These issues are usually due to a lack of knowledge about diabetes in general, the prescribed treatment and implications of not adhering to the regimen.

It is important to identify and address any adherence issues a patient may have. This can be within a planned medicines review or opportunistically at the point of dispensing. Solutions to adherence issues should be discussed with the patient and their GP, assuming consent is given.

Patient's knowledge of medication and condition

• Many patients with diabetes will be prescribed drugs for other conditions such as high blood pressure or cholesterol. Does the patient know what each medicine is prescribed for?
• Does the patient understand the interrelationship between food intake, exercise, insulin and blood glucose levels?

Dosage regime

• Is the patient taking the medication as prescribed?
• Are they under or over using treatment?
• Does the patient have any problems with the medicine and does this stop them taking any doses?

Side effects

• Does the patient experience any side effects?
• Could side effects be transient?
• Can the side effects be managed?
• Do they experience hypoglycaemic events and can they recognise the early signs of an episode?

Compliance

• Does the patient take all their medication?
• If not why not?
• Change of therapy not explained?
• The patient feels well so has stopped taking a medicine?
• Does not know how to use testing equipment
• Does the patient understand the risks of complications if they do not take their medicine as prescribed or not following lifestyle advice?

Formulation

• Does the patient have problems swallowing their tablets?
• Does the patient have difficulty using blister packs?
• If the patient uses a blood glucose meter, check they:
  • use a clean lancet every time - risk of infection.
  • always wash their hands in warm water before each test - warm water and rubbing hands improves the blood flow - alcohol swabs dry the skin.
  • regularly calibrate their meter.
  • are confident using or reading the meter.

Efficacy

• How do they monitor their blood glucose results?
• How often do they experience a hypo?
• Do they amend their treatment or diet depending upon their results?

Other considerations

• How do they store their insulin or test strips?
• When was their last review at their clinic or with GP?
• When did they last have a HbA1-c test, do they know the result and what they should aim for?
• Do they have any problems accessing local diabetic services?