The Effect of a Pill Box on Glycemic Control among Patients with Type 2 Diabetes Mellitus and Hypertension at Pattani Hospital

Abstract

Introduction: Optimal glycemic control can reduce the risk of complications associated with diabetes mellitus and hypertension. Medication adherence is a multifaceted and complex behavior influenced by various factors, with forgetfulness being a major contributor to medication non-adherence. Therefore, recognizing this issue, the researchers hypothesized that a pill box could improve medication adherence and subsequently enhance glycemic control. Objective: To investigate the effect of using a pill box on glycemic control among patients with type 2 diabetes mellitus and hypertension who have not yet achieved their target blood glucose levels. Methods: Patients with type 2 diabetes and hypertension with HbA1c levels >8.0% who were taking more than three oral medications daily were enrolled. Participants were randomly allocated by simple randomization to either the intervention group, which received a 7-day pill box, or the control group, which received standard care. Fasting blood glucose (FBG), HbA1c, and eGFR were measured at baseline, 12 weeks, and 24 weeks. Results: At the end of the study, 40 participants completed the study, with 20 participants in the pill box group and 20 in the control group. Baseline characteristics were generally comparable between the two groups, except that the pill box group had a higher HbA1c level and a higher proportion of patients receiving ACEIs or ARBs. At 12 and 24 weeks, the pill box group demonstrated significantly greater reductions in HbA1c than the control group, with mean differences of −1.30% (95% CI: −2.43 to −0.17; p=0.024) and −1.82% (95% CI: −2.87 to −0.77; p<0.001), respectively. Similarly, FBG levels decreased significantly more in the pill box group than in the control group, with mean differences of −49.45 mg/dL (95% CI: −85.69 to −13.21, p=0.007) and −51.15 mg/dL (95% CI: −84.03 to −18.27, p=0.002) at 12 and 24 weeks, respectively. The trajectories of changes in FBG and HbA1c from baseline to 24 weeks differed significantly between the two groups (interaction p<0.001). Conclusions: The use of a 7-day pill box was significantly associated with reductions in FBG and HbA1c levels in patients with type 2 diabetes mellitus. Improved medication adherence may be a potential mechanism; however, adherence was not directly measured in this study. Further studies are needed to assess medication adherence and its contribution to glycemic control.