Despite success in management diabetes mellitus type 1 (DM1) and type 2 (DM2)a high percentage of patients do not achieve therapeutic goals recommended by clinical guidelines. This affects development chronic micro- and macrovascular complicationswhich affects quality of life and increases mortality. In fact, non-adherence continues to be a significant problem as it directly affects metabolic control and complications.
“Lack of adherence is one of the problems we face in treating diabetes, as patients sometimes skip treatment with both non-insulin medications and insulin, especially those that can cause hypoglycemia,” explains Dr. Amparo Marco Martinez, endocrinologist and secretary of the Spanish Diabetes Society (SED) in an interview with ConSalud.es.
In type 1 diabetes, although patients are more aware of the need for insulin, “sometimes they skip treatment.”
The prevalence of non-adherence to therapeutic regimen in type 2 diabetes was estimated. from 50 to 60%and with type 1 it varies from 12 to 60% depending on the population and research methodology. One of the antihyperglycemic drugs for which non-adherence causes the most problems is insulin, which is vital in the treatment of T1DM in the early and late stages of T2DM. In patients with the latter, refusal of insulin treatment is common, and in T1DM, voluntary insulin restriction for weight loss has been reported in both adolescents and adults. Dr. Marco points out that with type 1 diabetes, although patients are more aware of the need for insulin, “sometimes they skip treatment.”
Reasons for non-adherence to treatment may vary. In many cases, patients do not have adequate awareness of the disease or “they want to avoid polypharmacy”, – says the expert. Moreover, when patients achieve a certain goal, such as obtaining good glycated hemoglobin, they tend to think that they no longer need the drug and can do without it. “There is a downside to this: when a patient takes pharmacological treatment incorrectly, metabolic control deteriorates, and if this continues over time, vascular risk increases,” warns the specialist.
One of the main tasks is to solve the problem proper diabetes education. The specialist emphasizes the importance individualize treatment and discuss risks with the patient avoidance of medications, as well as the benefits of proper medication adherence. “Many medications used for diabetes can help you lose weight or control other vascular risk factors, slowing the progression of chronic complications. Influencing a positive message can encourage patients to become more compliant with treatment,” he adds.
Obstacles to optimal glycemic control include forgetting to take insulin before unexpected administration, bolus delays, and dosing errors. These factors often go unnoticed in clinical practice due to a lack of information from the patient. “One of our challenges is to correctly identify patients who have poor adherence to treatment, since they are often unaware or unaware of it,” comments the doctor.
TECHNOLOGY, COMMITMENT CONTROL STRATEGY
Technological evolution in recent years has led to the availability of new tools to improve medication adherence and optimize glycemic control. Among them, plug-in pens and caps stand out, which record the time and dose of insulin administered, warning of missed or late boluses. “These tools can help patients become more compliant with treatment and avoid forgetfulness. Sometimes non-compliance is voluntary, but sometimes it is also involuntary,” says Dr. Marco.
Combining digital devices such as smart pens with continuous glucose monitoring (CGM) improves the treatment of these patients and therefore their adherence to treatment. According to an article in the journal Diabetes, “the frequency of missed boluses is decreasing from 25% to 14% using smart pens, which significantly improves glycemic control.”
“We lack tools to identify patients who are not adhering to treatment, but digital solutions can help minimize these problems.”
Technology and innovation in digital health offer an opportunity to reduce the burden of chronic disease. Integrating capillary blood glucose, CGM, insulin dosage, intake and activity data along with dosage prediction and recommendation software creates an ecosystem that makes diabetes self-management easier. “We lack tools to identify patients who are non-adherent to treatment, but digital solutions can help minimize these problems,” says Dr. Marco.
The future of diabetes care focuses on exploring new technologies, such as artificial intelligence, to improve adherence to treatment and glycemic control. While these tools still need to be implemented in a safe and regulated manner, the expert is optimistic. “All tools that promote adherence are welcome, regardless of patient safety,” he concludes.