Type 2 Diabetes and Medication Adherence

Nearly 40% of type 2 diabetes patients stop taking their second-line medication

Elizabeth Pratt

A person holds a pill pack with 6 pillsShare on PinterestMedical experts are expressing concerns about people not taking their prescribed medications for type 2 diabetes. Dmytro Skrypnykov/Getty Images

  • Most people with type 2 diabetes require more than one medication to manage their condition.
  • A new study reports that almost 40% of people with type 2 diabetes stop taking their secondary medications within a year.
  • Experts say side effects, cost, and a high pill burden may contribute to lack of compliance with medications.

Almost 40% of people with type 2 diabetes discontinue their secondary medications within a year.

That’s according to new research published in the American Journal of Managed Care.

In their study, researchers reported that two-thirds of people with type 2 diabetes discontinued their medication, switched their medication, or changed their dosage within 12 months of it being prescribed.

They noted the issue was particularly acute with people taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are a class of medications designed to treat obesity as well as type 2 diabetes.

“Discontinuation is bad. It is common in all five types of medications, but we see significantly more in those prescribed the GLP-1 RAs,” David Liss, PhD, a co-author of the study and a research associate professor of general internal medicine at Northwestern University Feinberg School of Medicine in Chicago, said in a press release.

“Presumably, the doctor is saying, ‘You need to start a new medication to control your type 2 diabetes’ and then within a year, half of them just stop and don’t start another one, and that’s not a good thing,” Liss added. “Our findings highlight the need for new prescribing approaches and to better understand the barriers patients face when taking these medications, to ultimately reduce wasting patients’ time, clinicians’ time, and the health system’s money.”

The researchers reported that 77% of people who take medications for type 2 diabetes are prescribed metformin as their first line treatment. However, many people require secondary medications for long term glycemic control.

The researchers studied 82,000 people living with type 2 diabetes between 2014 and 2017. They analyzed five non-insulin forms of diabetes medications and reported that in four out of five of those medications, 38% of people stopped taking the medication.

Why people stop taking type 2 diabetes medications

Dr. Marilyn Tan, an endocrinologist and clinical associate professor of medicine at the Stanford University School of Medicine in California, says the rates of discontinuation aren’t surprising.

“There are many reasons patients have difficulty with adhering to medications. Some reasons include busy schedules, a high pill burden, medication side effects, perceived lack of efficacy, and importantly, costs,” Tan, who was not involved in the study, told Medical News Today.

“Patients with diabetes frequently have multiple medications and complicated medication schedules. Most of the time, diabetes does not occur in isolation and patients frequently also need medications for hypertension, hyperlipidemia, and other medical conditions. Many medications need to be taken more than once daily,” she added.

“In addition, some medications cannot be taken together and must be spaced out strategically from other medications,” Tan noted. “Some medications must be taken on an empty stomach, whereas some must be taken with food, and some must be taken before a meal. The medication regimen can become very complicated and burdensome.”

Ozempic has high rate of discontinuation

For GLP-1 RAs drugs such as Ozempic, the discontinuation rate among study participants was higher at 50%.

The researchers said this may be due to the gastrointestinal side effects sometimes associated with the drug, including nausea, vomiting, and diarrhea.

Cost and the method of administration of the drug may also be factors.

“These medications are given by injection. A lot of people don’t like giving themselves injections. They would rather take an oral medication if they could, rather than taking an injection,” Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center in California, told Medical News Today.

Cutler, who was not involved in the study, said the high rate of medication discontinuation among those living with type 2 diabetes is worrisome.

“It’s very concerning with diabetes because this is such an impactful disease in terms of its effect on increased cardiovascular risk, the risk of kidney disease, eye disease, circulatory disease, neuropathy. The complications associated with diabetes are quite rampant,” he said.

The researchers were able to analyze insurance claims data of the subjects in the study, meaning they could identify the date a medication was prescribed and if the dosage was changed or switched to a different class of medication.

Being in a younger age group and being female were associated with a higher rate of discontinuation, changes to dosage, or switching medications.

People may be stopping medications without consulting physicians

While the researchers believe people who switched or changed dosage of their medications did so in consultation with their doctor, they say those who discontinued their medication may have done so without first speaking with their healthcare provider.

“Our results may represent a ‘wake-up call’ for clinicians that many of their patients were not taking the medicines that were prescribed,” Liss said.

“While we don’t know if providers were aware of the discontinuation events observed in this study, our results highlight the need for ongoing communication between patients and prescribers over time — around medication benefits, side effects and costs — not just at the time of prescribing,” he added.

Tan argues it can be problematic when people decide to stop their medications without proper consultation with their healthcare provider.

“It’s concerning when patients self-discontinue medications or adjust doses on their own without discussion with their physicians. Miscommunication about doses and medication adherence can be dangerous. For example, if a patient has multiple medications on their medication list that they aren’t actually taking, they get admitted to the hospital, and a doctor orders to continue all home medications, this could lead to low blood sugar or medication side effects,” she said.

“It’s critical to be transparent with your healthcare providers about what medications you are taking, what doses you’re taking, how consistent you are with the medication, and how you are taking the medications,” Tan added.

Although medications like Ozempic had a high rate of discontinuation, Cutler argues there are plenty of medication options for people with type 2 diabetes that may be well-tolerated.

“In most situations, because there’s such a wide variety of medications available for controlling diabetes, the diabetes can be controlled without significant side effects,” he said.

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