A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol Polypharmacy and medication adherence in patients with type 2 diabetes. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study Impact of family support improvement behaviors on anti diabetic medication adherence and cognition in type 2 diabetic patients Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia Clinical and Behavioral Correlates of Achieving and Maintaining Glycemic Targets in an Underserved Population With Type 2 Diabetes Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study Refill adherence and polypharmacy among patients with type 2 diabetes in general practice. Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus Effect of pharmaceutical care on medication adherence of patients newly prescribed insulin therapy: a randomized controlled study Mobile Diabetes Intervention for Glycemic Control Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital Integrated Management of Type 2 Diabetes Mellitus and Depression Treatment to Improve Medication Adherence: A Randomized Controlled Trial Strategies to improve adherence with medications in chronic, ‘silent’ diseases representing high cardiovascular risk
Background : Non-adherence to oral antidiabetics drugs ( OADs ) has been a common problem and may contribute to poor glycemic control . Aim : To describe an experimental study protocol that aims at implementing and evaluating the effect of the “ action planning and coping planning ” interventions on medication adherence to OADs  in patients with type 2 diabetes mellitus ( T2DM ) in follow-up at primary care services . Design : A r and omized controlled trial . Methods : Two groups ( intervention and control ) will be followed over a period of 105 days . The intervention group will receive a combination of the “ action planning ” and “ coping planning ” intervention strategies . There will be in-person meetings and phone calls to reinforce the intervention . The control group will receive the usual care from the health unit . Conclusions : It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence OBJECTIVE To determine medication adherence and predictors of suboptimal adherence in a community cohort of patients with diabetes and to test the hypothesis that adherence decreases with increased number of medicines prescribed . RESEARCH DESIGN AND METHODS A total of 128 r and omly selected patients with type 2 diabetes from a single community health center responded to a pharmacist-administered question naire regarding medication use . Survey data were linked to clinical data available from the electronic medical record . We assessed self-reported adherence rates for each diabetes-related medicine , barriers and attitudes regarding medication use , and HbA(1c ) , total cholesterol , and blood pressure levels . RESULTS Patients were taking a mean of 4.1 ( + /-1.9 ) diabetes-related medicines . The average 7-day adherence was 6.7 + /- 1.1 days . Total number of medicines prescribed was not correlated with medication adherence . Adherence was significantly lower for medicines not felt to be improving current or future health ( 6.1 vs. 6.9 days out of 7 , P < 0.001 ) . Among patients on three or more medicines , 71 % ( 15 of 21 patients ) with suboptimal adherence were perfectly adherent with all but one medicine . Side effects were the most commonly reported problem with medication use . Of 29 medicines causing side effects that interfered with adherence , 24 ( 83 % ) did so for > 1 month , and only 7 ( 24 % ) were reported to the patient 's primary care physician . CONCLUSIONS In this sample , patients reported very high medication adherence rates regardless of number of medicines prescribed . Among patients on multiple medicines , most patients with suboptimal adherence were perfectly adherent to all but one medicine . Unreported side effects and a lack of confidence in immediate or future benefits were significant predictors of suboptimal adherence . Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia , hypertension , and hyperlipidemia BACKGROUND Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients . OBJECTIVE This study aims to evaluate whether a pharmacist-led medication therapy management , compared to the usual care , could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus . METHODS A prospect i ve r and omized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30 , 2016 . Patients in the control group ( n=65 ) received the usual care while patients in the intervention group ( n=62 ) received a personalized pharmacotherapeutic care plan and diabetes education . The two groups were compared by repeated measure ANOVA at 3 and 6-months with medication adherence ( using Morisky medication adherence scale ) and number of hospital admissions as the main outcome variables . RESULTS A total of 127 patients were included in the study . A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group ( increased from 9.2 % at baseline to 61 % at 6 month ) compared with the control group ( increased from 13.2 % at baseline ( to 30.2 % at 6 month ; p-value<0.01 ) . Furthermore , at the 6-month follow-up , only 23 patients in MTM group with poorly controlled blood glucose levels result ed in hospital admissions compared to 48 patients in non-MTM group , result ing in a 52.1 % fewer hospital admissions ( p < 0.001 ) . CONCLUSIONS