The World Health Organization (WHO) has reported that adherence to long-term therapies for chronic illnesses (including diabetes) averages less than 50% globally. This means, less than half of the individuals diagnosed with a long-term and life-threatening disease comply with the care instructions provided by their physicians; and several are without access to regular physician and prescription drugs.
Most patients would want to follow the doctor’s advice, take medication, and avoid complications, and compliance continues to be the largest contributing factor to long-term health management for diabetics. If it were as simple as eating fewer carbohydrates and taking medicines regularly, every diabetic’s health would be well-managed with reduced long-term risk factors. Social policies must address the complex psychology and challenges to manage chronic illnesses, particularly diabetes, which experts predict will impact 552 million people globally by 2030.
Challenges that Impact Patient Prescription Adherence
With the availability of a variety of medicines and therapies, as well as educational programs geared at helping patients understand the long-term health risks of diabetes, medical compliance is key to reducing risk factors. There are three measurable considerations that impact prescription compliance for diabetic patients.
Several medicines are effective in regulating blood glucose, along with lifestyle changes that promote a healthy and consistent Body Mass Index (BMI) score. The most common prescription drug used is Metformin, coupled with other glucose regulators such as Glimepiride (Amaryl). There are many oral medicines that can be prescribed as part of the oral drug therapy for Type 2 diabetes. Over time, physicians may recommend several companion drugs to achieve glucose-control in the patient.
Some of the newer pharmaceuticals available for Type 2 Diabetics are expensive. The cost of some drugs range from $400 to over $500 per month. A prescription medical plan may cost a patient about $60 per month in prescription co-pay, but for an individual who does not have a comprehensive medical insurance plan, some of the best alternatives automatically become unaffordable. This can mean trying different affordable medicines in higher dosages, with a greater out-of-pocket expense for the patient.
According to research reviewed in ‘The economic burden of diabetes in India: a review of the literature’ by Charles AK Yesudian, Mari Grepstad, Erica Visintin and Alessandra Ferrario, the cost of patient management in India is rapidly accelerating.
“In 2012, 60% of all deaths in India were due to non-communicable diseases (NCDs) including cardiovascular diseases, chronic respiratory diseases, cancer and diabetes.” In India, rapid urbanization of culture, increased affluence, and changing fitness and diet habits, combined with increased life expectancy have increased the Disability Adjusted Life Years (DALYs) for patients to 43%.
Access to supervised therapies, and medication monitoring and testing have had a profound impact on health outcomes, and reduced the risk of complications or secondary chronic disease. Personal economic resources have a tremendous impact on health outcomes for Type II diabetics. Many people without quality insurance benefits try to “go without” the expense of medications and medical supervision for long periods of time to economize, placing their personal health in jeopardy.
In countries such as Canada, Thailand and the UAE where Universal health care is provided to citizens, health complications and medical costs are greatly reduced. This is because patients are assisted with effective management of chronic diseases even before symptoms become life-threatening.
2. Quantity and Schedule of Medications
The treatment of diabetes requires that the patient undergoes a dramatic lifestyle change to reduce associated health risks. A few changes that patients find challenging to deal with are the dosage of oral medicines, and supplemental insulin injections or insulin pumps.
Diabetes medication is prescribed along with blood pressure regulators and cholesterol-reducing oral prescriptions. Another complication related to Type 2 diabetes includes thyroid performance, which also requires daily medication.
When you add it up, a diabetic can be taking between four and ten different medicines per day. Forgetting to take medication is a common problem, and one that makes blood glucose management difficult.
3. Emotional Considerations
Patients with Type II diabetes are constantly confronted with terrifying possibilities and health complications, including amputation, painful neuropathy (nerve pain), heart attack, blindness, pancreatic cancer, and kidney malfunction.
While fear mobilizes many people to make dramatic lifestyle changes, including weight loss, diet modification and medication compliance, the overwhelming feeling can turn into anxiety and even depression for others. Mood swings are further complicated by low and high blood glucose, which can dramatically impact energy levels. Many patients remain in a state of denial about Type 2 diabetes, thereby worsening their symptoms by not following the physician’s guidance.
It is estimated that by 2030, 552 million people around the world will be affected by Type I or Type 2 diabetes. The challenge to educate diabetics about the importance of persistent compliance versus personal complacency is essential to prevent health complications, and increased diabetes-related mortality rates worldwide. Social programs should be developed and further improved to support individuals with chronic disease to avoid negative health outcomes in the future.
‘The current state of diabetes mellitus in India’. Seema Abhijeet Kaveeshwar and Jon Cornwall
Anjana RM, Ali MK, Pradeepa R, Deepa M, Datta M, Unnikrishnan R, Rema M, Mohan V. The need for obtaining accurate nationwide estimates of diabetes prevalence in India - rationale for a national study on diabetes. Indian J Med Res. 2011;133:369–80. [PMC free article] [PubMed]
Image copyright: Chris Potter, flickr, CC BY
Article last time updated on 05.07.2016.