Systematic Review of Interventions Addressing Adherence to Anti-Diabetic Medications in Patients with Type 2 Diabetes—Components of Interventions

Abstract

BackgroundPoor 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 aimed to promote adherence to anti-diabetic medications.MethodUsing appropriate search terms in Medline, Embase, CINAHL, International Pharmaceutical Abstracts (IPA), PUBmed, and PsychINFO (years 2000–2013), we identified 52 studies which met the inclusion criteria.ResultsForty-nine studies consisted of patient-level interventions, two provider-level interventions, and one consisted of both. Interventions were classified as educational (n = 7), behavioural (n = 3), affective, economic (n = 3) or multifaceted (a combination of the above; n = 40). One study consisted of two interventions. 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. Most of the interventions addressed patient-related (n = 35), condition-related (n = 31), and therapy-related (n = 20) factors as defined by the World Health Organization, while fewer addressed health care system (n = 5) and socio-economic-related factors (n = 13).ConclusionThere is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications. However, research limitations, such as limited use of standardized methods and tools to measure adherence, lack of individually tailored adherence promoting strategies and variability in the interventions developed, reduce the ability to generalize the findings of the studies reviewed. Furthermore, this review highlights the need to develop multifaceted interventions which can be tailored to the individual patient’s needs over the duration of their diabetes management.

Mediators of medication adherence and glycaemic control and their implications for direct outpatient medical costs: a cross‐sectional study

“…As previously reported, higher distress level was found to be independently associated with poorer glycaemic control [24]. Taken together, the indirect effect of diabetes-related distress may explain the poor glycaemic control despite proven and effective interventions with regard to medication adherence [26]. The findings from the present study show that it is crucial to consider diabetes-related distress before addressing medication adherence directly.…”

Targeted Adherence Intervention to Reach Glycemic Control with Insulin Therapy for patients with Diabetes (TARGIT-Diabetes): rationale and design of a pragmatic randomised clinical trial

“…[6][7][8] As a result, the clinical impact of even multifaceted interventions has been modest. 8 9 Improving the use of evidence-based therapies will not likely occur with a 'one size fits all' approach.…”

Seeing the Person, Not the Illness: Promoting Diabetes Medication Adherence Through Patient-Centered Collaboration

“…In other words, nonadherence is not specifically or solely a “patient problem.” Another implication is that targeting only one factor for improvement (e.g., patient understanding) is unlikely to have much of an effect on population adherence. Instead, approaches to adherence promotion will need to be multifactorial if they are going to be broadly effective (6), involving concurrent changes in patient and provider behavior as well as in the health care system itself.…”