Cardiovascular Disease and Medication Adherence Among Patients with Type 2 Diabetes Mellitus in an Underserved Community.

Optimal management of Type 2 diabetes mellitus (Type 2 DM) is impeded by widespread nonadherence to efficacious medication regimens. Cardiovascular disease (CVD) is the most common cause of morbidity and mortality among persons with Type 2 DM. In this work we evaluated the relationship between CVD and medication adherence to antihypertensives, oral hypoglycemic agents, and antidepressants among patients with Type 2 DM. We also sought to understand how patients perceived barriers to and facilitators of adherence to medications. Adherence to medications was measured in 72 primary care patients from the West Philadelphia area using electronic monitoring (Medication Event Monitoring System caps) over 12 weeks. Standard questions assessed the presence of CVD. Participants answered open-ended questions about barriers to and facilitators of medication adherence. Participants who had CVD were significantly less likely to achieve ≥80% adherence to an antidepressant, oral hypoglycemic agent, and antihypertensive medications at 12 weeks. Participants identified four themes related to medication adherence: Interference from Psychosocial Demands, Need for Technological Innovation, Awareness of Disease Severity, and Integrating Community Linkages. Interventions to improve medication adherence among persons with Type 2 DM in underserved communities may aim to address social determinants of health, create community linkages, emphasize disease severity and utilize apps which are integrated with existing primary care services.