Does a medication event monitoring system (MEMS-3) assess sulfonylurea adherence and correlate with metabolic control better than provider assessment, patient self-report, or pill counts in outpatient veterans with non-insulin-dependent diabetes mellitus?
Electronic medication monitoring (MEMS-3) detects significantly higher rates of sulfonylurea nonadherence than traditional methods and correlates better with actual metabolic control in patients with diabetes.
This study was designed to compare sulfonylurea adherence assessment by providers, patients' self-report, pill counts, and a medication event monitoring system (MEMS-3) device, and correlate the estimates of metabolic control by provider, patient, and laboratory. Forty-seven outpatient 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 medication monitoring microprocessor. Pill counts and fasting plasma glucoses were measured monthly, and glycohemoglobin and a 24-hour diet recall were obtained at 0 and 60 days. Investigators then asked providers and patients to assess adherence and metabolic control. Forty-seven percent were nonadherent to medication using MEMS-3, 29% using pill counts, 29% using provider assessment, and 31% using self-report. Thirty-one 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 control as closely as assessment by MEMS-3.
Mason et al. (1995) studied this question.