It was no surprise to me when I saw a headline stating that people who have a poor understanding of how their type 2 diabetes medications work also have poorer blood glucose control. I see this often in my practice as a registered dietitian nutritionist (RDN) and certified diabetes educator (CDE). My patients struggle much less with taking their medications after they understand the drugs’ specific roles.
To be clear, the research cited in the article doesn’t claim that increasing the understanding of medications increases medication adherence and leads to better glycemic control.[i] But in the study of 479 Japanese patients, about 60% of those with poor control also had poor medication adherence. Of course, there are many factors that could lead to poor understanding and poor glycemic control. It seems reasonable that poverty could influence both. Work or family stress might also have an effect. My own observation, however, is that when people know that their medications target one or more core defects in type 2 diabetes, they are more willing to take them regularly. They recognize their medications as an adjunct to other treatment strategies.
How Medications Work
Patients with diabetes typically understand that diabetes medications are designed to lower their blood sugar levels. But they also know that they can improve glycemic control with diet changes and increased exercise. As a result, many don’t see the need for both. My role as a CDE allows me time and opportunity to briefly discuss the pathophysiology of type 2 diabetes and the ways in which various diabetes medications target these problems.
I recently witnessed an aha moment when I told a patient that metformin works to stop the liver from leaking out too much sugar while she slept. I explained that her fasting blood glucose numbers were frequently higher than her bedtime numbers because of what her liver was putting out during fasting. It wasn’t because of what she ate the day before. Two years later and she’s nearly 100% adherent with her medications, and with the help of both meds and lifestyle changes, her AIC has dropped from 8.0% to 6.2%.
Key Messages about Type 2 Diabetes Medications
The messages we give our patients must be specific to their needs. I’ve found that some variation of these explanations usually works well in helping patients understand how diabetes medications work:
- Metformin stops your liver from pushing too much sugar into your blood while you’re sleeping and during fasting.
- DPP-4 inhibitors act on the hormones in your gut to fix some of the problems with type 2 diabetes. One way this drug helps is by keeping food in your stomach longer, which keeps you full longer and slows the passage of sugar into your blood.
- A GLP-1 receptor agonist targets the finicky hormones in your gut to slow down digestion, help your pancreas produce just the right amount of insulin, and it even acts on your brain to help you manage hunger.
- An SGLT-2 inhibitor helps your body urinate out the extra blood sugar that your kidneys want to send back to your blood.
Patients vary in how much information they want or need, but a couple nonjudgmental sentences about how their medications work can contribute to medication adherence.
Sakai et al. Understanding of antidiabetic medication is associated with blood glucose in patients with type 2 diabetes: At baseline date of KAMOGAWA-DM cohort study. J Diabetes Investig. First published Aug. 22, 2018.
Jill Weisenberger, MS, RDN, CDE, CHWC, FAND is an internationally recognized nutrition and diabetes expert.