• Barriers To Medication Adherence In Type 2 Diabetic Patients On Oral Hypoglycemic Drugs: A Comprehensive Review
  • Department of Pharmacy Practice, Srinivas College of Pharmacy, Manglore -574143.


Type 2 diabetes mellitus is a chronic and progressive metabolic disorder that requires lifelong management. In order to achieve ideal glycemic control and avoid problems, medication adherence is crucial. However, several obstacles prevent type 2 diabetes patients who are administered with oral hypoglycemic medicines from adhering to their prescription regimens. The many different reasons that contribute to non-adherence in this group are explored and analyzed in-depth in this thorough review. Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative medication beliefs of patients. Solutions to these problems would require behavioral innovations as well as new methods and modes of drug delivery. Patients' limited understanding of their condition and medications can hinder their ability to make informed decisions about treatment. Furthermore, psychosocial factors, including mental health, stigma, and cultural beliefs, play a significant role in influencing medication adherence. Forgetfulness emerges as another critical barrier, often exacerbated by complex medication regimens. Access to healthcare services, including affordability and transportation challenges, can further limit patients' ability to obtain and adhere to their medications. Financial constraints and high medication costs are explored as formidable barriers. The review underscores the challenges posed by complex medication regimens, particularly in the context of polypharmacy. The intricacies of managing multiple medications, combined with concerns about interactions and side effects, can overwhelm patients. Complex regimens can lead to medication errors and contribute to non-adherence. Effective communication between healthcare providers and patients is identified as a pivotal factor in addressing these barriers. Ineffective communication can result in misunderstandings about treatment plans, contributing to non-adherence. A patient-centered and collaborative approach, tailored to individual needs and preferences, is essential for mitigating these barriers and achieving better glycemic control and long-term health outcomes in type 2 diabetic patients. Reducing these barriers not only benefits individual patients but also alleviates the burden of diabetes-related complications on healthcare systems and society as a whole.


