Pharmacist-Led Education on Diabetes Increased Medication Adherence in Patients with T2D

Education on T2D can significantly reduce A1C and systolic blood pressure after six months.

Patients with T2D require strict medication adherence, a task many individuals find difficult to achieve. Following the recommended diet and exercise regimen to attain weight loss are also essential for glycemic control. This study looked at pharmacist-led diabetes education and what effect it had on improving medication adherence. Factors such as A1C, systolic blood pressure, diet, and physical activity were also examined. Pharmacists were chosen for this study due to their high levels of patient interaction.

The researchers of this quasi-experimental study recruited 227 patients with T2D from two hospitals. Inclusion criteria were primary diagnosis of T2D and taking diabetes medication for at least six months. Those with T1D and gestational diabetes were excluded from the study. Baseline interviews were conducted using a questionnaire. Individuals with baseline A1C ≥7% were placed into the intervention group, while those with A1C <7% were placed in the control group. The intervention included patient-specific education led by a pharmacist. The guidance provided resolution of adherence-related problems. Information on appropriate diet and exercise was also offered. The control group continued to receive their standard treatment. Follow-up was at six months and included repeating the original questionnaire along with an A1C and blood pressure check.

The participants of this Nigerian study were mostly female (79.6%), with a mean age of 63 years. The control group had a mean A1C of 6.1% at baseline, with no change at six months. The intervention group had a mean A1C of 8.7% at baseline, which was lowered to 7.8% at six months. At baseline, 68.4% of patients in the control group and 42.5% in the intervention group reported optimal medication adherence. After six months, 78.9% in the control group and 75.5% in the intervention group reported optimal medication adherence. Individuals with the intervention saw a significant reduction in A1C post six months (p < 0.001). The intervention group also saw a reduction in average systolic blood pressure (136.9 mmHg, 131 mmHg, p = 0.002). The control also saw a significant decrease in systolic blood pressure (129.3 mmHg 125.3, p = 0.004).

The reasons listed for medication non-compliance include financial limitations [control (49%), intervention (46%)], and forgetfulness (31%, 34.6%). Individuals did not follow diet recommendations due to not knowing the importance of following the diet for diabetes management (18%, 38.3%), financial constraints (18.8%, 18.3%), difficulty accessing recommended foods (31%, 7%), lack or refrigeration (31%, 23%), and inability to follow diet due to temptation (0%, 13%). Individuals did not follow exercise recommendations due to tiredness or discomfort (36%, 33%), lack of time (25%, 33%), unwillingness (22%, 19%) and illness (16%, 14%).

The study found that patients who received diabetes education by a pharmacist showed significant improvement with adherence to their treatment. The researchers believed that improving patient knowledge on their disease and therapy contributed to this finding. Previous studies have shown that education was the most effective method for resolving knowledge-related medication nonadherence. Individuals utilizing the intervention also saw a significant improvement in their glycemic control. Pharmacists providing additional patient education can greatly improve patient outcomes. A previous United Kingdom Prospective Diabetes Study found that each 1% reduction in A1C led to a 21% drop in the risk of diabetes-related complications. Pharmacists have the greatest access to patients with T2D, making them great tools for improving outcomes.  Limitations of the study include self-reporting data collection and quasi-experimental design where group assignment was designated based on A1C.

Practice Pearls:

• Patients with T2D receiving diabetes education from a pharmacist showed significant improvement with adherence to their treatment. These individuals also saw a significant reduction in A1C and systolic blood pressure after six months.
• Pharmacists can improve patient outcomes with T2D by providing additional education on the disease state. They can also state the importance of medication adherence, diet, and exercise.
• Individuals with T2D did not follow diet recommendations because they did not know the importance of diet in their diabetes management. They also had financial constraints, difficulty accessing recommended foods, lack of refrigeration, and inability to follow diet due to temptation.

Ipingbemi, Aduke E et al. “Pharmacist-led intervention in treatment nonadherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria.” BMC health services research vol. 21,1 1000. 22 Sep. 2021, doi:10.1186/s12913-021-06979-z. https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-021-06979-z.pdf

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions