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Poor Understanding of Diabetes Therapy Leads to Increased Hba1c In Type 2 Diabetes

Oct 6, 2018
Editor: Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE

Author: Clarke Powell, Pharm.D. Candidate 2019, LECOM School of Pharmacy

Thorough knowledge of anti-diabetes medications found to lead to better management, adherence.

A lack of knowledge regarding one’s own diabetes medications may lead to worse adherence and poor glycemic management, a new study finds. Investigators out of Kyoto, Japan examined the relationship between the extent of patient’s knowledge of their diabetes medications and HbA1c in order to answer the question: Does having a better understanding of your own medication regimen lead to improved glycemic control and better outcomes for type 2 diabetes?

Currently, there are over 100 million people living with diabetes or prediabetes around the world. In the United States, prevalence of diabetes varies significantly by level of education, with people who have less than a high school education being the most prevalent group.

While it may be difficult to ascertain that lack of education leads to worse outcomes associated with diabetes in general, it can be said that a lack of education regarding diabetes medications is most likely a contributor to poor medication adherence.

Recently published in the Journal of Diabetes Investigation, a cross-sectional study conducted from 2014 to 2016 enrolled patients with type 2 diabetes using data from the KAMOGAWA-DM cohort study, an ongoing study of patients with diabetes. Thorough data regarding treatment regimens was obtained from medical records, as well as additional lifestyle factors. Knowledge of anti-diabetes therapy was assessed through a questionnaire survey, with patients categorized as having a good understanding of anti-diabetes medications or poor understanding of anti-diabetes medications (PUAD) through a series of question and answers.

A total of 479 patients (305 men and 174 women) with type 2 diabetes were included in the study for analysis. 89% of the patients analyzed were taking an anti-diabetes medication throughout the study period, with 8.4% of patients categorized as having a PUAD.

Results of the study showed that patients with PUAD had significantly higher HbA1c values than those with a sound understanding of their medication regimen (HbA1c=7.5% vs. 7.2%, respectively, p=0.041). Additionally, the number of anti-diabetes medications that patients were taking was significantly lower in patients with PUAD than those with an adequate knowledge of their regimens.

Based on these results, it is clear that when patients with type 2 diabetes have a thorough knowledge and understanding of their anti-diabetes medications, long-term blood glucose levels are better management. As to why this is the case, adherence is likely the main culprit. Investigators noted that around 60% of patients with PUAD did not take their prescribed anti-diabetes medications properly, if at all, supporting their findings of a lower number of medications in patients with PUAD.

Medication adherence is one of the biggest challenges when it comes to diabetes care, and a poor understanding of the disease and medications associated with it plays a large role in the lack of adherence for this patient population. Incorporation of tools to promote diabetes education is crucial for future practice in order to improve adherence and overall glycemic management. Hopefully, with improved education and better knowledge of one’s diabetes care, the diabetes community may soon see a more promising future.

Practice Pearls:

  • Patients with type 2 diabetes and a poor understanding of their anti-diabetic medications had significantly higher HbA1c than those with a thorough understanding of their medications and regimens.
  • Over half of patients with a poor understanding of their anti-diabetes medications were found to be non-adherent to their diabetes care regimens.
  • Future practice for diabetes care must incorporate educational tools for patients in order to promote both better adherence and greater glycemic management.


Sakai, R., Hashimoto, Y., Ushigome, E., Okamura, T., Hamaguchi, M., Yamazaki, M., Fukui, M. (2018). Understanding of anti-diabetic medication is associated with blood glucose in patients with type 2 diabetes: At baseline date of the KAMOGAWA-DM cohort study. Journal of Diabetes Investigation. doi:10.1111/jdi.12916

New CDC report: More than 100 million Americans have diabetes or prediabetes. (2017, July 18). Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Clarke Powell, Pharm.D. Candidate 2019, LECOM School of Pharmacy