Long-Term Impact of Pillbox Use on Medication Adherence in Patients with Type 2 Diabetes Mellitus
Main Article Content
Keywords
long-term adherence, pillbox, predictors
Abstract
Background: This follow-up study assessed the long-term impact of pillbox use on medication adherence in type 2 diabetes mellitus (T2DM) patients over two years. Method: A cross-sectional study consisting of 52 participants was divided into two groups: pillbox (intervention) and non-pillbox (control). Adherence was measured using the pill count method, and clinical outcomes such as blood glucose levels were recorded. Results: Results revealed that the pillbox group had significantly higher adherence rates over time, with adherence increasing from 94.01% initially to 96.67% after two years. In contrast, adherence in the non-pillbox group declined from 88.62% to 88.26%. Postprandial blood glucose control improved significantly in the pillbox group (141.38 mg/dl to 129.88 mg/dl), whereas the non-pillbox group experienced an increase (137.96 mg/dl to 145.69 mg/dl). Fasting and random blood glucose levels did not show statistically significant changes. The analysis identified education and occupation as important predictors of adherence, while factors such as age, gender, comorbidities, and medication changes showed marginal or non-significant effects. Conclusion: These findings suggest that pillbox interventions can effectively improve long-term medication adherence and postprandial blood glucose control in T2DM patients, particularly when considering sociodemographic factors like education and occupation. Further research should explore the broader implications of these findings for diabetes management and potential strategies to improve adherence in diverse patient populations.
References
1. Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. Hindawi Publishing Corporation; 2015;2015.
PMID: 26539470
2. Leporini C, De Sarro G, Russo E. Adherence to therapy and adverse drug reactions: Is there a link? Expert Opin Drug Saf.
2014;13(SUPPL. 1):41–55. PMID: 25171158
3. Zurita-Cruz JN, Manuel-Apolinar L, Arellano-Flores ML, Gutierrez-Gonzalez A, Najera-Ahumada AG, Cisneros-González N.
Health and quality of life outcomes impairment of quality of life in type 2 diabetes mellitus: A cross-sectional study. Health
Qual Life Outcomes. Health and Quality of Life Outcomes; 2018;16(1). PMID: 29764429
4. Iljaz R, Brodnik A, Zrimec T, Cukjati I. E-Healthcare For Diabetes Mellitus Type 2 Patients - A Randomised Controlled Trial In
Slovenia. Zdr Varst. 2017;
5. Fitria N, Husnia K, Ananta FT, Sari YO. The effect of pillbox use in increasing patients ’ adherence to type 2 diabetes mellitus
therapy in Lubuk Kilangan health center. Pharm Pract (Granada) [Internet]. 2023;21(4):1–5. Available from: https://doi.
org/10.18549/PharmPract.2023.4.2904
6. Febriyanti AP, Tahar N, Badriani B, Dhuha NS, Wahyudin M, Khaerani K, Leboe DW. A Comparative Study to Enhance Medication
Adherence: Pillbox vs Medication Reminder Chart. Proc Int Pharm Ulul Albab Conf Semin. 2021;1:26.
7. Ernawati I, Lubada EI, Lusiyani R, Prasetya RA. Association of adherence measured by self-reported pill count with achieved
blood pressure level in hypertension patients: a cross-sectional study. Clin Hypertens. 2022 Apr;28(1):12. PMID: 35422008
8. Seuring T, Marthoenis, Rhode S, Rogge L, Rau H, Besançon S, Zufry H, Sofyan H, Vollmer S. Using peer education to improve
diabetes management and outcomes in a low-income setting: a randomized controlled trial. Trials. 2019 Sep;20(1):548. PMID:
31477164
9. Fitria N, Sari YO, Putry AR, Putrizeti F, Sukma A. Future challenge on probiotics uses from fermented milk on the endocrine
disorder in human. IOP Conf Ser Earth Environ Sci 888(1)012047 DOI 101088/1755-1315/888/1/012047. IOP Publishing Ltd;
2021 Nov 15;888(1):1–7.
10. Fitria N, van Asselt ADIADI, Postma MJMJMJ. Cost-effectiveness of controlling gestational diabetes mellitus: a systematic
review. Eur J Heal Econ. Springer Berlin Heidelberg; 2019;20(3):407–417. PMID: 30229375
11. International Diabetes Federation. International Diabetic Federation Diabetic Atlas 10th edition. International Diabetes
Federation (IDF). 2021.
