The economic rationale for adherence in the treatment of type 2 diabetes mellitus.

Among patients with type 2 diabetes mellitus, adherence to prescribed medications has been reported to be as low as 60%, meaning that many patients may not be following the treatment plan that has been prescribed for them. The importance of treatment adherence is intuitive: better adherence would promote better outcomes. Data show this to be the case: for every 25% increase in medication adherence, a patient's glycated hemoglobin (A1C) is reduced by 0.34%. Unfortunately, only a little more than half of patients with diabetes achieve an A1C target below 7%. Poor therapeutic adherence affects diabetes-related costs. Patients who are nonadherent are far more likely to require hospitalization and to incur significantly higher healthcare costs. The lesser costs of lower medication utilization in nonadherent patients are more than compensated for by the increased costs arising from poorer glycemic control, as multiple studies employing large managed care databases have demonstrated. Improvements in outcomes and reductions in costs related to the management of diabetes require focused efforts toward facilitating treatment adherence, efforts that should be undertaken by third-party payers in addition to physicians and patients.