Research Article| Volume 17, ISSUE 2, P180-184, April 2023

Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes

Published:February 18, 2023DOI:


      • Randomized trial investigating adherence patterns to oral hypoglycemic agents.
      • Three patterns were identified: nonadherence, increasing adherence and adherence.
      • Patient Prioritized Planning interventions showed increased adherence patterns.



      To examine patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus and to assess whether these patterns were associated with baseline intervention allocation, sociodemographic characteristics, and clinical indicators.


      Adherence patterns were examined by Medication Event Monitoring System (MEMS) caps at baseline and 12 weeks. Participants (n = 72) were randomly allocated to a Patient Prioritized Planning (PPP) intervention or a control group. The PPP intervention employed a card-sort task to identify health-related priorities that included social determinants of health to address medication nonadherence. Next, a problem-solving process was used to address unmet needs involving referral to resources. Multinomial logistic regression examined patterns of adherence in relation to baseline intervention allocation, sociodemographic characteristics, and clinical indicators.


      Three patterns of adherence were found: adherent, increasing adherence, and nonadherent. Participants assigned to the PPP intervention were significantly more likely to have a pattern of improving adherence (Adjusted Odds Ratio (AOR)= 11.28, 95% confidence interval (CI)= 1.78, 71.60) and adherence (AOR=4.68, 95% CI=1.15, 19.02) than participants assigned to the control group.


      Primary care PPP interventions incorporating social determinants may be effective in fostering and improving patient adherence.


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      1. Standards of Medical Care in Diabetes —2021. Diabetes Care, 2021 Jan;44(Supplement 1):S1–S2.

        • Fang M.
        Trends in Diabetes Managements Among US Adults: 1999–2016.
        J. Gen. Intern Med. 2020; 35 (Epub 2020 Jan 2): 1427-1434
        • Kim Y.
        • Lee J.
        • Kang H.
        • Park S.
        Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65,067 newly diagnosed type 2 diabetes patients.
        Sci. Rep. 2018; 8: 12190
        • Khunti K.
        • Seidu S.
        • Kunutsor S.
        • Davies M.
        Association between adherence to pharmacotherapy and outcomes in type 2 diabetes: a meta-analysis.
        Diabetes Care. 2017; 40 (doi: 10.2337/dc16-1925. Epub 2017 Aug 11.): 1588-1596
        • Capoccia K.
        • Odegard P.
        • Letassy N.
        Medication adherence with diabetes medication: a systematic review of the literature.
        Diabetes Educ. 2016; 42 (Epub 2015 Dec 4): 34-71
        • Krass I.
        • Schieback P.
        • Dhippayom T.
        Adherence to diabetes medication: a systematic review.
        Diabet. Med. 2015; 32 (10.1111/dme.12651. Epub 2015 Jan 9): 725-737
        • Bailey C.
        • Kodack M.
        Patient adherence to medication requirements for therapy of type 2 diabetes.
        Int J. Clin. Pr. 2011; 65: 314-322
        • van Eijken M.
        • Tsang S.
        • Wensing M.
        • de Smet P.
        • Grol R.
        Interventions to improve medication compliance in older patients living in the community: a systematic review of the literature.
        Drugs Aging. 2003; 20: 229-240
        • Haynes R.
        • Ackloo E.
        • Sahota N.
        • McDonald H.
        • Yao X.
        Interventions for enhancing medication adheren ce.
        Cochrane Database Syst. Rev. 2008; 2CD000011
        • Kirk J.
        • Ebert C.
        • Gamble G.
        • Ebert C.
        Social support strategies in adult patients with diabetes: a review of strategies in the USA and Europe.
        Expert Rev. Endocrinol. Metab. 2013; 8: 379
        • van Dam H.
        • van der Horst F.
        • Knoops L.
        • Ryckman R.
        • Crebolder H.
        • van den Borne B.
        Social support in diabetes: a systematic review of controlled intervention studies.
        Patient Educ. Couns. 2005; 59: 1-12
        • Reach G.
        • Le Pautremat V.
        • Gupta S.
        Determinants and consequences of insulin initiation for type 2 diabetes in France: analysis of the National Health and Wellness Survey.
        Patient Prefer. Adherence. 2013; 7: 1007-1023
        • Kirkman M.
        • Rowan-Martin M.
        • Levin R.
        • Fonseca V.
        • Schmittdiel J.
        • Herman W.
        • Aubert R.
        Determinants of adherence to diabetes medications: findings from a large pharmacy claims database.
        Diabetes Care. 2015; 38: 604-609
        • Chen C.
        • Tseng C.
        • Cheng S.
        Continuity of care, medication adherence, and health care outcomes among patients with newly diagnosed type 2 diabetes: a longitudinal analysis.
        Med Care. 2013; 51: 231-237
        • Rolnick S.
        • Pawloski P.
        • Hedblom B.
        • Asche S.
        • Bruzek R.
        Patient characteristics associated with medication adherence.
        Clin. Med. Res. 2013; 11: 54-65
        • Chew B.
        • Hassan N.
        • Sherina M.
        Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study.
        Patient Prefer. Adherence. 2015; 9: 639-648
        • Ahmad N.
        • Ramli A.
        • Islahudin F.
        • Paraidathathu T.
        Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia.
        Patient Prefer. Adherence. 2013; 7: 525-530
        • de Vries McClintock H.
        • Boyle K.
        • Rooney K.
        • Bogner H.
        Diabetes and depression care: a randomized controlled pilot trial.
        Am. J. Health Behav. 2016; 40: 503-513
        • Yu M.
        • Zhan X.
        • Yang Z.
        • Huang Y.
        Measuring the global, regional, and national burden of type 2 diabetes with the attributable risk factors in all 194 countries.
        J. Diabetes. 2021 24; (Online ahead of print)
        • World Health Organization
        Adherence to Long-term Therapies: Evidence for Action.
        World Health Organization,, Geneva2003
        • Kahn R.
        • Alperin P.
        • Eddy D.
        • Borch-Johnsen K.
        • Buse J.
        • Feigelman J.
        • Gregg E.
        • Holman R.
        • Kirkman M.
        • Stern M.
        • Tumilehto J.
        • Wareham N.
        Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis.
        Lancet. 2010; 375: 1365-1374
        • Angst J.
        Clinical course of affective disorders.
        Depress Illn. 1988; : 1-48
        • Crum R.
        • Anthony J.
        • Bassett S.
        M. Folstein. Population-based norms for the Mini-Mental State Examination by age and educational level.
        Jama. 1993; 269: 2386-2391
        • Stewart A.
        • Hays R.
        • Ware Jr., J.
        The MOS short-form general health survey. Reliability and validity in a patient population.
        Med. Care. 1988; 26: 724-735
        • Moridani M.
        • Verjee Z.
        • Allen L.
        Analytical evaluation of hemoglobin A(1c) dual kit assay on Bio-Rad Variant II: an automated HPLC hemoglobin analyzer for the management of diabetic patients.
        Clin. Biochem. 2003; 36: 317-320
        • Foley K.
        • Reed P.
        • Mutran E.
        R. DeVellis. Measurement adequacy of the CES-D among a sample of older African-Americans.
        Psychiatry Res. 2002; 109: 61-69
        • Radloff L.
        The CES-D Scale: a self-report depression scale for research in the general population.
        Appl. Psychol. Meas. 1977; 1: 385-401
        • Jasti S.
        • Siega-Riz A.
        • Cogswell M.
        • Hartzema A.
        • Bentley M.
        Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women.
        J. Nutr. 2005; 135: 1093-1101
        • Lee M.
        • Lee H.
        • Kang S.
        • Yang J.
        • Ahn H.
        • Rhee M.
        • Ko Y.
        • Joe S.
        • Jung I.
        • Kim S.
        Variables influencing antidepressant medication adherence for treating outpatients with depressive disorders.
        J. Affect Disord. 2010; 123: 216-221
        • Crits-Christoph P.
        • Gibbons M.
        • Hamilton J.
        • Ring-Kurtz S.
        The dependability of alliance assessments: the alliance-outcome correlation is larger than you might think.
        J. Consult Clin. Psychol. 2011; 79: 267-278
        • Maslow A.
        A theory of human motivation.
        Psychol. Rev. 1943; 50: 370-396
      2. Group Health Research Institute. The chronic care model. Improving Chronic Illness Care: 2006–2012. Available at Accessed March 7, 2016.

