Supporting Adherence in the Treatment of Type 2 Diabetes - the Significance of Personal Interaction of a Patient and an Expert

The focus on individualization of treatment is emphasized, which implies, among other, active involvement of the patient in treatment – from respecting the patient’s own choices, to supporting adherence in treatment. Standards for Diabetes Self-Management Education and Support (DSMES) are essential to making informed decisions and responsibility in day-to-day diabetes management. DSMES is central in defining and implementing the patient care principles. DSMES programs mainly involve personal contacts in the group or individually together with a trained educator whose work quality is subject to evaluation. The programs are based on evidence, and are tailor-made according to the needs of the individual, yet within the needs of the local population. They are implemented in accordance with a structured plan and include supporting materials to boost patients and their caregivers in order to develop attitudes, beliefs, knowledge and skills for proper diabetes management. It is self-understood to allow for useful knowledge about illness and treatment, and how to prevent, detect and treat complications as well as to deal with situations in different circumstances, such as travel or fasting. DSMES play an important role at any time, but especially at diagnosis, annually, if /when complications arise and if there are changes in care. They include monitoring patient progress, which implies health status and quality of life. Just like the staff running the program, DSMES is subject to regular quality assessment.

Applied from the moment of diagnosis, DSMES programs in diabetes can improve adherence to medication, healthy nutrition and physical activity, raising the patient’s level of effectiveness. In type 2 diabetes, high-quality evidence has consistently shown that DSMES is a cost-effective intervention in the healthcare systems studied. It significantly improves clinical and psychological outcomes, improves glycemic control, reduces hospital admissions, improves patient knowledge, and reduces the risk of all-cause mortality. The best outcomes are achieved in the programs with a theory-based and structured curriculum, and with contact time of over 10 h. Online programs may reinforce learning, but there is little evidence if they are effective when used alone.

The recommendation of a joint report, i.e. consensus, is that when prescribing medications for diabetes 2 one must specifically consider allowing adherence to drugs. Adherence to therapy lower than optimum, including poor persistence, is common to almost half of the patients treated for diabetes, leading to sub-optimal glycemic control and increase in cardiovascular risk, as well as increased diabetes complications, mortality, hospitalization and costs for the healthcare system. Multiple factors contribute to inconsistent medication use and treatment discontinuation, including patient-perceived lack of medication efficacy, fear of hypoglycemia, lack of access to medication and adverse effects of medication. Medication adherence (including persistence) varies across medication classes and careful consideration of these differences may help improve outcomes.

Experience of Marti Farm Ltd. as a recognized partner in the field of patient support programs which are conducted in accordance with all applicable professional, legal and ethical requirements, is fully in line with the recommendations of the consensus. Personal two-way communication with a highly educated specialist within a pre-designed, structured program contributes to the proper treatment and patient satisfaction.