Many diabetic educators have abandoned the word
“compliance” as one that is used as a diagnosis and
may be used to judge a patient’s character or
personal values--rather than a description of the
obstacles they face. The purpose of the assessment
is not simply to determine whether a patient is not
adhering to recommended therapies, but to determine
the barriers to adherence so that they can be
Clinical and Other Flags:
high levels of A1c
fluctuations of blood glucose and
of medication ineffectiveness
non-adherence and weight gain
self-monitoring of blood
Non-adherence should not only be identified early,
but carefully assessed in order for the patient,
caregivers, and providers to determine the most
suitable course of action to improve adherence and
outcomes. A social worker can be most helpful in
these situations, and should be asked to meet with
the patient to determine if the issues surrounding
their non-adherence are intentional, and therefore
will need to be addressed.
if the patient is non-adherent, the reasons could be
due to other barriers they may have which prevent
them from following their medication and testing
regimens. These barriers may be self-imposed, and
centered on fears or events which are influencing
their behavior with regard to their therapy. The
social worker can help to find the root cause of
these problems and motivate them to become adherent
using an analytical approach. The social worker
should be invited to take part in health care team
meetings in order to educate the other team members
as to the best way to relate to this patient.
Clinical signs can trigger an assessment.
Laboratory values that are at odds with what should
be seen in therapy-adherent patients suggest the
need to investigate both adherence and the
appropriateness of medications and dosing levels.
Persistent hemoglobin A1c, erratic changes in blood
sugar levels, and episodes of diabetic crisis
resulting from lack of blood glucose control should
be evaluated for possible non-adherence issues.
Other co-existing conditions that are
medication-controlled, such as hypertension and
hyperlipidemia, can be evaluated for effectiveness.
If hypertension and hyperlipidemia are persistent
despite prescribed medications and other therapies,
an assessment for overall adherence to therapy
recommendations should be completed.
If patients experience weight gain or continued
elevated hemoglobin A1c levels despite dietary
recommendations that should control those issues,
then non-adherence should be explored. If the
patient does not have adequate records of
self-monitoring of blood glucose, routinely misses
appointments, and fails to follow through on
recommended clinical testing, a well-rounded
assessment may identify barriers to adherence.