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Multiple and complex medication therapies can be very daunting. According to Daly et al, of the patients surveyed, most were not adherent to medications because of cost, forgetting to take them, or interference by depression. Oral medications are now recommended by the American Diabetes Association on diagnosis, rather than waiting for a trial of lifestyle management. In some cases, multiple oral antihyperglycemic medications may be prescribed, and they may have different dosing schedules. There may be additional medications prescribed for co-morbidities, such as hypertension and hyperlipidemia. While each of these is important, it may be difficult for a patient to be motivated when there are no tangible changes they will notice. Finally, adverse events can hamper adherence efforts. Some medications have gastrointestinal effects. But, there is probably most concern about the possibility of hypoglycemia, which is possible with single medications and even more of a concern with intensive therapy with multiple medications. If a patient has problems with adhering to regimens with multiple medications and dosing schedules, it has been recommended to consider combination therapies that reduce pill burden as well as simplify the dosing schedules. A team pharmacist can assist in making recommendations for coordinating and streamlining a schedule of medications that may be required to control co-existing problems, such as hypertension and hyperlipidemia.

The American Diabetes Association suggests that patient training in self-management is essential to the success of diabetes control. In one study, follow-up through automated telephone calls and self-care training reduced adherence problems by 21%. Daly et al suggested that patients may not follow through on monitoring blood glucose because of costs, too much of a bother, interference of depression, lack of understanding, dislike for doing it, pain involved in self-monitoring, and a lack of knowledge on how to use the results.

Still, if these barriers are overcome, self-monitoring can improve patient efforts to adhere to therapies through direct feedback on how well their efforts are working. According to research by Malanda et al, the emotions and stress involved with diabetes management can be barriers to patient adherence, which may be overcome by self monitoring of glucose levels.

Daly JM, Hartz AJ, Xu Y, Levy BT, James PA, Merchant ML, Garrett RE. An assessment of attitudes, behaviors, and outcomes of patients with type 2 diabetes. JABFM. 2009;22:280-290.

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