Type 2 diabetes mellitus, Barriers, Medication Adherence


  1. Mohamadzadeh S, Ezate G. A determination of self-care performance among diabetic patients in endocrine clinic of Taleghane hospital in Tehran. Iran J Nurs Res. 2014;4(31):11–18.
  2.  Masoudnia E, Foroozannia K, Montazeri M. Relationship between perceived social support and adherence to medical advices among patients with coronary heart disease after by-pass surgery. J Shahid Sadoughi Univ Med Sci Health Serv. 2012;19(6):798–806.
  3. Malik C, Khanna S, Jain Y, Jain R. Geriatric population in India: Demography, vulnerabilities, and healthcare challenges. J Family Med Prim Care. 2021;10(1):72.
  4. Jha AK, Aubert RE, Yao J, Teagarden JR, Epstein RS. Greater adherence to diabetes drugs is linked to less hospital use and could save nearly $5 billion annually. Health Aff (Millwood). 2012;31(8):1836-46.
  5. Gonzalez JS, McCarl LA. Cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. J Cogn Psychother. 2010;24(4):329.
  6. Morisky DE1, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348–54.
  7. Sontakke S, Jadhav M, Pimpalkhute S, Jaiswal K, Bajait C. Evaluation of adherence to therapy in patients of type 2 diabetes mellitus. J Young Pharm.2015;7(4s):462.
  8. Curkendall SM, Thomas N, Bell KF, Juneau PL, Weiss AJ. Predictors of medication adherence in patients with type 2 diabetes mellitus. Curr Med Res Opin. 2013;29(10):1275-86.
  9. Nau DP. Recommendations for improving adherence to type 2 diabetes mellitus therapy—focus on optimizing oral and non-insulin therapies. Am J Manag Care. 2012;18(3):49.
  10. Tabish SA. Is diabetes becoming the biggest epidemic of the twenty-first century? Int. J. Health Sci.2007;1(2):132-9
  11. Lorenzati B, Zucco C, Miglietta S, Lamberti F, Bruno G. Oral hypoglycemic drugs: pathophysiological basis of their mechanism of action. Pharmaceuticals. 2010 ;3(9):3005-20.
  12. Ahmed NO, Abugalambo S, Almethen GH. Adherence to oral hypoglycemic medication among patients with diabetes in Saudi Arabia. Int. J. Health Sci. 2017;11(3):45.
  13. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med. J.2011;26(3):155.
  14. Wang Y, Perri III M. A systematic review of patient-reported satisfaction with oral medication therapy in patients with type 2 diabetes. Value in Health. 2018;21(11):1346-53.
  15. Adu MD, Malabu UH, Malau-Aduli AE, Malau-Aduli BS. Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS one. 2019;14(6):e0217771.
  16. Allen-Meares P, Lowry B, Estrella ML, Mansuri S. Health literacy barriers in the health care system: barriers and opportunities for the profession. Health & Social Work. 2020;45(1):62-4.
  17. Kalra S, Jena BN, Yeravdekar R. Emotional and psychological needs of people with diabetes. Indian J Endocrinol Metab. 2018;22(5):696.
  18. Wong H, Singh J, Go RM, Ahluwalia N, Guerrero-Go MA. The effects of mental stress on non-insulin-dependent diabetes: determining the relationship between catecholamine and adrenergic signals from stress, anxiety, and depression on the physiological changes in the pancreatic hormone secretion. Cureus. 2019;11(8).
  19. Miller TA, DiMatteo MR. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes, metabolic syndrome and obesity: targets and therapy. 2013:421-6.
  20. Rezaei M, Valiee S, Tahan M, Ebtekar F, Ghanei Gheshlagh R. Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study. Diabetes, metabolic syndrome and obesity: targets and therapy. 2019:589-99.
  21. Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient preference and adherence. 2016:1299-307.
  22. Lam WY, Fresco P. Medication adherence measures: an overview. BioMed Res. 2015;6(9)2015.
  23. Muhammad Haskani NH, Goh HP, Wee DV, Hermansyah A, Goh KW, Ming LC. Medication Knowledge and Adherence in Type 2 Diabetes Mellitus Patients in Brunei Darussalam: A Pioneer Study in Brunei Darussalam. Int. J. Environ. Res. Public Health. 2022;19(12):7470.
  24. Faisal K, Tusiimire J, Yadesa TM. Prevalence and factors associated with non-adherence to antidiabetic medication among patients at Mbarara Regional Referral Hospital, Mbarara, Uganda. Patient preference and adherence. 2022:479-91.
  25. Bhattarai B, Bista B, Shrestha S, Budhathoki B, Dhamala B. Contributing factors of non-adherence to treatment among the patients with type II diabetes mellitus. Journal of Manmohan Memorial Institute of Health Sciences. 2019;5(1):68-78.
  26. Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. Journal of community health. 2013;38:976-93.
  27. Williams JL, Walker RJ, Smalls BL, Campbell JA, Egede LE. Effective interventions to improve medication adherence in Type 2 diabetes: a systematic review. Diabetes Management (London, England). 2014;4(1):29.
  28. Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008; 31:213-24.
  29. Cooney D, Pascuzzi K. Polypharmacy in the elderly: focus on drug interactions and adherence in hypertension. Clin Geriatr Med. 2009; 25:221–33.
  30. Hanchak NA, Patel MB, Berlin JA, Strom BL. Patient misunderstanding of dosing instructions. Journal General Internal Medicine. 1996; 11:325–328.
  31. Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clinics in geriatric medicine. 2012;28(2):287-300.
  32. Stoehr GP, Lu SY, Lavery L, et al. Factors associated with adherence to medication regimens in older primary care patients: the Steel Valley Seniors Survey. Am J Geriatr Pharmacother. 2008; 6:255–63.
  33. Nieuwlaat R, Wilczynski N, Navarro T, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;2014(11).
  34. Taylor SI. The high cost of diabetes drugs: disparate impact on the most vulnerable patients. Diabetes Care. 2020;43(10):2330.
  35. Piragine E, Petri D, Martelli A, Calderone V, Lucenteforte E. Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis. J. Clin. Med. 2023;12(5):1981.
  36. Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: A systematic review. J Am Board Fam Pract. 2002;15(1):25–38.
  37. Heisler M, Cole I, Weir D, Kerr EA, Hayward RA. Does physician communication influence older patients’ diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS) J Gerontol A Biol Sci Med Sci. 2007;62(12):1435–1442.
  38. Bezreh T, Laws MB, Taubin T, Rifkin DE, Wilson IB. Challenges to physician-patient communication about medication use: A window into the skeptical patient’s world. Patient Prefer Adherence. 2012; 6:11–18.
  39. Peron EP, Ogbonna KC, Donohoe KL. Antidiabetic medications and polypharmacy. Clinics in geriatric medicine. 2015;31(1):17-27.
  40. Grant RW, Devita NG, Singer DE, Meigs JB. Polypharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care. 2003;26(5):1408-1412.
  41. Sendekie AK, Netere AK, Kasahun AE, Belachew EA. Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. Plos one. 2022;17(9):e0274971.
  42. Donnan PT, MacDonald TM, Morris AD. Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study. Diabetic Medicine. 2002;19(4):279-84.
  43. Cramer JA. A systematic review of adherence with medication for diabetes. Diabetes Care. 2004; 27:1218–24.
  44. Stack RJ, Bundy C, Elliott RA, New JP, Gibson JM, Noyce PR. Patient perceptions of treatment and illness when prescribed multiple medicines for co-morbid type 2 diabetes. Diabetes Metab Syndr Obes. 2011; 4:127–35.
  45. Odegard PS, Capoccia K. Medication taking and diabetes. Diabetes Educ. 2007; 33:1014–29.
  46. García-Pérez LE, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther. 2013; 4:175–194.

Roma Bolar
Corresponding author

Department of Pharmacy Practice, Srinivas College of Pharmacy, Manglore -574143.

K. Vineetha

Department of Pharmacy Practice, Srinivas College of Pharmacy, Manglore -574143.

A. R. Shabaraya

Department of Pharmacy Practice, Srinivas College of Pharmacy, Manglore -574143.

K. Vineetha, B. Roma*, A. R. Shabaraya, Barriers To Medication Adherence In Type 2 Diabetic Patients On Oral Hypoglycemic Drugs: A Comprehensive Review, Int. J. in Pharm. Sci., 2023, Vol 1, Issue 11, 315-325.

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