12. Sari YO, Fitria N, Mariza W, Lailiani R, Permatasari D. Application of Home Medication Review ( HMR ) on Patient Adherence in
Type 2 Diabetes Mellitus ( T2DM ) Blood Sugar Management. 2022;160–167.
13. Schwartz JK. Pillbox use, satisfaction, and effectiveness among persons with chronic health conditions. Assist Technol. United
States; 2017;29(4):181–187. PMID: 27689861
14. Bolarinwa OA. Sample size estimation for health and social science researchers: The principles and considerations for different
study designs. Niger Postgrad Med J. Nigeria; 2020;27(2):67–75. PMID: 32295935
15. Fitria N, Febiana D, Akram M, Yosmar R. Aspirin-clopidogrel combination therapy for ischemic stroke patients : Clinical efficacy
and. Narra J. 2024;4(2):1–10.
16. Bartlett Ellis RJ, Ganci A, Head KJ, Ofner S. Characteristics of Adults Managing Vitamins/Supplements and Prescribed
Medications-Who Is Using, Not Using, and Abandoning Use of Pillboxes?: A Descriptive Study. Clin Nurse Spec. United States;
2018;32(5):231–239. PMID: 30095522
17. Mehdinia A, Loripoor M, Dehghan M, Heidari S. The Effect of Pillbox Use on Medication Adherence Among Elderly Patients: A
Randomized Controlled Trial. Int Electron J Med. 2020;9(1):38–43.
18. Graetz I, Hu X, Kocak M, Krukowski RA, Anderson JN, Waters T, Curry A, Paladino AJ, Stepanski E, Vidal GA, Schwartzberg LS.
A randomized controlled trial of a mobile app and tailored messages to improve outcomes among women with breast cancer
receiving adjuvant endocrine therapy. J Clin Oncol. 2023;41(16_suppl):512–512.
19. Hudani ZK, Rojas-Fernandez CH. A scoping review on medication adherence in older patients with cognitive impairment or
dementia. Res Social Adm Pharm. United States; 2016;12(6):815–829. PMID: 26797263
20. Miguel-Cruz A, Felipe Bohórquez A, Aya Parra PA. What does the literature say about using electronic pillboxes for older
adults? A systematic literature review. Disabil Rehabil Assist Technol. England; 2019 Nov;14(8):776–787. PMID: 30451543
21. Choi EPH. A Pilot Study to Evaluate the Acceptability of Using a Smart Pillbox to Enhance Medication Adherence Among
Primary Care Patients. Int J Environ Res Public Health. 2019 Oct;16(20). PMID: 31627440
22. Gast A, Mathes T. Medication adherence influencing factors-an (updated) overview of systematic reviews. Syst Rev. England;
2019 May;8(1):112. PMID: 31077247
23. Jankowska-Polańska B, Karniej P, Polański J, Seń M, Świątoniowska-Lonc N, Grochans E. Diabetes Mellitus Versus Hypertension—
Does Disease Affect Pharmacological Adherence? Front Pharmacol. 2020;11(August):1–9.
24. Said AH, Rahim ISA, Zaini NNBM, Nizam NIBS. Factors Affecting Adherence to Lipid-lowering Drugs: A Scoping Review. Oman
Med J. 2023;38(4).
25. Fitria N, Sari YO, Ananta FT, Husnia K. Adherence Assessment on Hypertension Therapy Using The Pill Count Method in Lubuk Kilangan Health Center , Indonesia. J Sains Farm Klin. 2023;69–75.
26. Raparelli V, Proietti M, Romiti GF, Lenzi A, Basili S. The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors
on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study.
