Discussions may improve adherence to diabetes medication

Not taking medications exactly as prescribed is a major barrier to the treatment of diabetes and has been shown to be more common in African American patients than in their white counterparts.

Researchers have examined the role of two related factors—depressive symptoms and concerns about medication—among middle-aged and older African Americans. Their results, described in the Community Mental Health Journal, add to growing evidence that physicians should take a broader approach to care rather than simply writing prescriptions.

Eric Sah, a medical student at Thomas Jefferson University and study author, used data collected as part of a larger clinical trial, testing an education effort to reduce the need for emergency department visits by African American patients with diabetes.

He analyzed patients' responses to questions about their beliefs about their condition and their medication, as well as the depressive symptoms they experienced. He also included measures of their hemoglobin A1c, a long-term indication of blood glucose control. His research expanded on an earlier analysis of similar data, published in The American Journal of Geriatric Psychiatry.

Sah's analysis showed that the more signs of depression someone reported, the more likely they were to negatively view their medications' side effects and the barriers to taking medications as prescribed. Meanwhile, the worse patients' blood glucose control was, the more they perceived barriers to taking their medication properly. Worse control was also linked to symptoms of depression but to a lesser degree. These results echo those of the earlier analysis, which uncovered a similar pattern.

Findings from both studies suggest that doctors should ask patients about their beliefs about medications and directly address them, according to Barry Rovner, MD, senior researcher on all three studies. "A physician should ask, 'What do you think about these medications?'" Dr. Rovner says. "Because if a physician wants the patient to take the medication, that's going to be more effective than saying, 'You have diabetes? You need to take this pill.'"