Randomized Trial of Telephone Outreach to Improve Medication Adherence and Metabolic Control in Adults With Diabetes

Abstract

OBJECTIVEMedication nonadherence is a major obstacle to better control of glucose, blood pressure (BP), and LDL cholesterol in adults with diabetes. Inexpensive effective strategies to increase medication adherence are needed.RESEARCH DESIGN AND METHODSIn a pragmatic randomized trial, we randomly assigned 2,378 adults with diabetes mellitus who had recently been prescribed a new class of medication for treating elevated levels of glycated hemoglobin (A1C) ≥8% (64 mmol/mol), BP ≥140/90 mmHg, or LDL cholesterol ≥100 mg/dL, to receive 1) one scripted telephone call from a diabetes educator or clinical pharmacist to identify and address nonadherence to the new medication or 2) usual care. Hierarchical linear and logistic regression models were used to assess the impact on 1) the first medication fill within 60 days of the prescription; 2) two or more medication fills within 180 days of the prescription; and 3) clinically significant improvement in levels of A1C, BP, or LDL cholesterol.RESULTSOf the 2,378 subjects, 89.3% in the intervention group and 87.4% in the usual-care group had sufficient data to analyze study outcomes. In intent-to-treat analyses, intervention was not associated with significant improvement in primary adherence, medication persistence, or intermediate outcomes of care. Results were similar across subgroups of patients defined by age, sex, race/ethnicity, and study site, and when limiting the analysis to those who completed the intended intervention.CONCLUSIONSThis low-intensity intervention did not significantly improve medication adherence or control of glucose, BP, or LDL cholesterol. Wide use of this strategy does not appear to be warranted; alternative approaches to identify and improve medication adherence and persistence are needed.

Efficacy of the Telemedical Lifestyle intervention Program TeLiPro in Advanced Stages of Type 2 Diabetes: A Randomized Controlled Trial

“…The speed of the glucose-lowering effect using the TeLiPro approach was comparable with that observed after bariatric surgery (25). The number of telemedical approaches for lifestyle alterations and chronic disease self-management programs are increasing and encouraging (26,27), although it has been shown that telephone calls alone are not sufficient to sustainably alter behavior (28). Therefore, the TeLiPro combines different interventions; this multifactorial approach does not allow dissection of the effect of the individual components.…”

Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

“…The authors of 34 studies that included adults over a wider age range were contacted, and five replied with study information. The majority of studies (123) were published after 2012 . Five studies were conducted in Europe , five in North America , two in Australia and one in the Western Pacific region .…”

“…The majority of studies (123) were published after 2012 . Five studies were conducted in Europe , five in North America , two in Australia and one in the Western Pacific region . Most studies were conducted in type 1 diabetes (eight studies) , three studies included both type 1 and 2 diabetes , and two studies included only type 2 diabetes .…”

“…Five studies were conducted in Europe , five in North America , two in Australia and one in the Western Pacific region . Most studies were conducted in type 1 diabetes (eight studies) , three studies included both type 1 and 2 diabetes , and two studies included only type 2 diabetes . Ten studies were conducted in tertiary diabetes clinics , two in the community and one in primary care .…”

Automated Outreach for Cardiovascular‐Related Medication Refill Reminders

“…A randomized trial of telephone outreach was conducted at four large multispecialty medical groups to improve medication adherence and intermediate outcomes of care. 20 The intervention, which was delivered by pharmacists, diabetes educators, or nurse health managers, failed to significantly improve glucose, BP, or LDL-C control.…”