Adherence in Diabetes: Focusing on Tools Rather than Behaviors

Among diabetics, poor adherence or nonadherence results in poorer glycemic control and increased risk of complications and disability, as well as increased healthcare costs.

Let’s start with the facts: unless healthcare providers offer self-management education (SME) to patients who have chronic diseases, optimal disease management is unlikely, and approximately half of such patients are nonadherent to either their prescribed medications, lifestyle interventions, or both after six months of treatment. Among diabetics, poor adherence or nonadherence results in poorer glycemic control and increased risk of complications and disability, as well as increased healthcare costs.

Physicians and patients struggle with long-term treatment. On the one hand, it manages the patient’s disease but, on the other, the likelihood of adverse events increases as the duration of treatment lengthens. Adherence among patients with diabetes and its relevance in SME is the topic of an article published in the July 2014 issue of Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.

This article gives an excellent description of the evolving theories of chronic illness. Of note, the author discusses the idea that patients with chronic illnesses have unique rights and responsibilities. He also discusses the triad of challenges patients face: the disease diagnosis, everyday life, and rebuilding identity to include the disease. Each patient navigates a series of stages, learning to cope and manage, rebuild confidence, and develop disease management strategies.

The author stresses a point that many clinicians forget: patients and health care professionals have a different relationship with the disease in general, with the patient more attuned to the social impact of disease and the clinicians focused on the pathophysiologic aspects. He discusses the impact of patient suspicion toward healthcare professionals and pharmaceutical firms.

Key elements for the development of structured therapeutic education include: 1) access to health literacy, 2) contextualization of education activities to the patient’s specific social and cultural preferences, 3) a fluid long-term chronic approach to self-management, and 4) the organizational aspects of health and care. This helps the patient understand the disease on many levels.

The author recommends moving away from promoting behavioral changes and instead providing tools and resources to help diabetics manage their disease in their own context.

Debussche X. Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review. Diabetes Metab Syndr Obes. 2014 Jul 29;7:357-67.