It’s easy to justify taking medications with an immediate, cause-and-effect benefit. You have strep throat, so you take an antibiotic and start to feel better within a few days, or you take aspirin to ease a headache (hopefully) within a few hours.
Medications for chronic diseases like type 2 diabetes and hypertension also have immediate effects, but it’s the long-term benefits accrued over years of taking them that make the biggest difference. It can take up to 10 years of tight blood sugar control, for example, before someone with type 2 diabetes lowers her risk for vascular complications. Despite the evidence that careful, early management of a chronic condition can prevent complications down the road, a new study shows that knowing about the “time requirements” of a medication—the tradeoff between taking it now and its delayed benefits—makes some patients less likely to take them.
“It’s actually quite scary as a doctor,” said Neda Laiteerapong, MD, lead author of the new study. “I have this information and it’s true, but if I share it with patients it will dissuade them from taking medicine, the exact opposite of what I want them to do.”
In the study, published last month in the journal BMJ Open Diabetes Research & Care, Laiteerapong and her colleagues from the University of Chicago Department of Medicine interviewed 60 patients between 40 and 70 years old who had hypertension, and type 2 diabetes for less than 10 years. A large majority (70 percent) said they were very likely to start a medications recommended by their doctor. But after being told about the time requirements for a diabetes medication, i.e. that it would take up to 10 years before they would benefit from it, about 40 percent said they were less likely to start taking it.
Laiteerapong said patients might think differently about treating a chronic disease than something more serious and acute. If someone is diagnosed with cancer, they want to begin treatment as soon as possible. But when they may not feel any symptoms of high blood pressure or elevated blood sugars, it’s harder to find the urgency.
“No one wants to know that it takes 10 years to benefit from their medications, but they still have to take them every day,” she said. “It’s tedious.”
There is a bright side though: When told that they could continue to benefit from a diabetes medication long after they stopped taking it, the same patients were more likely to start. These “legacy effects” seemed to be more convincing because they offer patients the possibility of discontinuing them some day.
This is one of the first studies to look at what patients think about time requirements for chronic disease medications. Laiteerapong says it underscores the need for doctors to have more conversations with their patients about the long-term arc of their health. Many patients, she says, think that as long as they feel okay, they’re fine. Having conversations about complications that could occur down the road—serious problems like a heart attack or a stroke—might help underscore why they need to be diligent about taking their medications, even when they don’t feel bad.
“It helps reframe their expectation of the disease,” Laiteerapong said. “They start to come to my side where they understand the scope of the problem we’re dealing with.”