Diabetes Drug Adherence Rates

March 9, 2018

Which drug is associated with the lowest rate of patient compliance among patients with type 2 diabetes?

a. gliclazide

b. metformin

c. pioglitazone

d. sitagliptin

Answer: b

Metformin is widely prescribed, but its adherence is poor: One-third of patients with type 2 diabetes do not take the medication as prescribed, according to recent research, which involved the review of clinical trials and observational studies to determine how 1.6 million patients with type 2 diabetes took tablet and injectable therapies.

The study noted 30% of metformin doses were not taken, 23% of sulfonylureas (such as gliclazide) doses were skipped, and 20% of pioglitazone doses went unused. DPP-4 inhibitors (such as sitagliptin) had the highest rate of adherence with 80% to 90% of patients taking doses as directed.

It’s no surprise that many patients with diabetes don’t comply with prescribed therapies, but diabetic patients who don’t take their medications are at increased risk of suffering complications such as eye disease and kidney damage, according to Dr. Andy McGovern, a clinical researcher at the University of Surrey in England and co-author of the study. He said non-adherence is not an intrinsic to patients—it’s more often attributable to the drug—and one of the easiest ways to improve adherence is to switch to a different medication class.

This study showed that some medications are easier for patients to take than others and suggested healthcare providers need to ask patients with type 2 diabetes specifically about their adherence to prescribed therapies. Dr. McGovern said patients who are struggling with metformin-related side effects should first be tried on a modified release preparation and, if that doesn’t work, switched to an alternative therapy.

—Dan Cook

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