ASSESSMENT OF SULFONYLUREA ADHERENCE AND METABOLIC CONTROL

This study was designed to compare sulfonylurea adherence assessment b y providers, patients' self-report, pill counts, and a medication even t monitoring system (MEMS-3(R)) device, and correlate the estimates of metabolic control by provider, patient, and laboratory. Forty-seven o utpatient veterans with fair to poor metabolic control of non-insulin- dependent diabetes mellitus were enrolled and received monthly refills of sulfonylurea in vials with a cap containing an electronic medicati on monitoring microprocessor. Pill counts and fasting plasma glucoses were measured monthly, and glycohemoglobin and a 24-hour diet recall w ere obtained at 0 and 60 days. Investigators then asked providers and patients to assess adherence and metabolic control. Forty-seven percen t were nonadherent to medication using MEMS-3(R), 29% using pill count s, 29% using provider assessment, and 31% using self-report. Thirty-on e percent of providers and 53% of patients assessed metabolic control differently than laboratory values. Assessment of medication adherence by provider, patient, and pill counts did not explain metabolic contr ol as closely as assessment by MEMS-3(R).