        • Walker R.
        • Strom-Williams J.
        • Egede L.
        Influence of race, ethnicity and social determinants of health on diabetes outcomes.
        Am. J. Med Sci. 2016; 351: 366-373
        • Ayalon L.
        • Arean P.
        • Linkins K.
        • Lynch M.
        • Estes C.
        Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly.
        Am. J. Geriatr. Psychiatry. 2007; 15: 906-912
        • Unutzer J.
        • Katon W.
        • Callahan C.
        • Williams Jr, J.
        • Hunkeler E.
        • Harpole L.
        • Hoffing M.
        • Penna R.
        • Noël P.
        • Lin E.
        • Areán P.
        • Hegel M.
        • Tang L.
        • Belin T.
        • Oidhi S.
        • Langston C.
        Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.
        Jama. 2002; 288: 2836-2845
        • Bogner H.
        • Dahlberg B.
        • de Vries H.
        • Cahill E.
        • Barg F.
        Older patients’ views on the relationship between depression and heart disease.
        Fam. Med. 2008; 40: 652-657
        • Farmer K.
        Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice.
        Clin. Ther. 1999; 21: 1074-1090
        • Winkler A.
        • Teuscher A.
        • Mueller B.
        • Diem P.
        Monotoring adherence to prescribed medication in type 2 diabetic patients treated with sulfonylureas.
        Swiss Med Wkly. 2002; 132: 379-385
        • Xu H.
        • Yu Y.
        • Zhang Q.
        • Hu H.
        • Li M.
        Tailored interventions to improve medication adherence for cardiovascular diseases.
        Front Pharm. 2020; 11510339