Not Taking Prescribed Drugs Linked with Death in People with Diabetes

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A recently published study of over 11,500 people with diabetes showed that a significant number—21%—do not take their blood-pressure–lowering, cholesterol-lowering, or blood-glucose–lowering pills regularly. Not surprisingly, the study found that these people have higher blood pressure, LDL (“bad”) cholesterol, and HbA1c levels (a measure of blood glucose over time). They also have a much higher chance of being hospitalized or dying than people who take their medicines regularly.

The study, which was led by Dr. P. Michael Ho and published in the September 25 issue of the journal Archives of Internal Medicine, examined the effects of what it called “medication nonadherence.” People being studied were designated “nonadherent” if they did not fill their prescriptions often enough to be able to take their drugs at prescribed levels at least 80% of the time.

The people in the study who did not take their prescribed medicines regularly tended to be younger and have fewer illnesses other than diabetes. However, these factors did not protect them from increased rates of hospitalization or death. In fact, the people who did not adhere to their drug regimens had a 58% greater chance of ending up in the hospital and an 81% greater chance of dying than those who did adhere, even when other factors that may have contributed to these outcomes were accounted for.

A second study, also led by Dr. Ho and published in the same issue of Archives of Internal Medicine, followed 1,521 people who had been hospitalized for myocardial infarction (heart attack) for one year. These people had all been instructed to take aspirin, beta-blockers (used to treat high blood pressure), and statins (used to treat abnormal cholesterol levels). The researchers learned that about one in eight people stopped taking all three types of medicine after just one month, and one in five people stopped using one of the medicines in the same period. The people who stopped taking all their drugs had a much greater chance of dying in the following 11 months than those who continued to take at least one of the drugs.

While the takeaway message from these studies seems clear (take your medicine as directed!), the researchers understand that people with diabetes or heart disease who do not take their medicines regularly are not the only ones at fault—poor communication between health-care professionals and patients also contributes to nonadherence. They urge health-care professionals to assess whether or not people are taking their medicines during routine appointments. Other researchers suggest additional interventions such as electronic reminders for doctors, automated voice messages for people using drug therapy, and outreach from pharmacy staff.

If you are having trouble taking your medicines regularly for financial or other reasons, bring the issue up with a member of your health-care team so you can find a solution together.

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