About 40% of type 2 diabetes patients stop taking second-line therapies too early, according to a new study. The retrospective cohort study looked at more than 82,000 insured participants from 2013 to 2017. Researchers found that despite alarming numbers of people stopping their medications, those who continued had decreased complications, emphasizing the importance of taking medications as prescribed. 

“You can look at the situation as being either the glass half full or the glass half empty,” says David Cutler, MD, a board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, California. “It's good that we're prescribing this medicine, it would be better if we had higher levels of adherence to the medications.”

Increasing adherence to the medications requires more than just writing a prescription. Doctors may need to address barriers to access–including cognitive barriers—and emphasize the long-term benefits of the drugs, Dr. Cutler says.

According to Dr. Cutler, some barriers to access and compliance include:

• Cognitive barriers. Patients not understanding the importance of the medications.

• Convenience barriers. Patients not having the time, patience, or tolerance for giving themselves injections – which are necessary for some of these medications, notably GLP-1 agonists.

• Cost barriers. Drugs associated with low levels of patient compliance tend to have a higher cost than those associated with a more extended uptake, according to research.

  Harris E. “Alarming” Number of Patients Stop Taking Second-Line Diabetes Drugs. JAMA. Published online January 03, 2024. doi:10.1001/jama.2023.26110

   

• Side effects barriers.

“There are a lot of reasons why these people might have stopped taking the medication,” Dr. Cutler says. “[Addressing the issue] is really about getting a partnership with patients and having them buy into the fact that treating diabetes is very important to their overall well-being, and reducing complications such as heart attacks and strokes. And if you can get them to buy into the importance of taking their medication, it's much more likely that they will be adherent to that therapy.”

“There are a lot of people that don't believe that controlling their diabetes is going to impact their life – because the negative effects of taking this medication are immediate,” Dr. Cutler says. “They feel the money coming out of their pocket immediately; they feel any side effects that the drug might cause right away; they feel the inconvenience of getting themselves an injection right when they give a shot. But the benefits are very distant — that heart attack or that stroke that you prevent may be many years down the line.”

That being said, convincing someone of the importance of these medications is not easy, he adds. He encourages doctors to present patients with examples of other patients or community members who have benefited from their drugs and be open and honest when answering questions and concerns.

“It's very difficult to encourage somebody to do something when the bad effects are immediate and the good effects they won't feel for a very long time,” Dr. Cutler says. “[Listen] to what the patients have to say about their concerns, [let] them know that you want to take care of them.”