A Disease of Halves: Why better patient adherence to treatment is important to manage diabetes?  

Diabetes Mellitus is a major health issue with nearly half a billion people living with this ailment globally. Diabetes is a serious, chronic or long-term condition that occurs when there are elevated levels of glucose in a person’s blood because their body cannot produce any or enough of the hormone insulin, or cannot effectively use the insulin it produces.

Since diabetes is a chronic disease with no cure found yet, it is important to manage the disease effectively in order to maintain good quality of life and avoid diabetes-linked complications, which can at times be severe and life-threatening. Co-morbidities associated with diabetes include cardiovascular, kidney and eye diseases, and diabetic foot or lower limb complications, among others. Approximately 4.2 million adults aged 20–79 years are estimated to have died as a result of diabetes and its complications in 2019¹.

The number of people living with diabetes is increasing rapidly. From 151 million in 2000, the prevalence of diabetes has risen to 463 million or 9.3% of global population in 2019¹. By 2030, this number is expected to jump to 578 million¹, which calls for immediate action to create awareness about managing this disease effectively.

Diabetes is often described as a disease of “halves”: half diagnosed, half treated, half compliant, especially in developing economies. This poses a huge risk on patients’ lives.

Of the total 463 million diabetics, nearly 80% live in low-and-middle income countries¹, where access and affordability of medication, and inadequate healthcare infrastructure, are huge challenges.

Apart from these challenges, one of the main concerns around diabetes management is patient adherence to treatment regimes. Non-adherence or inadequate compliance leads to several complications, some of which can be fatal, and worsens the quality of life of patients.

In Type 1 diabetes, patients are put on insulin immediately after they are diagnosed, while in Type 2 diabetes, patients are usually first prescribed oral medicines along with lifestyle modifications and later if the oral drugs are not able to control their blood glucose levels, they are put on insulin.

Globally, 90% of the total diabetic population has Type 2 diabetes. Meanwhile, Type 1 diabetes is usually found in children or young adolescents. Over one million children and adolescents suffer from Type-1 diabetes as of 2019¹.

Poor medication adherence is associated with inadequate glycemic control, higher chances of morbidity and mortality, and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Hence, it is important to address this problem.

There are several reasons for poor adherence or non-compliance by patients. These include lack of discipline to sustain lifestyle or dietary changes advised by the doctor, complicated treatment regime with too many different medicines prescribed, demographic issues like lack of proper education and healthcare facilities, higher expenditure, and phobia or fear of injections in case insulin is part of the daily treatment regime.

Especially with regards to insulin therapy, patients could face various issues such as needle phobia, social stigma, inability to properly adjust insulin doses, and episodes of hypoglycaemia, which can be serious deterrents to adherence.

Some factors leading to poor patient adherence need intervention from governments to help improve access and affordability of oral medicines as well as insulin, and to build a strong healthcare infrastructure with a significant rise in primary healthcare centres that can help early diagnosis and provide the right treatment for diabetes. But support from doctors or healthcare professionals, family members, and other patients can also go a long way in ensuring better patient adherence to treatment.

Healthcare professionals should time and again educate the patients about the disease and how to manage it effectively, help them in understanding their treatment regime in terms of which tablets are used for what, and the right dose and way of administration of insulin.

It is also important for doctors to tell patients about the new treatment options available such as combination drugs, new devices for insulin delivery and new sugar monitoring devices, which can help manage their condition better. Improvement in doctor-patient relationship is crucial to address the issue of poor adherence to treatment.

Digital therapeutics and digital patient decision support systems, which involve evidence-backed, software-driven and delivered interventions meant to complement medications, can ensure better adherence and outcomes and play a crucial role in diabetes management and care in the years ahead.

Diabetes is essentially a self-managed disease and therefore requires patients to have a degree of autonomy and motivation to successfully perform optimal self-management. Healthcare professionals can provide autonomy support to their patients to enhance their success in disease management behaviours.

At the time when diabetes incidence is increasing at an alarming rate across the globe, it has become imperative for all stakeholders to come up with innovative solutions to tackle this disease, keeping patient needs in mind.

References:

1. IDF Diabetes Atlas 2019