Front Endocrinol (Lausanne). Switzerland; 2019;10:107. PMID: 30858826
27. Rattanapiratanon A, Kongsomboon K, Hanprasertpong T. Efficacy of a 28-compartment pillbox for improving iron supplement
compliance in healthy pregnant women: a randomised controlled trial. J Obstet Gynaecol J Inst Obstet Gynaecol. England;
2021 Nov;41(8):1210–1215. PMID: 33645407
28. Andanalusia M, Nita Y, Athiyah U. The effect of pillbox use and education by pharmacist toward medication adherence
in diabetes mellitus patients in a Primary Health Care Center in Mataram. J Basic Clin Physiol Pharmacol. Germany; 2021
Jun;32(4):577–582. PMID: 34214347
29. Fitria N, Idrus L, Putri AR, Sari YO. The usability testing of the integrated electronic healthcare services for diabetes mellitus
patients during the pandemic in Indonesia. Digit Heal. United States; 2023;9:20552076231173228. PMID: 37152237
30. Fitria N, Wulansari S, Sari YO. Potential Interactions Analysis of Antihypertensive Drugs Used in Geriatric. Int J Appl Pharm.
2023;15(Special Issue 1):29–33.
31. Arifin B, Idrus LR, van Asselt ADI, Purba FD, Perwitasari DA, Thobari JA, Cao Q, Krabbe PFM, Postma MJ. Health-related quality
of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D. Qual Life Res. Springer
International Publishing; 2019;28(5):1179–1190. PMID: 30649698
32. Choudhry NK, Isaac T, Lauffenburger JC, Gopalakrishnan C, Lee M, Vachon A, Iliadis TL, Hollands W, Elman S, Kraft JM, Naseem S,
Doheny S, Lee J, Barberio J, Patel L, Khan NF, Gagne JJ, Jackevicius CA, Fischer MA, Solomon DH, Sequist TD. Effect of a Remotely
Delivered Tailored Multicomponent Approach to Enhance Medication Taking for Patients With Hyperlipidemia, Hypertension,
and Diabetes: The STIC2IT Cluster Randomized Clinical Trial. JAMA Intern Med. United States; 2018 Sep;178(9):1182–1189.
PMID: 30083727
33. Alikari V, Tsironi M, Matziou V, Tzavella F, Stathoulis J, Babatsikou F, Fradelos E, Zyga S. The impact of education on knowledge,
adherence and quality of life among patients on haemodialysis. Qual life Res an Int J Qual life Asp Treat care Rehabil.
Netherlands; 2019 Jan;28(1):73–83. PMID: 30178430
34. Tan JP, Cheng KKF, Siah RCJ. A systematic review and meta-analysis on the effectiveness of education on medication adherence
for patients with hypertension, hyperlipidaemia and diabetes. J Adv Nurs. England; 2019 Nov;75(11):2478–2494. PMID: 30993749
PMID: 26539470
2. Leporini C, De Sarro G, Russo E. Adherence to therapy and adverse drug reactions: Is there a link? Expert Opin Drug Saf.
2014;13(SUPPL. 1):41–55. PMID: 25171158
3. Zurita-Cruz JN, Manuel-Apolinar L, Arellano-Flores ML, Gutierrez-Gonzalez A, Najera-Ahumada AG, Cisneros-González N.
Health and quality of life outcomes impairment of quality of life in type 2 diabetes mellitus: A cross-sectional study. Health
Qual Life Outcomes. Health and Quality of Life Outcomes; 2018;16(1). PMID: 29764429
4. Iljaz R, Brodnik A, Zrimec T, Cukjati I. E-Healthcare For Diabetes Mellitus Type 2 Patients - A Randomised Controlled Trial In
Slovenia. Zdr Varst. 2017;
5. Fitria N, Husnia K, Ananta FT, Sari YO. The effect of pillbox use in increasing patients ’ adherence to type 2 diabetes mellitus
therapy in Lubuk Kilangan health center. Pharm Pract (Granada) [Internet]. 2023;21(4):1–5. Available from: https://doi.
org/10.18549/PharmPract.2023.4.2904
6. Febriyanti AP, Tahar N, Badriani B, Dhuha NS, Wahyudin M, Khaerani K, Leboe DW. A Comparative Study to Enhance Medication
Adherence: Pillbox vs Medication Reminder Chart. Proc Int Pharm Ulul Albab Conf Semin. 2021;1:26.
