title: Understanding adherence to medications in type 2 diabetes care and clinical trials to overcome barriers: a narrative review.
abstract: OBJECTIVE
  To identify factors affecting adherence to medications in type 2 diabetes (T2D) care and clinical trials.
  
  
  BACKGROUND
  Adherence to medication is associated with better patient outcomes, lower healthcare costs, and improved quality and robustness of trial data. In T2D, non-adherence to regimens may compromise glycemic, blood pressure and lipid control, which can, in turn, increase morbidity and mortality rates.
  
  
  METHODS
  A literature search was performed to identify studies reporting adherence to medications and highlighting specific adherence challenges/approaches in T2D. The search was limited to clinical trials, comparative studies or meta-analyses, reported in English with a freely available abstract.
  
  
  METHODS
  MEDLINE (31 December 2008 to 31 December 2013).
  
  
  METHODS
  Studies not reporting adherence to medications or highlighting adherence challenges/approaches in T2D, presenting only self-reported adherence or including fewer than 100 patients were excluded. Eligible reports are discussed narratively.
  
  
  RESULTS
  Factors identified as having a detrimental impact on adherence were smoking, depression and polypharmacy. Conversely, increased convenience (e.g. pen compared with vial and syringe; medication supplied by mail order vs. retail pharmacy) was associated with better patient adherence, as were interventions that increased patient motivation (e.g. individualized, nurse-led consultation) and education.
  
  
  CONCLUSIONS
  Medication adherence is influenced by complex and multifactorial issues, which can include smoking, depression, polypharmacy, convenience of obtaining and administering the medication, patient motivation and education. We recommend simplifying treatment regimens, where possible, improving provider-patient communication, and providing support and education to increase medication adherence, with a view to improving patient outcomes and clinical trial data quality.
authors.affiliation: a a Endocrinology, Case Western Reserve University , Cleveland , Ohio , USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Tiktin
authors.affiliation: b b Istanbul Faculty of Medicine, Division of Endocrinology and Metabolism, Istanbul University , Istanbul , Turkey.
authors.forename: Selda
authors.initials: S
authors.lastname: Celik
authors.affiliation: c c Winnipeg Regional Health Authority Health Sciences Centre , University of Manitoba , Winnipeg , Canada.
authors.forename: Lori
authors.initials: L
authors.lastname: Berard
mesh_terms: D003142:Communication; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D017048:Health Care Costs; D006801:Humans; D055118:Medication Adherence; D019338:Polypharmacy
keywords: Adherence; Antidiabetic; Antihyperglycemic; Compliance; Diabetes mellitus; Drug; Literature review; Medication