The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus . Hence , policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes Background Glycaemic control is the main goal of treatment for type 2 diabetic patients . Hyperglycaemia may result in cognitive decline . More family support may increase medication adherence and decrease glycaemic level . The purpose of this study was to determine the impact of family support improvement behavior on anti diabetic medication adherence and cognition in type 2 diabetic patients . Method The r and omized control trial study was conducted on 91 patients from an outpatient diabetes clinic . They were r and omly divided to intervention ( n = 45 ) and control  ( n = 46 ) group . Data on the patients ’ demographic information and their family gathered using a question naire , For two groups Morisky Medication Adherence Scale ( MMAS ) , drug administration part of  Diabetes Social Support Question naire – family version ( DSSQ ) , Number Connection Test ( NCT ) were applied and hemoglobin A1C was measured two times in the onset of study and three months later for control group and before and after intervention for intervention group . The key family members of the intervention group were taught according to their educational needs in small groups . Result In intervention group mean of NCT score was significantly decreased after intervention ( P = 0.006 ) however in the control group there was no significant difference after three months . In intervention group a significant correlation was noted between DSSQ scores and MMAS scores after intervention(r = 0.67 , P < 0.001 ) but , there was no significant correlation in the control group . Conclusion Family support instruction based on the educational needs of family members , may improve medication adherence through direct effect and cognitive status with indirect effect Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration Background : Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia . Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved . Aims : The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia . Patients and Method : The study consists of two phases . A cross-sectional review of r and omly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview , with pre tested adherence and self management and monitoring tool question er of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic . Result : Oral hypoglycemic agent were prescribed for 351(91.4 ) of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6 % ) . About 312 ( 88.9 % ) patients on oral hypoglycemic agent were on mono therapy , the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3 % ) and metformine 80(25.7 % ) . Only 41.8 % of the patient had adequate glycemic control . The main external factors for non adherence were lack of finance ( 37.1 % ) followed by perceived side effect of drug 29.2 % . Only 6.5 % patient who missed their medications disclosed to physician during consultation . The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied . Conclusion : Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine . While the current prescribing strategy do not achieve glycemic control on majority of the patient . This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management OBJECTIVE —In an underserved Latino area , we established a disease-management program and proved its effectiveness . However , many patients still remained above target . This study was design ed to evaluate which factors are associated with reaching program goals . RESEARCH DESIGN AND METHODS —This was a r and omized , prospect i ve , observational study in which patients enrolled in our program were followed for 2 years with outcomes , measures , and question naires assessed at baseline and at 6 , 12 , and 24 months . RESULTS —Overall , A1C fell by 1 % . Adherence to medication was the strongest predictor of reaching the target A1C of < 8 % ; baseline A1C was also predictive . Knowledge scores increased in those who reached target , but the measures of self-efficacy and empowerment did not change for either group . CONCLUSIONS —Diabetes management is effective in a lower-income Latino population . However , adherence was suboptimal even when medications were provided on-site for free . Further research into barriers associated with medication adherence is needed Background Adherence to prescribed medications is a key dimension of healthcare quality . The aim of this large population -based study was to evaluate self-reported medication adherence and to identify factors linked with poor adherence in patients with type 2 diabetes in France . Methodology The ENTRED study 2007 , a French national survey of people treated for diabetes , was based on a representative sample of patients who cl aim ed reimbursement for oral hypoglycaemic agents and /or insulin at least three times between August 2006 and July 2007 , and who were r and omly selected from the data base of the two main National Health Insurance Systems . Medication adherence was determined using a six-item self-administered question naire . A multinomial polychotomous logistic regression model was used to identify factors associated with medication adherence in the 3,637 persons with type 2 diabetes . Principal Findings Thirty nine percent of patients reported good medication adherence , 49 % medium adherence and 