A systematic literature review of methodologies used to assess medication adherence in patients with diabetes
Abstract
OBJECTIVE: Adhering to prescribed medication is often a problem for patients with diabetes yet there is no consensus on how best to measure adherence in this patient population. This systematic literature review critically reviewed and summarized the methods used to measure medication adherence in patients with diabetes (on oral hypoglycemic agents [OHAs] and/or insulin) in original research published between 2007-2013. STUDY DESIGN: Literature review. METHODS: A systematic search for methods to assess medication adherence in patients with type I or type II diabetes was conducted using PubMed, EMBASE, PsychInfo, and Cochrane databases. Two researchers independently screened abstracts for initial eligibility and then applied the inclusion/exclusion criteria to the relevant full-text articles. RESULTS: Fifty-nine articles met the criteria for inclusion. Subjective assessment (observer-reported and patient-reported), pill counts, Medication Event Monitoring System (MEMS), cell-phone real-time assessment, and logbooks were used in prospective studies. In pharmacy claims databases, medication possession ratios (MPRs), or some derivation thereof, were utilized. Each method has strengths and weaknesses, but few approaches specifically addressed issues unique to assessing insulin adherence. Three novel approaches (using cell-phone real-time assessment, computerized logbooks, and a questionnaire about different dosing irregularities) provided insight on timing and dosing issues that could be useful for highlighting interventions to improve insulin adherence. CONCLUSION: No gold standard exists for measuring medication adherence in patients with diabetes. The plethora of adherence methods precludes the comparison of adherence rates across studies. Greater consistency is therefore needed in adherence measurement, including question content, recall period, and response options for self-report measures. Novel methods for understanding adherence to variable-dosed insulin require further research. Researchers should select a methodology that best fits their research question, study design, patient population and resources.
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The assessment of adherence is a major challenge with potential dishonesty of patients being only one issue.
“The assessment of adherence is a major challenge with potential dishonesty of patients’ being only one issue[6,7].”
From Adherence is associated with a favorable outcome after lung transplantation (2019) · cites this paper as [6]
Cites
1 retracted
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Optimal recall period and response task for self-reported HIV medication adherence
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Integrative Health Coaching for Patients With Type 2 Diabetes
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“20 A review of studies found that among patients with diabetes, hypertension, and dyslipidemia, only 59% had MPR 80%.”
Forbes, C. A., Deshpande, S., Sorio-Vilela, F., Kutikova, L., Duffy, S., Gouni-Berthold, I., & Hagström, E. (2018) · Current Medical Research and Opinion · doi:10.1080/03007995.2018.1477747 · Cited by 149 · see citing works
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Adherence is associated with a favorable outcome after lung transplantation
Bertram, A., Fuge, J., Suhling, H., Tudorache, I., Haverich, A., Welte, T., & Gottlieb, J. (2019) · PLoS ONE · doi:10.1371/journal.pone.0226167 · Cited by 34 · see citing works
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Methodological Approaches in Studying Type-2 Diabetes-Related Health Behaviors—A Systematic Review
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- Authors
- Clifford, S., Perez-Nieves, M., Skalicky, A. M., Reaney, M., & Coyne, K. S.
- Affiliations
- Evidera, Bethesda MDUSA
- Eli Lilly and Company Indianapolis, INUSA
- Eli Lilly (United Kingdom) (GB)
- Corresponding author
- Coyne, Karin S.
- Venue
- Current Medical Research and Opinion
- Publisher
- Informa UK Limited
- Published
- 2014-02-11
- Volume
- 30
- Issue
- 6
- Pages
- 1071-1085
- ISSN
- 0300-7995 (ISSN-L)
- 1473-4877
- OpenAlex
- W2129218314
- Cited by
- 99
- References
- 10
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 6 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 10 · 2019: 9 · 2018: 8 · 2017: 11 · 2016: 13 · 2015: 6 · 2014: 2
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Medical Research and Opinion (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- medication adherence, diabetes mellitus, type 1 diabetes, type 2 diabetes, oral antidiabetic drugs, insulin adherence, adherence measurement methods, pill count, medication event monitoring system, medication possession ratio, pharmacy claims data, patient-reported adherence
- MeSH terms
- Assessment of Medication Adherence, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Databases, Factual, Drug Monitoring, Medication Adherence
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