Diabetes: The consequences of medication nonadherence

The reasons for nonadherence are varied, but medications are not effective if they are not taken as prescribed.

Diabetes is a chronic condition that occurs when the body loses its ability to produce or properly use insulin. Insulin is a hormone produced by the pancreas to control the amount of glucose (sugar) in the blood. Without insulin, sugar builds up in the bloodstream. There are three main types of diabetes: type 1, type 2 and gestational diabetes. In addition, prediabetes is when your blood sugar level is higher than it should be but not high enough for your doctor to diagnose diabetes. People with type 2 diabetes almost always had prediabetes first. But it doesn't usually cause symptoms.

In new 2019 figures released by Diabetes Canada, every three minutes someone in Canada is diagnosed with diabetes and currently 11 million are living with diabetes or prediabetes. If not managed appropriately, it can lead to serious consequences, including blindness, amputation, kidney failure, heart attack and stroke. For patients with diabetes and prediabetes, preventing these outcomes in the long term means carefully controlling their blood sugar levels every day.

Diabetes: The reasons(s) behind medication nonadherence
Experts agree that taking medication consistently is essential to how one lives with diabetes. However, as many as 70 per cent of Canadian patients are not taking their medications as directed by their physicians.1 Known as medication nonadherence, Express Scripts Canada data shows that it affects the most prevalent chronic conditions (high blood pressure, diabetes, depression), with those making claims for diabetes medications being the top nonadherent therapy class 48 per cent.2

Significant factors that affect nonadherence include behavioral issues, such as forgetfulness or procrastination, and complicated dosing schedules. Remedies for this can include offering renewal reminders or automatic renewals, encouraging 90-day fills (which is common with home delivery), providing patients with adherence aids such as timers or pillboxes and encouraging patients to consult with pharmacists to establish simplified dosing regimens.

The Express Scripts Canada Pharmacy delivers elevated care through home delivery. For members with chronic and complex diseases, like diabetes, we take the time necessary to help them understand and stay on their medication. In fact, our home delivery service has seen increased adherence success by 15.5%.

Sticking to a daily medication routine can help avoid serious health impacts
Most people diagnosed will need to manage multiple medications, with varying dosing schedules. Therefore, having a routine and managing the regimen with a pharmacist is important. In the short term, the following conditions may be experienced by those with diabetes who do not take their medication as scheduled:

High blood glucose. Also known as hyperglycemia, this occurs when the body doesn't have enough insulin or can't use insulin effectively. This has a major impact on the complications of diabetes.
Diabetic ketoacidosis. This is a life-threatening condition that occurs when the body burns fat instead of glucose for energy. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.

Blood glucose testing, taking medication regularly and at the appropriate dose can keep blood sugar stable and prevent the need for additional medications to control their diabetes. Failing to pick up prescriptions, a few days of missed therapy, or taking doses at the wrong time can add up over time and lead to long-term complications such as stroke, heart disease and damage to the eyes or kidneys. This is where refill and renewal reminders help.

Managing diabetes is a team effort
Along with a healthy diet and exercise, adherence to diabetes medication can ensure patients live a long, active life. A variety of diabetes education and support programs are available which may include group classes, individual counselling sessions or strategies that use technology (such as Internet-based computer programs and mobile apps). A diabetes team can help a patient set goals for caring for their diabetes and health and identify strategies to help them manage their condition.

Watch: “I've watched my dad struggle with diabetes for years and I am worried that this could happen to me. Any advice?”

While medication adherence can be challenging for those living with diabetes, it is important for them to remember they are not alone. If patients have questions about their health or medication, they can reach out to their healthcare provider or pharmacist. These professionals can help with any concerns and provide them with the guidance they need to feel empowered to manage their medication for optimal health.

Diabetes: The consequences of medication nonadherence

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