7. Ernawati I, Lubada EI, Lusiyani R, Prasetya RA. Association of adherence measured by self-reported pill count with achieved
blood pressure level in hypertension patients: a cross-sectional study. Clin Hypertens. 2022 Apr;28(1):12. PMID: 35422008
8. Seuring T, Marthoenis, Rhode S, Rogge L, Rau H, Besançon S, Zufry H, Sofyan H, Vollmer S. Using peer education to improve
diabetes management and outcomes in a low-income setting: a randomized controlled trial. Trials. 2019 Sep;20(1):548. PMID:
31477164
9. Fitria N, Sari YO, Putry AR, Putrizeti F, Sukma A. Future challenge on probiotics uses from fermented milk on the endocrine
disorder in human. IOP Conf Ser Earth Environ Sci 888(1)012047 DOI 101088/1755-1315/888/1/012047. IOP Publishing Ltd;
2021 Nov 15;888(1):1–7.
10. Fitria N, van Asselt ADIADI, Postma MJMJMJ. Cost-effectiveness of controlling gestational diabetes mellitus: a systematic
review. Eur J Heal Econ. Springer Berlin Heidelberg; 2019;20(3):407–417. PMID: 30229375
11. International Diabetes Federation. International Diabetic Federation Diabetic Atlas 10th edition. International Diabetes
Federation (IDF). 2021.
12. Sari YO, Fitria N, Mariza W, Lailiani R, Permatasari D. Application of Home Medication Review ( HMR ) on Patient Adherence in
Type 2 Diabetes Mellitus ( T2DM ) Blood Sugar Management. 2022;160–167.
13. Schwartz JK. Pillbox use, satisfaction, and effectiveness among persons with chronic health conditions. Assist Technol. United
States; 2017;29(4):181–187. PMID: 27689861
14. Bolarinwa OA. Sample size estimation for health and social science researchers: The principles and considerations for different
study designs. Niger Postgrad Med J. Nigeria; 2020;27(2):67–75. PMID: 32295935
15. Fitria N, Febiana D, Akram M, Yosmar R. Aspirin-clopidogrel combination therapy for ischemic stroke patients : Clinical efficacy
and. Narra J. 2024;4(2):1–10.
16. Bartlett Ellis RJ, Ganci A, Head KJ, Ofner S. Characteristics of Adults Managing Vitamins/Supplements and Prescribed
Medications-Who Is Using, Not Using, and Abandoning Use of Pillboxes?: A Descriptive Study. Clin Nurse Spec. United States;
2018;32(5):231–239. PMID: 30095522
17. Mehdinia A, Loripoor M, Dehghan M, Heidari S. The Effect of Pillbox Use on Medication Adherence Among Elderly Patients: A
Randomized Controlled Trial. Int Electron J Med. 2020;9(1):38–43.
18. Graetz I, Hu X, Kocak M, Krukowski RA, Anderson JN, Waters T, Curry A, Paladino AJ, Stepanski E, Vidal GA, Schwartzberg LS.
A randomized controlled trial of a mobile app and tailored messages to improve outcomes among women with breast cancer
receiving adjuvant endocrine therapy. J Clin Oncol. 2023;41(16_suppl):512–512.
19. Hudani ZK, Rojas-Fernandez CH. A scoping review on medication adherence in older patients with cognitive impairment or
dementia. Res Social Adm Pharm. United States; 2016;12(6):815–829. PMID: 26797263
20. Miguel-Cruz A, Felipe Bohórquez A, Aya Parra PA. What does the literature say about using electronic pillboxes for older
adults? A systematic literature review. Disabil Rehabil Assist Technol. England; 2019 Nov;14(8):776–787. PMID: 30451543
21. Choi EPH. A Pilot Study to Evaluate the Acceptability of Using a Smart Pillbox to Enhance Medication Adherence Among
Primary Care Patients. Int J Environ Res Public Health. 2019 Oct;16(20). PMID: 31627440
22. Gast A, Mathes T. Medication adherence influencing factors-an (updated) overview of systematic reviews. Syst Rev. England;
2019 May;8(1):112. PMID: 31077247
23. Jankowska-Polańska B, Karniej P, Polański J, Seń M, Świątoniowska-Lonc N, Grochans E. Diabetes Mellitus Versus Hypertension—
Does Disease Affect Pharmacological Adherence? Front Pharmacol. 2020;11(August):1–9.
