Improving Patient Adherence for Diabetes: 5 Drop-Off Points

Improving patient adherence in diabetes care has very little to do with getting a prescription approved. More than 40 million Americans (12% of the population) live with diagnosed or undiagnosed diabetes, according to the Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report. Medication non-adherence is where the consequences show up in the months after the prescription gets written.

What’s needed to improve patient adherence in diabetes?

Improving adherence in patients with diabetes means addressing loss of momentum due to prior authorization (PA) delays, cost at the pharmacy, onboarding complexity in the first 90 days, treatment burden, and missed refills.

Below are five points in the diabetes treatment journey where patients most often fall off, in roughly the order they happen, from before the prescription reaches the pharmacy counter to the months after a missed refill.

1. The ‘pending’ prior authorization

Diabetes treatments often run into PA friction before reaching the patient. However, that friction looks different depending on what’s being prescribed.

For GLP-1s, a confirmed type 2 diabetes diagnosis is usually the easier path through PA. Payers typically route diabetes-coded GLP-1 prescriptions through a dedicated pathway that still requires documented proof of diagnosis and, in most plans, a 90-day “fail-first” trial of metformin before approval, according to a 2026 analysis in Family Practice Management. The scrutiny built into that pathway is aimed at screening out off-label weight-loss use, but incomplete documentation can still leave a patient with type 2 diabetes waiting.

Access to continuous glucose monitors (CGMs) creates a more direct version of the problem, and it affects patients diagnosed with diabetes specifically, not a secondary weight-loss population. According to Health Affairs, prior authorization is required for most covered CGMs. What’s more, analysis by Georgetown Center on Health Insurance Reforms found that clinical coverage criteria for CGMs often don’t match current American Diabetes Association recommendations, such as patients with type 2 diabetes who have been prescribed insulin. Patients who are diagnosed with type 2 diabetes and aren’t insulin-dependent have historically had the hardest time getting a CGM approved, regardless of how well the evidence supports using one.

That gap is a plausible part of why CGMs are now available direct-to-consumer. One CGM manufacturer built its over-the-counter sensor specifically for people with type 2 diabetes who don’t use insulin. That’s the same group payers have been slowest to cover, and the company has said that it “makes it easier for the target population to access CGM and offers an option for those who don’t have insurance coverage for CGM,” notes Drug Delivery Business.

Other CGM manufacturers have followed suit. When manufacturers design a consumer product explicitly for the patients that payer criteria exclude, that’s a reasonable signal that demand for a chronic-disease management tool didn’t disappear just because coverage didn’t keep up.

The wait for approval is where adherence breaks down. A patient with no visibility into timing has no way to tell if PA approval will be a two-day wait or a two-week one, and many lose their motivation to pursue CGM access or simply forget to follow up.

2. Cost at the pharmacy counter

Insulin pricing has moved more in the past three years than in the previous decade. The Inflation Reduction Act capped insulin out-of-pocket costs at $35 a month for Medicare Part D enrollees, and major manufacturers extended similar caps into the commercial market. One pharmaceutical company, for example, applies $35-a-month pricing across its full insulin portfolio regardless of insurance status, according to Fierce Pharma.

But none of that helps if the patient standing at the pharmacy counter doesn’t know it applies to them. A $35 cap a patient assumes is “probably not for me” produces the same abandoned fill as no cap at all.

Affordability policies have moved fast, but patient awareness hasn’t kept pace, and that gap can cause non-adherence.

3. The first 90 days after prescribing

Starting a new diabetes medication is rarely as simple as picking up a prescription. Whether a patient is starting a first-line oral medication like metformin or moving to self-injectables like a GLP-1 or insulin, it can be intimidating for first-time users. Likewise, insulin pumps and CGMs require device setup that patients may need guidance on.

Some prescribed medications, like GLP-1s, may also have complex dose titration schedules that change over the first several weeks to minimize side effects. These friction points are concentrated in the earliest window of treatment, more than any other point in the journey, which can contribute to abandonment.

4. Treatment burden and side effects

Gastrointestinal side effects and injection fatigue are well-documented reasons that patients stop GLP-1 therapy. It’s worth being precise about which population the most alarming numbers describe.

A widely cited figure, that nearly 85% of patients stopped GLP-1 therapy within two years, comes from patients taking GLP-1s for weight loss without diabetes, not from people with type 2 diabetes, per HLTH. The diabetes-specific numbers are less extreme but still notable: a meta-analysis presented at the American Diabetes Association’s 2026 Scientific Sessions found GLP-1 persistence and adherence in real-world type 2 diabetes care remained consistently low across studies spanning 2014 to 2025.

Drug tolerability is a factor that patient support teams can plan for with earlier, more proactive side-effect counseling.

5. The follow-up gap

Most adherence infrastructure is built to catch two moments: when a claim gets rejected or when a patient starts therapy. What’s missing is the moment in between, when a patient who started treatment quietly stops refilling, with nothing to flag the drop-off. By the time a gap shows up, the patient may have been off therapy for months.

This is the point adherence programs tend to skip, and it may be the most fixable one on this list. Reaching a patient when it’s time for a refill is different than reaching them months after they’ve forgotten it. For a therapy class with as much real-world drop-off as diabetes, re-engagement after a lapse deserves the same attention most programs currently reserve for onboarding.

Improve patient adherence by addressing those five friction points

PA delays, cost, onboarding complexity, treatment burden, and the follow-up gap have one thing in common: they happen after a diabetes treatment is approved. Most Diabetes Awareness Month content focuses on access to treatment, and skips what comes next. With more than 40 million Americans with diabetes, what happens after approval is where the biggest gaps are.

For brand, market access, and patient support teams working on diabetes programs, the real question is which of these five gaps your program can’t see yet. That’s a good starting point, whether it happens internally or with a partner that can help.

Curious how Timely^® by DrFirst^® can help? Check out this insulin success story, and then let’s talk!