Adherence to diabetes care

children, and an elderly mother. Her husband works abroad. You have prescribed metformin, gliclazide, simvastatin, and ramipril. Her HbA1c, blood pressure and cholesterol are all too high. Is she taking her tablets? ‘Ooh yes, doctor,’ she says. Would you increase her medication? As she later told the nurse, Mrs Smith doesn’t want to upset her doctor. In reality she forgets most of her tablets, most days. She means to take them, but her husband is away, her mother has dementia, and life is hectic. Have you ever taken prescribed medication exactly according to instructions? At the right time, in the right way, without missing a single dose? Adherence, compliance or concordance?1 • Adherence: ‘Persistence in a practice or tenet; steady observance or maintenance.’ • Compliance: ‘The acting in accordance with, or the yielding to a desire, request, condition, direction, etc; a consenting to act in conformity with; an acceding to; practical assent.’ • Concordance: ‘The fact of agreeing or being concordant; agreement, harmony’ or ‘Accord, concord, agreement; amicable relations (between parties).’