Type 2 Diabetes Medication Adherence Rates Remain Low—And Pharmacists Can Help

Medication adherence drives glycemic outcomes and complication risk in patients with type 2 diabetes (T2D). To further understand obstacles to adherence, a team of researchers performed a narrative review covering evidence on nonadherence prevalence, outcomes, measurement approaches, and interventions, with findings published in Diabetologia in November 2025.¹

Understanding Medication Adherence Rates in T2D

The researchers estimate that approximately 38% of patients with T2D do not take medications as prescribed. Medication adherence varies by product class, which can guide where pharmacists focus follow-up. Adherence rates are estimated at 63% to 68% for oral glucose-lowering drugs, 43% to 54% for injectable glucagon-like peptide-1 receptor agonists, and 41% to 64% for insulin.¹

Pharmacists can emphasize to patients that nonadherence can result in avoidable hospital visits. A retrospective analysis linked better adherence to glucose-lowering medications with a 31% lower chance of hospitalization or an emergency department visit.²

Dose simplification can improve adherence when regimen complexity drives missed doses. Fixed-dose combinations reduce pill burden while maintaining each medication’s bioavailability. A meta-analysis summarized in the review found that fixed-dose combinations were associated with higher adherence than free-equivalent combinations. Researchers in real-world studies reported improvements after patients switched, including improved glycemia and reduced health care utilization.¹

Pharmacist-delivered services, including education, medication reviews, reminders, organizational support, and monitoring, can improve adherence and hemoglobin A_1C levels. Importantly, pharmacists can tailor adherence support to patient barriers. Some patients need simplified regimens and refill synchronization, whereas others benefit more from education, reminders, or ongoing follow-up. Pharmacists can also individualize adherence strategies based on patient needs. For example, older adults may need low-technology support and caregiver involvement, whereas younger patients may respond better to app-based reminders.

Assessing Research on Medication Adherence

When evaluating the studies in the narrative review, the authors said adherence should ideally be assessed using more than 1 method because each tool addresses different barriers. The researchers note that there is no gold standard and recommend combining subjective and objective approaches.¹

Practical measurement methods include using pharmacy records to spot access, cost, initiation, or early discontinuation problems; using interviews or questionnaires to identify adverse effect concerns; and considering objective options when possible, including biochemical adherence testing, which some guidelines prefer.¹

The researchers conclude that multifaceted interventions work best when tailored to individual barriers and delivered for at least 3 months. The researchers recommend mixed-method adherence measurement over time, because single check-ins can miss changing patterns.

REFERENCES

1. Highton PJ, Funnell MP, Gupta P, et al. Improving medication adherence in type 2 diabetes: strategies for better clinical and economic outcomes. Diabetologia. 2026;69(3):541-556. doi:10.1007/s00125-025-06617-x

2. Juarez DT, Tan C, Davis J, Mau M. Factors affecting sustained medication adherence and its impact on health care utilization in patients with diabetes. J Pharm Health Serv Res. 2013;4(2):89-94. doi:10.1111/jphs.12016