Poor outcomes in diabetes care: is medication nonadherence or lack of treatment intensification to blame?

Abstract

The majority of patients with diabetes mellitus have glucose, blood pressure and cholesterol levels above the established treatment targets. Multiple factors could contribute to this situation, including clinical inertia and medication nonadherence. In this Practice Point commentary, I discuss the results and implications of a study that aimed to assess these two parameters. Schmittdiel et al. analyzed HbA_1C, blood pressure and cholesterol levels in >160,000 patients with diabetes mellitus. They found that both medication nonadherence and clinical inertia were common. In addition, many patients did not have their treatment intensified, despite good medication adherence. Both clinical inertia and medication nonadherence had a negative effect on achievement of treatment targets. These findings confirm that medication nonadherence does not explain clinical inertia, and that both need to be addressed in order to improve quality of diabetes care. Although data are still lacking for insulin-treated patients, sufficient observational evidence exists to support initiation of interventional studies to determine whether targeting these factors leads to improved outcomes.