12 % poor adherence . The factors significantly associated with poor adherence in multivariate analysis were socio-demographic factors : age < 45 years , non-European geographical origin , financial difficulties and being professionally active ; disease and therapy-related factors : HbA1c>8 % and existing diabetes complications ; and health care-related factors : difficulties for taking medication alone , decision making by the patient only , poor acceptability of medical recommendations , lack of family or social support , need for information on treatment , reporting no confidence in the future , need for medical support and follow-up by a specialist physician . Conclusions In a country with a high level of access to healthcare , our study demonstrated a substantial low level of medication adherence in type 2 diabetic patients . Better identification of those with poor adherence and individualised suitable recommendations remain essential for better healthcare management BACKGROUND AND AIMS Non-adherence is considered a major barrier to better outcomes of diabetes care . A relationship has been established between polypharmacy and patients ' adherence . This study aims to investigate the occurrence of polypharmacy and non-adherence in general practice , their mutual relationship and the association between adherence and the intermediate outcomes of diabetes care . MATERIAL S AND METHODS We used the baseline and follow-up data of a r and omised controlled trial ( RCT ) that compared usual care with care in accordance with a locally adapted national guideline . This study took place in the Netherl and s and involved 30 general practice s and 1283 patients . We obtained a complete medication profile of all participants and calculated the number of prescribed drugs and the adherence indices ( AI )  for oral blood glucose , blood pressure and cholesterol lowering drugs .  Patients with an adherence index < 0.8 were considered non-adherent . Clustering at practice level and case-mix were taken into account . RESULTS Approximately 80 % of the participating patients demonstrated an adherence index > or= 0.8 for oral blood glucose , blood pressure and cholesterol lowering drugs . In the intervention group , increase of drug prescriptions exceeded that of controls ( 1.1 + /- 2.0 vs. 0.6 + /- 1.5 , p < 0.001 , adjusted p < 0.05 ) . There was evidence of an inverse relationship between the number of drugs that had been prescribed during the last 6 months of the study and patients ' adherence to blood pressure lowering medications ( adjusted OR 0.84 , 95%CI 0.78 - 0.91 ) . After one year , HbA1c and total cholesterol levels were significantly lower in adherent patients . CONCLUSION During the intervention the mean number of drug prescriptions increased in both the study groups . This did not result in a lower adherence to blood glucose and cholesterol lowering medications . Given the relationship between the number of medications and patients ' adherence to blood pressure lowering drugs , it may be wise to discuss adherence before prescribing multiple drug regimens AIMS Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control ( PGC ) in a cohort of patients with type 2 diabetes mellitus in Germany . METHODS Baseline data of the DIANA- study , a prospect i ve cohort study of type 2 diabetes mellitus patients in South-West Germany , were analysed . Information on medication adherence and factors related to PGC was obtained by self-administered question naire . PGC was defined as HbA(1c)≥7.5 % . Bivariate and multivariate analyses using log-binomial regression were employed to assess overall and gender-specific associations of non-adherence and PGC . RESULTS 624 men and 518 women were included in the analyses . In total , 147 men ( 24 % ) and 114 women ( 23 % ) reported non-adherence to medication . In men , PGC was found in 37 % of the participants reporting non-adherence and in 19 % reporting adherence ( adjusted prevalence ratio (PR)=1.90 , 95%-CI : 1.46 - 2.49 ) . In women , PGC was found in 19 % of the participants reporting non-adherence and in 18 % reporting adherence ( adjusted PR=0.97 , 95%-CI : 0.65 - 1.46 ) . CONCLUSIONS Our results show gender-specific differences in the association of adherence and PGC . This underlines the need for efforts to improve glycaemic control in patients with type 2 diabetes mellitus with a particular focus on men Background Diabetes mellitus is a lifelong chronic condition that requires self-management . Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes . Purpose To assess the effects of a pharmaceutical care ( PC ) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus . Patients and methods A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at r and om to the control ( n=121 ) or intervention ( n=120 ) groups . Participants in the intervention group received PC from an experienced pharmacist , whereas those in the control group were provided the st and ard pharmacy service .  