Study Finds Low Levels of Adherence & Persistence Remain Barriers to Reducing Costs of Diabetes Complications

PARSIPPANY, N.J.–(BUSINESS WIRE)–Despite improved diagnosis and advances in treatment options for individuals with Type 2 Diabetes, sub-optimal therapy adherence and persistence result in significant economic and societal burden as well as avoidable patient complications in six diverse healthcare systems around the world, according to a new report series issued today by the IMS Institute for Healthcare Informatics. Disease complications account for an estimated 61 – 80 percent of Type 2 Diabetes-related costs in the countries studied, with 4 – 15 percent of costs linked to poor adherence and persistence. Effective patient activation—how well people understand their role in the care process along with their ability and willingness to actively manage their own health and care—is key to deriving greater value from existing diabetes treatments.

The report series—Improving Type 2 Diabetes Therapy Adherence and Persistence: How to Address Avoidable Economic and Societal Burden—analyzes the unique epidemiology, local healthcare dynamics and drivers for adherence and persistence in Brazil, Germany, the Kingdom of Saudi Arabia, Mexico, the U.K. and the U.S. Avoidable Type 2 Diabetes costs due to diabetes-related complications were determined using IMS Health’s CORE Diabetes Model, a validated, peer-reviewed algorithm that simulates clinical outcomes and costs for cohorts of people with the condition.

The reports highlight a number of practical, actionable recommendations to raise levels of adherence and persistence in Type 2 Diabetes therapies that span diet, exercise and use of glucose-lowering medicines. They include identifying and profiling patients in need of help; improving access to customized education materials; maximizing engagement between healthcare providers and patients; and using digital technology to maintain effective disease self management.

“The rising prevalence of Type 2 Diabetes and its associated complications is the root of considerable strain on society and an economic burden on healthcare systems,” said Murray Aitken, IMS Health senior vice president and executive director of the IMS Institute for Healthcare Informatics. “Simple, customized interventions that put patients on the path to optimal adherence and persistence can yield tangible results, but require alignment between healthcare and government leaders, as well as the active involvement of voluntary associations and the private sector.”

Key findings of the report series include the following:

  • Sub-optimal adherence and persistence is a significant issue for people with diabetes. On average, less than 40 percent of individuals with Type 2 Diabetes globally are achieving optimal levels of adherence (the extent to which a patient follows the prescribed interval and dose of a medicine regimen) and persistence (the time from initiation to discontinuation of a therapy). Among the six countries studied, levels of non-adherence vary significantly and the Institute’s estimates range from 46 to 77 percent. The reports found that current strategies to improve Type 2 Diabetes outcomes in these countries were not directly focused on addressing sub-optimal therapy adherence and persistence.
  • Complications from diabetes lead to a significant increase in comorbidities and associated healthcare costs.Undetected or poorly managed Type 2 Diabetes resulting in persistently elevated blood glucose levels increases the risk of long-term debilitating and life-threatening complications. These include macrovascular comorbidities such as stroke and myocardial infarction, as well as microvascular damage that presents as nephropathy, foot ulcers leading to amputations and retinopathy leading to blindness. Beyond these long-term conditions, near-term complications can include lethargy, poor wound healing and a propensity for opportunistic infections. All of these health consequences can vastly decrease quality of life, productivity and life expectancy of people with diabetes while increasing lifelong healthcare costs.
  • Improved adherence and persistence can reduce costs of complications by 4 -15 percent. Estimates of the potential reduction in Diabetes Type 2 complications costs for each country studied were derived using IMS Health’s CORE Diabetes Model, customized to reflect average levels of adherence and persistence. For the U.S. Medicare population, this approach yielded an estimated $4 billion annual avoidable cost, which is equal to about 32 percent of the total annual Medicare spend on diabetes medications and supplies—or 4 percent of the total spend on all diabetes care for seniors. In Saudi Arabia, avoidable costs were estimated at more than 15 percent of total complications costs, or approximately SAR3.9 billion per year.
  • Greater patient activation is directly linked to increases in therapy adherence and lower healthcare costs. Patient costs can vary more than 20 percent depending on the level of patient activation, according to recent research. Five interrelated drivers of activation are: health beliefs and attitude; personal circumstances; health status; health literacy; as well as access and affordability. Together, these factors determine an individual’s willingness and ability to take actions to manage their own health. For example, improving health literacy may positively impact health beliefs and attitude, enabling a patient to identify opportunities for overcoming barriers to access and affordability.
  • Effective patient activation requires multi-stakeholder engagement. The path to optimal adherence and persistence involves policymakers, payers, healthcare providers, the private sector, caregivers, families and patients themselves. Policymakers can play a vital role in addressing barriers in the integration and provision of care by improving access, health literacy, health beliefs and attitudes. Multi-stakeholder involvement ultimately enables healthcare providers to address an individual’s specific support and information needs through a customized, patient-centric approach.

The report series, including a detailed description of methodologies, are available at This study is based on research and analysis undertaken by the IMS Consulting Group with support from Lilly Diabetes.

About the IMS Institute for Healthcare Informatics

The IMS Institute for Healthcare Informatics provides key policy setters and decision makers in the global health sector with unique and transformational insights into healthcare dynamics derived from granular analysis of information. It is a research-driven entity with a worldwide reach that collaborates with external healthcare experts from across academia and the public and private sectors to objectively apply IMS Health’s proprietary global information and analytical assets. More information about the IMS Institute can be found at:

About IMS Health

IMS Health is a leading global information and technology services company providing clients in the healthcare industry with end-to-end solutions to measure and improve their performance. Our 7,000 services experts connect configurable SaaS applications to 15+ petabytes of complex healthcare data in the IMS One™ cloud platform, delivering unique insights into diseases, treatments, costs and outcomes. The company’s 15,000 employees blend global consistency and local market knowledge across 100 countries to help clients run their operations more efficiently. Customers include pharmaceutical, consumer health and medical device manufacturers and distributors, providers, payers, government agencies, policymakers, researchers and the financial community.

As a global leader in protecting individual patient privacy, IMS Health uses anonymous healthcare data to deliver critical, real-world disease and treatment insights. These insights help biotech and pharmaceutical companies, medical researchers, government agencies, payers and other healthcare stakeholders to identify unmet treatment needs and understand the effectiveness and value of pharmaceutical products in improving overall health outcomes. Additional information is available

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