Reports From the Field

Patients fail to control diabetes

A potentially disastrous failure of many diabetics to take their medication properly and to achieve recommended cholesterol and blood pressure levels was reported at the recent American Diabetes Association’s 60th Annual Scientific Sessions in San Antonio.

"Only one-third of the people with type 2 diabetes have their prescriptions filled often enough to take at least 90% of their pills," says Andrew D. Morris, MD, senior lecturer in medicine and diabetes at the University of Dundee, Scotland, noting that this finding is even more surprising coming from Scotland, where prescribed medications are paid for by the National Health Service.

The Scottish researchers accessed prescription records for 400,000 residents of Tayside, Scotland. They examined records for all patients taking oral medication for type 2 diabetes over a three-year period. Researchers defined adequate adherence as having prescriptions filled often enough to enable the patient to take at least 90% of the recommended dosage of each medication.

"Of nearly 3,000 people with diabetes, only 31% of those taking sulfonylureas and 34% of those taking metformin filled their prescriptions often enough to maintain adequate adherence," Morris says. "Adherence for those who were supposed to take both medications was even lower at 13%."

Researchers found that patients who were expected to take only one pill per day did the best, with a 22% decrease in adherence for each increase in the frequency of the daily dose. Beyond frequency of diabetes pills, overall adherence was best in patients who took fewer co-medications and who had had diabetes for the least amount of time.

Reports from the Centers for Disease Control and Prevention (CDC) in Atlanta found similar dismal results in U.S. diabetics. In fact, based on a review of tests of blood pressure, cholesterol, and other lipids in more than 1,000 U.S. adults with diabetes who participated in the Third National Health and Nutrition Examination Survey, the CDC found that U.S. diabetics also run a high risk of cardiovascular disease.

Recent CDC studies have found that among 97% of adult diabetics with one or more cholesterol abnormalities, only 1% had reached recommended treatment goals. Among 71% of diabetics with hypertension, only 12% had reached recommended treatment goals. "Based on their lipid profiles, risk of cardiovascular disease was considered high for 76% and borderline for 21% of patients," says Anne Fagot-Campagna, MD, medical epidemiologist in the CDC division of diabetes translation. "However, only 32% reported being treated by diet, exercise, or prescribed medicine, and in nearly every case, lipid levels did not reach today’s standards even among those being treated."

Bruce Zimmerman, MD, president of the American Diabetes Association in Alexandria, VA, adds, "When patients don’t take proper care of themselves and don’t achieve desired goals, we must look to the health care system to ask why not. All too often, doctors and other health care professionals don’t take diabetes seriously, and people don’t receive adequate patient education. This must change."