Assessment of patient knowledge of diabetic goals, self-reported medication adherence, and goal attainment

  • Heather P. Whitley
  • Joli D. Fermo
  • Kelly R. Ragucci
  • Elinor C. Chumney
Keywords: Patient Compliance. Diabetes Mellitus. Comprehension. Treatment Outcome. United States


Background: Medication adherence is an integral aspect of disease state management for patients with chronic illnesses, including diabetes mellitus. It has been hypothesized that patients with diabetes who have poor medication adherence may have less knowledge of overall therapeutic goals and may be less likely to attain these goals.

Objective:  The purpose of this study was to assess self-reported medication adherence, knowledge of therapeutic goals (hemoglobin A1C [A1C], low density lipoprotein cholesterol [LDL-C] and blood pressure [BP]), and goal attainment in adult patients with diabetes.

Methods:  A survey was created to assess medication adherence, knowledge of therapeutic goals, and goal attainment for adult patients with diabetes followed at an internal medicine or a family medicine clinic. Surveys were self-administered prior to office visits. Additional data were collected from the electronic medical record.  Statistical analysis was performed.

Results:  A total of 149 patients were enrolled. Knowledge of therapeutic goals was reported by 14%, 34%, and 18% of survived patients for LDL-C, BP, and A1C, respectively.  Forty-six percent, 37%, and 40% of patients achieved LDL-C, BP, and A1C goals, respectively.  Low prescribing of cholesterol- lowering medications was an interesting secondary finding; 36% of patients not at LDL-C goal had not been prescribed a medication targeted to lower cholesterol.  Forty-eight percent of patients were medication non-adherent; most frequently reported reasons for non-adherence were forgot (34%) and too expensive (14%).  Patients at A1C goal were more adherent than patients not at goal (p=0.025).

Conclusion:  The majority did not reach goals and were unknowledgeable of goals; however, most were provided prescriptions to treat these parameters. Goal parameters should be revisited often amongst multidisciplinary team members with frequent and open communications.  Additionally, it is imperative that practitioners discuss the importance of medication adherence with every patient at every visit.


Download data is not yet available.


1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and prevention, 2005.

2. American Diabetes Association. Available from: (Accessed January 19, 2006).

3. The Diabetes Control and Complications Trial Research Group, The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. N Engl J Med 1993;329:977-986.

4. Stratton IM, Adler AI, Neil HAW, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-12.

5. Adler AI, Stratton IM, Neil HAW, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000;321:412-9.

6. DCCT/EDIC Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643-53.

7. Standards of Medical Care in Diabetes–2006. American Diabetes Association. Diabetes Care 2006;29:S4-42.

8. Chobanian AV, Bakris GL, Black HR, et al, and the National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52.

9. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-97.

10. Zhou J, Werstuck GH, Lhoták S, et al. Association of multiple cellular Stress Pathways with accelerated atherosclerosis in hyperhomocysteinemic apolipoprotein E-deficient mice. Circulation 2004;110:227-39.

11. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care 1986;24(1):67-74.

12. Department of health and environmental control (DHEC). Burden of diabetes in South Carolina 2003. Diabetes initiative of South Carolina. 2003:26.

13. Fuke D, Hunt J, Siemienczuk J, et al. Cholesterol Management of Patients With Diabetes in a Primary Care Practice–Based Research Network. Am J Manag Care 2004;10(2):130-136.

14. Furmaga E. Pharmacist management of a hyperlipidemia clinic. Am J Hosp Pharm 1993;50:91-5.

15. Ito M. Should hyperlipidemia in the elderly be treated? Am J Health-Syst Pharm 1993;53:2867-71.

16. MacKinnon G. Hyperlipidemia management: opportunity for pharmacists in community practice. Pharm Times 1998;Dec:24-39.

17. Jafari M, Masih M, Emerson JF. The value of pharmacist involvement in a point-of-care service, walk-in lipid screening program. Pharmacotherapy 2001;21(11):1403-1406.

18. Ching Lee SS, Cheung PP, Chow MSS. Benefits of individualized counseling by the pharmacist on the treatment outcomes of hyperlipidemia in Hong Kong. J Clin Pharmacol 2004;44:632-639.

19. Carson J. Pharmacist-coordinated program to improve use of pharmacotherapies for reducing risk of coronary artery disease in low-income adults. Am J Health-Syst Pharm 1999;56:2319-24.

20. Cording MA, Engelbrecht-Zadvorny EB, Pettit BJ, Eastham JH, Sandoval R. Development of a pharmacist-managed lipid clinic. Ann Pharmacother 2002;36:892-904.

21. Shaffer J, Wexler L. Reducing low-density lipoprotein cholesterol levels in an ambulatory care system: results of a mulitdisiplinary collaborative practice lipid clinic compared with traditional physician-based care. Arch Intern Med 1995;155:2330-5.

22. Kost GJ. Preventing medical errors in point-of-care-testing security, validation, performance, safeguards, and connectivity. Arch Pathol Lab Med 2001;125:1307-15.

23. Taylor JR, Lopez LM. Cholesterol: Point-of-care testing. Ann Pharmacother 2004;38:1252-7.

24. Gutierres SL, Welty TE. Point-of-care testing: an introduction. Ann Pharmacother 2004;38:119-25.

25. Kennedy L, Herman WH, Strange P, Harris A. GOAL AIC Team. Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial. Diabetes Care 2006;29(1):1-8.

26. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97.

27. Reasner CA, Goke B. Overcoming the barriers to effective glycemic control for type 2 diabetes. Br J Diabetes Vasc Dis 2002;2:290-5.

28. Blandford L, Dans PE, Ober JD, Wheelock C. Analyzing variations in medication compliance related to individual drug, drug class, and prescribing physician. J Managed Care Pharm 1999;5:47-5.

29. Hsaio LD, Salmon JW. Predicting adherence to prescription medication purchase among HMO enrollees with diabetes. J Managed Care Pharm 1999;5:336-41.
How to Cite
Whitley HP, Fermo JD, Ragucci KR, Chumney EC. Assessment of patient knowledge of diabetic goals, self-reported medication adherence, and goal attainment. Pharm Pract (Granada) [Internet]. 1 [cited 2019Nov.14];4(4):183-90. Available from:
Original Research