5 Tips to Help Your Patients with Diabetes Stay on Track with Their Medication

Health care providers prescribe medications hundreds of times each week, but to a person newly diagnosed with Type 2 diabetes, hearing “I want you to take ____” is a public admission of failure. Failure to lose weight. Not making time for exercise. Inability to change habits like flavored coffee for breakfast or a favorite aunt’s cinnamon buns during family gatherings.

For many people with diabetes , a prescription for oral medication or even worse – insulin – is a sure signal that amputation, blindness, renal failure and death is just around the corner. Often too shocked, scared, or angry to ask questions, your patient leaves your office with prescription in hand but never fills it. Or they fill it, but decide they won’t take it because they hope to make the lifestyle changes that they’ve been putting off for months or years. Sometimes they fill the script but only take the medication when they remember, or when no one else is around so they don’t have to admit they have diabetes, or when they feel like their blood sugar is high.

Here are 5 important strategies we’ve found successful in empowering and motivating people with type 2 diabetes to take their meds as prescribed:
1. WIFM: What’s In It For Me. Explain why the medication is necessary both for short-term management of diabetes as well as prevention of long-term complications. Talk about how the med will address how the person feels on a daily basis, addressing any complaints they talked about during their examination.

2. Describe how the medication works in easily understandable language and provide clear, easy to understand written materials. Often newly diagnosed people with diabetes don’t know the difference between oral meds and insulin, or that oral meds work in a variety of ways. If you don’t provide written information, many people go home and do a Google search which may lead them to inaccurate information or promises of ‘natural’ cures.

3. Talk about possible side effects and how to minimize them. Ask what side effects they’ve heard about, or which ones concern them the most. Weight gain or inability to lose weight and fear of hypoglycemia are two of the most common fears.

4. Know the cost of the medication and if the insurance plan will cover it. People often don’t want to admit that they can’t afford a medication, and take it less often than prescribed or won’t refill the script.

5. Ask open-ended questions that show you are listening to their fears and that you’re working together to improve their health. Examples of questions to encourage an open discussion:
a. How will you manage taking this medication? What is your usual routine for taking medication and how will you add this med to your routine?
b. What have you heard from your family, friends or other people with diabetes about this medication?
c. What might get in the way of taking this med?

If you don’t have time to explain how the medication works and answer questions, assign this task to another member of your health care team. Tell your patient why you’re prescribing the medication and that you will have them meet with this professional to explain how to take the medication and answer all their questions.

We often label people with diabetes non-compliant when they don’t follow-through with prescribed medications. Non-compliance is like an onion: peel away the layers until you find the actual reason why your patient didn’t fill the script or ‘forgets’ to take the med. We can’t assume that people with diabetes take their meds as prescribed, and we also can’t assume that we know why they don’t take their medications. The only way to find out the truth is to have an open and honest discussion.

Written by:

Lynn Grieger, RD, CDE, CPT, CWC

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References:
Medication Adherence. Its Importance in Cardiovascular Outcomes. Ho PM, Bryson CL, Rumsfeld JS. Circulation. 2009; 119: 3028-3035.
Working With Patients to Enhance Medication Adherence. Lin EHB, Ciechanowski P. Clinical Diabetes January 2008 vol. 26 no. 1 17-19.

Helping Patients Find Their Voice: Too Much, Too Fast?

As healthcare providers we tend to give a large amount of information to our patients at one time. It’s not that we don’t care or that we don’t understand adult learning; sometimes there is just a lot of new information that’s important to know. Think about the patient that is new to monitoring their blood glucose and new to insulin. It’s not just learning two new skills (which can be frightening enough for some) but learning how to treat lows, figuring out how to fit testing and injections into their lifestyle, what to do if they miss a dose and on and on. Those “two things” come with a lot of other little things to learn.

Here’s a few of things we’ve learned at Fit4D to make a difference in the complex world of diabetes, where there is frequently too much information that’s too fast!

  • Frequent check-ins are a must.  You might be thinking, but that’s not scalable—it’s expensive and certainly not realistic. But wait…check-ins come through online live events like webinars and support groups, texting their Fit4D coach, interacting on CDE led twitter groups, and phone calls when really needed.
  • Most of the questions come after the appointment.  We’ve all heard the stats that patients only retain 50% of the information given once out the door. Once they get home that’s when the questions start.  Sure, some people will call the office, but some people won’t.  Maybe they just called but then thought of another question or they’re embarrassed to call in the first place because they think they should already know the answer.  Having a place to go about “what‘s bugging them the most about their diabetes” is crucial. I’m not talking about a pile of handouts or even a website. What I mean is technology that is smart enough to individualize and yet escalate to their coach when needed.
  • Create a trusted relationship.  It’s important to get patients honest concerns and create an environment to help them feel like it’s OK to ask, in their mind, the “silly” questions. You may be thinking, how can just one question or one small piece of information make a difference?  Timing of medication is one very common mistake patients make.  Depending on type of medication simply helping them simply understand when  (and why) they are taking their medication can make a big difference in blood sugars and increase medication adherence.

I’d love to hear how you make a difference for patients and conquer the “too much, too fast” dilemma. 

Written by:

Sherri Isaak, MS,RD,CDE, BC-ADM

Just ask…

Just ask…..

What are you eating? Are you exercising? How often are you testing your blood sugar? What are your blood sugar results? Are you taking your medications? How is your stress level? Are you doing foot exams? Are you setting goals? Do you smoke? Are you ready to change—today, tomorrow, next week? The list of questions and topics for patients really is exhausting. They’re frequently bombarded with information they may or may not want to hear. Instead, how about focusing on what the patient’s needs are right now. Actually…the one need that’s “bugging them most about their diabetes.”

It’s hard because we as clinicians think to help our patients; we need to cover every topic—now.  Maybe we have a checklist of information we’re supposed to run through. But, is that really what’s best for the patient?  Nope. Helping them focus what’s on the top of their mind, “what’s bugging them” about their diabetes is far more impactful.

One of my patients went through my hospital-based diabetes education course a few years back. It really was a great series of classes with excellent educators. We even made it fun with hands on activities, healthy snacks, and included a multidisciplinary team of nurses, an exercise physiologist and dietitians. A year later she came back into my office and said, “I loved your course but I really didn’t pay much attention to what you said.  There was a lot of information I wasn’t ready for. I was really stressed out and needed to deal with that first. Now I’d like to focus getting on track with my eating.”  Yep—ready to focus on what’s bugging her most.

We have multiple drugs for diabetes, amazing technology, and well trained healthcare providers but if we seek out our plan, not what’s on the forefront of the patient’s mind, all of that really doesn’t matter quite as much.   Think about the patient, smiling and nodding in the office (pretending to listen about the importance of taking medication twice per day), but they are so focused on their only social event out, pizza night, that they think you just took away.  Now that’s something we could easy clear up, if we would have just started with that one question….what’s bugging you?  By doing that, now you have a relieved (and much happier) patient, who learned how to fit pizza into their meal plan!

Other than working on the challenges the patient wants to address first, why does it matter?    It matters because a step-by-step approach can help patients be more adherent to their diabetes care plan. Deal with their initial concerns, gain their trust and weave in the care plan challenges at just the right time for them. That’s what we’ve found that works best anyway

Helping patients focus on what’s on their mind and their top priorities gets better results and a bigger impact. It’s a simple question, “what bugs you most about your diabetes?”.…and let the patient lead from there.

 

Written by:

Sherri Isaak, MS, RD, CDE, BC-ADM