Medication adherence was assessed using the Malaysian Medication Adherence Scale , and glycemic levels ( glycated hemoglobin values and fasting blood glucose [ FBG ] ) of participants were obtained at baseline and after 4 , 8 , and 12 months . Results At baseline , there were no significant differences in demographic data , medication adherence , and glycemic levels between participants in the control and intervention groups . However , statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4 , 8 , and 12 after the provision of PC ( median FBG , 9.0 versus 7.2 mmol/L [ P<0.001 ] ; median glycated hemoglobin level , 9.1 % versus 8.0 % [ P<0.001 ] at 12 months ) . Medication adherence was also significantly associated with the provision of PC , with a higher proportion in the intervention group than in the control group achieving it ( 75.0 % versus 58.7 % ; P=0.007 ) . Conclusion The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes . Therefore , the PC model used in this study should be duplicated in other health care setting s for the benefit of more patients with type 2 diabetes PURPOSE The purpose of this study is to characterize the adherence and medication management barriers for adults with poorly controlled type 2 diabetes mellitus ( DM ) ( those with A1c 9 % or above ) and to identify specific adherence characteristics associated with poor diabetes control . METHODS This was a cross-sectional analysis of baseline data from a r and omized , controlled diabetes intervention conducted in University of Washington ( UW ) Medicine Clinics in the greater Seattle , Washington , area . The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months . Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Question naire . Specific adherence characteristics associated with poor diabetes control ( A1c > 9 % ) were identified using multivariate regression analysis . RESULTS Seventy-seven subjects ( mean A1c , 10.4 % ; mean duration of DM , 7 years ) were studied . The most common adherence challenges included paying for medications ( 34 % ) , remembering doses ( 31 % ) , reading prescription labels ( 21 % ) , and obtaining refills ( 21 % ) . Taking more than 2 doses of DM medication daily ( beta = .78 , SE = 0.32 , P = .02 ) and difficulty reading the DM medication prescription label ( beta = .76 , SE = 0.37 , P = .04 ) were significantly associated with higher hemoglobin A1c . Self-reported adherence was not related to A1c control . CONCLUSIONS In this study , we identified 2 factors that were associated with poorer A1c control . These findings highlight the importance of identifying potential challenges to medication adherence for those with DM and providing support to minimize or resolve these barriers to control Background Poor adherence to insulin medications leads to a high rate of hospital admissions and poor health-related quality of life in the patients with diabetes mellitus . However , few strategies are effective and acceptable in improving medication adherence . The objectives of this study are to evaluate the effectiveness of pharmaceutical care by clinical pharmacists on medication adherence of patients newly prescribed insulin therapy .  Patients and methods A single-center , prospect i ve r and omized controlled study ( pharmaceutical care group and control group ) was performed from January 1 , 2014 to December 30 , 2014 .  Medication adherence was measured at the baseline and up to 12 months with Morisky – Green test and computerized dispensed medication history . The absolute change in A1c vs baseline , the change of hospitalization between two groups , and the number of patients to achieve Chinese Diabetes Society ( CDS ) goals at the baseline were the main outcome measures . Results A total of 322 patients were included in the study . After the 12-month interventions , significant improvements in the medication adherence were verified for the pharmaceutical care group according to the Morisky – Green test ( 50.8 % of adherent patients at baseline vs 80.7 % of adherent patients after 12-month interventions ; P<0.01 ) and the computerized dispensed medication history ( 55.2 % at baseline vs 83.3 % after interventions ; P<0.01 ) , while no significant changes were verified in the control group . After follow-up , the pharmaceutical care group showed a greater percent change in A1c ( 2.2±0.4 vs 0.8±0.2 , P<0.05 ) . Conclusion This study provides new evidence from a r and omized controlled trial on the beneficial effect of pharmaceutical care to enhance adherence in patients newly prescribed insulin therapy . Intervention by the pharmacist might potentially improve clinical outcomes on reducing hemoglobin A1c and enhancing the number of patients fulfilling the Chinese Diabetes Society goal on hemoglobin A1c Background : Of adults with type 2 diabetes , 84 % take antihyperglycemic medication . Successful treatment requires active monitoring and medication dose adjustment by health providers . The objective of this study was to determine how a mobile-phone-based coaching system for diabetes management influences physician prescribing behavior . Method : This secondary data analysis is based on a cluster r and omized clinical trial that reported patients provided with mobile self-management had reduction in glycated hemoglobin ( HbA1c ) of 1.9 % over 1 year , compared to 0.7 % in control patients ( P < .001 ) . Participants were primary care patients with type 2 diabetes r and omized at physician practice level into a control group ( n = 55 ) and intervention group ( n = 62 ) . Main study measures were patients ’ medication records ( medication , dose , frequency , start and end date ) abstract ed at baseline and study end .  