Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-

Table 1. Approach to the management of hyperglycemia (119) Consideration More stringent management (A1C < 7.0%)

Less stringent management (A1C 7.1 to 8.0%)

Risks associated with hypoglycemia and adverse events

Low

High

Diabetes duration

Newly diagnosed

Long-standing

Life expectancy

Long

Short

Important comorbidities

Absent

Severe

Established vascular complications

Absent

Severe

Highly motivated; excellent self-care

Individual attitude and expected treatment effort

Less motivated; poor self-care

Resources and support system

Readily available

Limited

B. Review of factors that may cause deterioration in glycemic control • Illness, infection, hospitalization, corticosteroid use, new medications

C. Assess adherence to currently prescribed antihyperglycemic agents It is important the team routinely assess that the individual is taking their medication every day as prescribed. Encouraging people to always take their medications as ordered leads to better care and treatment outcomes. • A review of the literature revealed adherence rates to diabetes medication varied from 38 to 93% and that 31.4% of new prescriptions were never filled (120). o Key factors contributing to poor adherence include perceived treatment efficacy, hypoglycemia, treatment complexity/convenience, cost, medication beliefs and physician trust (120). • A systematic review reported people with type 2 diabetes take only 67-85% of oral medications as prescribed and 60% of insulin doses (121). In one meta-analysis, people with good medication adherence (>80%) had a 10% lower rate of hospitalization and 28% decrease in all-cause mortality versus the group with poor adherence (rates 25%-91%; mean 37.8%) (122).