TABLE 1.

Barriers to Optimal Adherence to Metformin

Patient-Related Barriers	Practitioner-Related Barriers	Treatment-Related Barriers
● Difficulties in understanding the rationale for long-term metformin treatment	● Poor health care team–patient relationship	● Regimen complexity, especially in patients with multiple comorbid conditions
● Physical impairment such as difficulty swallowing; psychological difficulty swallowing tablets	● Lack of time for in-depth communication with patient	● Large size of or rough coating on metformin tablets
● Memory problems (e.g., in older patients)	● Lack of awareness of problems with treatment adherence	● Inflexible treatment regimens
● Socioeconomic factors (e.g., medication costs, lack of support during treatment)		● Gastrointestinal side effects
● Cultural attitudes and beliefs