Antihyperglycemic medications  , including sulfonylureas or thiazolidinediones , and antihypertensive and antilipemic medications were analyzed . Results : A higher percentage of patients in the intervention group had modification and intensification of incretin mimetics during the 1-year study period ( 9.7 % vs 0.0 % and 8.1 % vs 0.0 % , both P = .008 ) . A higher percentage of patients in the intervention group had modification and intensification of metformin  ( 24.2 % vs 7.3 % , P = .033 ) . The overall difference in physician prescribing of oral antihyperglycemic medications was not statistically significant . Conclusions : Our results suggest mobile diabetes interventions can encourage physicians to modify and intensify antihyperglycemic medications in patients with type 2 diabetes . Differences in physician prescribing behavior were modest , and do not appear to be large enough to explain a 1.2 % decrease in HbA1c OBJECTIVE : To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil . METHOD : A r and omized controlled trial with a 6-month follow-up period was performed in 70 adults , aged 45 years or older , with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8 % . Patients in the control group ( CG ) ( n = 36 ) received st and ard care , patients in the intervention group ( IG ) ( n = 34 ) received an individualized pharmacotherapeutic care plan and diabetes education . The primary outcome measure was change in HbA1c . Secondary outcomes included diabetes and medication knowledge , adherence to medication , insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life . Outcomes were evaluated at baseline and 6 months using question naires . RESULTS : Diabetes knowledge , medication knowledge , adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group . At the end of the study , mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group . Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group . CONCLUSION : The program improved health outcomes and result ed in better glycemic control in patients with type 2 diabetes undergoing insulin therapy PURPOSE Depression commonly accompanies diabetes , result ing in reduced adherence to medications and increased risk for morbidity and mortality . The objective of this study was to examine whether a simple , brief integrated approach to depression and type 2 diabetes mellitus ( type 2 diabetes ) treatment improved adherence to oral hypoglycemic agents and antidepressant medications , glycemic control , and depression among primary care patients . METHODS We undertook a r and omized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care . Patients were r and omly assigned to an integrated care intervention or usual care . Integrated care managers collaborated with physicians to offer education and guideline -based treatment recommendations and to monitor adherence and clinical status . Adherence was assessed using the Medication Event Monitoring System ( MEMS ) . We used  glycated hemoglobin ( HbA1c ) assays  to measure glycemic control and the 9-item Patient Health Question naire ( PHQ-9 ) to assess depression . RESULTS Intervention and usual care groups did not differ statistically on baseline measures . Patients who received the intervention were more likely to achieve HbA1c levels of less than 7 % ( intervention 60.9 % vs usual care 35.7 % ; P < .001 ) and remission of depression ( PHQ-9 score of less than 5 : intervention 58.7 % vs usual care 30.7 % ; P < .001 ) in comparison with patients in the usual care group at 12 weeks . CONCLUSIONS A r and omized controlled trial of a simple , brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care . An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practice s with competing dem and s for limited re sources Given the burden of illness related to diabetes , hypertension and dyslipidemia , it is very important to achieve glycemic control , optimal blood pressure and low-density lipoprotein cholesterol ( LDL-C ) in order to avoid severe long-term complications . Patients ’ adherence with , and persistence to , the treatment regimen is a critical factor in achieving this goal . Medication taking behavior in these chronic , nonsymptomatic ( ‘ silent ’ ) diseases is generally low , although a wide range of results have been reported . The literature has shown that nonadherence to medications is a multidimensional phenomenon ; relating factors can be grouped into the following categories : health system related , social/economic , condition-related , therapy-related and patient-related factors . Although several interventions exist to improve patients ’ medication-taking behavior , none appear to be clearly superior to others . The key steps to improve adherence are to identify individual barriers and to develop patient-specific self-management plans to overcome them ( called ‘ patient-centric ’ approach ) . When developing intervention strategies one should always remember that ‘ one size does not fit all ’ . Well design ed ( but not r and omized ) , observational studies ( for example , patient registries ) may be required with sufficient follow-up periods and multiple adherence measurements in order to advance the field
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 .
There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications .
BACKGROUND Poor 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 aim ed to promote adherence to anti-diabetic medications .