3 Ways to Improve Adherence Among Patients with Diabetes


Medication adherence rates struggle in many conditions and diabetes is among the worst of them. Michael Greenfield, MD, discusses 3 ways for clinicians to improve adherence.

Michael Greenfield, MD

Fifty percent of patients do not take their medications as prescribed. According to a study published in 2005 in the New England Journal of Medicine, this poor adherence to medication leads to increased morbidity, death, and is estimated to incur costs of approximately $100 billion per year. For patients with diabetes, there have been almost 100 studies and articles written on the topic, discussing the lack of adherence and impact of not following a care plan.

So, all patients need to do is to remember to take their medications? That’s easy, right? Well, not really. They are busy, they are distracted, and they just plain forget.

As clinicians, we have overlooked a key solution that can really help with adherence, digital health. Not only can it make remembering easier, it can also give real feedback to users regarding the impact of adhering to their care plan, and since we know that a vast majority of our patients have smartphones, offering a digital health solution is not only viable, but scalable.

Automated, In-the-Moment Reminders

Here are 3 ways digital health can improve adherence among patients with diabetes.Built into most digital health systems are tools to help patients with diabetes track and manage their care plan. Included are automated reminders that notify and nudge users to take their prescribed medicines. Since diabetes medications often have unique dosing, a system to manage this can be very valuable in not only adherence, but in helping the patient to administer the correct dosage. With an easy set-up, the digital health app will simply remind the patient at the right time/day of the week, what to do, right on their mobile phone.

Insights About Impact

Support from the Care Team

One area where adherence can make a huge impact on outcomes is insulin therapy. To support insulin adherence, digital health companies focused on diabetes management have received FDA clearance for tools that support not only reminders but the titration of the insulin dose. Since insulin dosing is a function of average fasting blood glucose levels and other factors, the dose can be different for a patient over time and requires a titration process, which requires math. Through digital health on the patient’s mobile phone, the timing, dosing and reminding about insulin therapy can all be handled to support the individual in the daily management of their diabetes regimen.When you know something is working, you are often more motivated to do it. The problem with the current standard of care, which consists of daily blood glucose testing, is that it only gives patients a snapshot of how their care plan is working but doesn’t show them their improvement or decline over time. It doesn’t connect the dots or provide more longitudinal insights. Digital health can highlight wins and uncover areas of improvement because it can review data like glucose, exercise, diet and more, which provide insights that can help a patient better understand the impact of their behaviors.State-of-the-art digital health systems often include a connection back to the care team. In the doctor-patient relationship, positive reinforcement is very important. People are more likely to take action if they feel supported and understood. Of course, things like rewards and comments need to be personal and individualized, but digital health offers a platform to provide encouragement at just the right time in a personal way.

Recently, I was speaking to a patient who I noticed had improved her adherence. I asked her why and she said that knowing that I was watching and supporting her, that someone is “on the other end” (of the app) and there if she needed them, really made the difference. The nice part about digital health is that it can scale personal interactions. I know when I first started using it, I was afraid it would monopolize my time. What I found is that I was able to better prioritize who I reached out to, based on their data and behavior. In addition, I have the tools to engage in light touches, like a quick digital message to both encourage and support my patients.

Adherence is one of the biggest challenges the healthcare system faces, and we need to look at new ways to drive adherence. Digital health truly can make the difference.

Michael Greenfield, MD, is Glooko's Chief Medical Officer and diabetes technology expert. Greenfield received his medical degree from Harvard Medical School in Boston, Massachusetts, and completed his endocrinology fellowship at Stanford University in Palo Alto, California. Greenfield helps to lead the Glooko effort to create patient- and clinically relevant and innovative analytics. Greenfield chairs the Institutional Review Board at El Camino Hospital in Silicon Valley and is an accomplished researcher and a beloved clinician.

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