24. Said AH, Rahim ISA, Zaini NNBM, Nizam NIBS. Factors Affecting Adherence to Lipid-lowering Drugs: A Scoping Review. Oman
Med J. 2023;38(4).
25. Fitria N, Sari YO, Ananta FT, Husnia K. Adherence Assessment on Hypertension Therapy Using The Pill Count Method in Lubuk Kilangan Health Center , Indonesia. J Sains Farm Klin. 2023;69–75.
26. Raparelli V, Proietti M, Romiti GF, Lenzi A, Basili S. The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors
on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study.
Front Endocrinol (Lausanne). Switzerland; 2019;10:107. PMID: 30858826
27. Rattanapiratanon A, Kongsomboon K, Hanprasertpong T. Efficacy of a 28-compartment pillbox for improving iron supplement
compliance in healthy pregnant women: a randomised controlled trial. J Obstet Gynaecol J Inst Obstet Gynaecol. England;
2021 Nov;41(8):1210–1215. PMID: 33645407
28. Andanalusia M, Nita Y, Athiyah U. The effect of pillbox use and education by pharmacist toward medication adherence
in diabetes mellitus patients in a Primary Health Care Center in Mataram. J Basic Clin Physiol Pharmacol. Germany; 2021
Jun;32(4):577–582. PMID: 34214347
29. Fitria N, Idrus L, Putri AR, Sari YO. The usability testing of the integrated electronic healthcare services for diabetes mellitus
patients during the pandemic in Indonesia. Digit Heal. United States; 2023;9:20552076231173228. PMID: 37152237
30. Fitria N, Wulansari S, Sari YO. Potential Interactions Analysis of Antihypertensive Drugs Used in Geriatric. Int J Appl Pharm.
2023;15(Special Issue 1):29–33.
31. Arifin B, Idrus LR, van Asselt ADI, Purba FD, Perwitasari DA, Thobari JA, Cao Q, Krabbe PFM, Postma MJ. Health-related quality
of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D. Qual Life Res. Springer
International Publishing; 2019;28(5):1179–1190. PMID: 30649698
32. Choudhry NK, Isaac T, Lauffenburger JC, Gopalakrishnan C, Lee M, Vachon A, Iliadis TL, Hollands W, Elman S, Kraft JM, Naseem S,
Doheny S, Lee J, Barberio J, Patel L, Khan NF, Gagne JJ, Jackevicius CA, Fischer MA, Solomon DH, Sequist TD. Effect of a Remotely
Delivered Tailored Multicomponent Approach to Enhance Medication Taking for Patients With Hyperlipidemia, Hypertension,
and Diabetes: The STIC2IT Cluster Randomized Clinical Trial. JAMA Intern Med. United States; 2018 Sep;178(9):1182–1189.
PMID: 30083727
33. Alikari V, Tsironi M, Matziou V, Tzavella F, Stathoulis J, Babatsikou F, Fradelos E, Zyga S. The impact of education on knowledge,
adherence and quality of life among patients on haemodialysis. Qual life Res an Int J Qual life Asp Treat care Rehabil.
Netherlands; 2019 Jan;28(1):73–83. PMID: 30178430
34. Tan JP, Cheng KKF, Siah RCJ. A systematic review and meta-analysis on the effectiveness of education on medication adherence
for patients with hypertension, hyperlipidaemia and diabetes. J Adv Nurs. England; 2019 Nov;75(11):2478–2494. PMID: 30993749
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Long-Term Impact of Pillbox Use on Medication Adherence in Patients with Type 2 Diabetes Mellitus. Pharm Pract (Granada) [Internet]. 2025 Oct. 8 [cited 2025 Oct. 22];23(3):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3236
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How to Cite
1.
Long-Term Impact of Pillbox Use on Medication Adherence in Patients with Type 2 Diabetes Mellitus. Pharm Pract (Granada) [Internet]. 2025 Oct. 8 [cited 2025 Oct. 22];23(3):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3236