Adherence to therapy is defined as the extent to which a person’s behavior in taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider. Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a healthy diet and exercise regimen, followed by early medication that generally includes one or more oral hypoglycemic agents and later may include an injectable treatment. To prevent the complications associated with type 2 diabetes, therapy frequently also includes medications for control of blood pressure, dyslipidemia and other disorders, since patients often have more than three or four chronic conditions. Despite the benefits of therapy, studies have indicated that recommended glycemic goals are achieved by less than 50% of patients, which may be associated with decreased adherence to therapies. As a result, hyperglycemia and long-term complications increase morbidity and premature mortality, and lead to increased costs to health services. Reasons for nonadherence are multifactorial and difficult to identify. They include age, information, perception and duration of disease, complexity of dosing regimen, polytherapy, psychological factors, safety, tolerability and cost. Various measures to increase patient satisfaction and increase adherence in type 2 diabetes have been investigated. These include reducing the complexity of therapy by fixed-dose combination pills and less frequent dosing regimens, using medications that are associated with fewer adverse events (hypoglycemia or weight gain), educational initiatives with improved patient–healthcare provider communication, reminder systems and social support to help reduce costs. In the current narrative review, factors that influence adherence to different therapies for type 2 diabetes are discussed, along with outcomes of poor adherence, the economic impact of nonadherence, and strategies aimed at improving adherence.

To evaluate the efficacy of a programme of home blood pressure measurement (HBPM) on therapeutic compliance in mild-to-moderate hypertension. A prospective controlled multicentre clinical trial. Forty primary care centres in Spain, with a duration of 6 months. A total of 250 patients with newly diagnosed or uncontrolled hypertension were included. The patients were randomly selected and distributed in two groups: (1) the control group (CG) who received standard health intervention; (2) the intervention group (IG): the patients in this group received an OMRON in their homes for a programme of HBPM. Four visits were scheduled, for the measurement of blood pressure (BP). They were provided with an electronic monitor for measuring compliance (monitoring events medication system; MEMS). Therapeutic compliance was defined as a drug consumption of 80–110%. A number of variables were calculated using the MEMS. The mean BP were calculated and the percentage of controlled patients. A total of 200 patients completed the study (100 in each group). Compliance was observed in 74 and 92%, respectively, in the CG and IG [95% confidence interval (CI) 63.9–84.1 and 86.7–97.3; P = 0.0001], the mean percentage compliances were 87.6 and 93.5% (95% CI 81.2–94 and 80.7–98.3; P = 0.0001), the percentages of correct days were 83.6 and 89.4%, the percentages of subjects who took the medication at the prescribed time were 79.89 and 88.06%, and the levels of therapeutic cover were 86.7 and 93.1%. The number needed to treat to avoid one case of non-compliance was 5.6 patients. The differences in the mean decreases in BP were significant for diastolic BP, with a greater decrease observed in the IG. An HBPM programme using electronic monitors is effective in improving compliance in arterial hypertension, measured using the MEMS.

INTRO: Digital interventions, such as smartphone applications (APP), are becoming an increasingly common way to support medication adherence and self-management in chronic illness. AIM: To evaluate the effectiveness of the intervention in pharmacological therapeutic adherence of the mild-moderate arterial hypertension (AHT), through an APP installed in the mobile phone, as well as the degree of control reached by the patient with this tool. METHODS: Prospective, randomized controlled trial, full-study and multicenter study. Four primary care centers participated. One hundred and fifty-four hypertensive patients under antihypertensive treatment were included. Two groups were established: a control group (CG) with usual intervention (n = 77) and an intervention group (n = 77) (IG), targeting hypertensive people who owned and regularly used a mobile smartphone, specifically using the APP called ALERHTA to promote health education and reminder of appointments. There were 3 visits: initial, 6 and 12 months. Drugs adherence was measured by electronic monitors (MEMS). Primary outcome was average adherence percentage daily between 80 and 100% %, and the AHT control. RESULTS: 148 patients finished the study. Mean age 57.5 ± 9.9. Were considered adherents of the global sample 77.02% (CI =70.25-83.79) and 74.32% (CI =67.29-81.35%) adherents with the daily dose intake. Adherents once daily were 93.15% and 86.3% in IG and 70.66% and 62.66% in CG after 6 and 12 months respectively (p <0.05). The percentage of uncontrolled patients was 28.3% (CI =21.05-35.55%). The control of high blood pressure at 12 months was 17.8% and 38.6% for IG and CG respectively (p <0.05). The NNT was 4.23 patients. CONCLUSIONS: The intervention with an APP installed in the mobile phone of hypertensive patients favors the pharmacological therapeutic adherence and improves the percentage of hypertensive patient control. Trial registration: Spanish Agency of Medicine: EPA-SP UN-HTA-2015-01.