Background: Virtual cognitive behavioral therapy (i.e., delivered by telephone or video) increases access to mental health treatment, but few studies describe the impact of virtual therapy on medication adherence among individuals with diabetes. We aimed to evaluate changes in medication adherence among adults with diabetes and common behavioral health issues such as depression or anxiety participating in a nationally available 8-week treatment program (AbleTo).

Methods: This retrospective cohort study included 524 participants consecutively enrolled between 1/1/2017-12/31/2017 of which 369 had complete adherence data for inclusion in the analytic sample (59% female, 43% non-white race/ethnicity, mean age 54+10 years). Prescription medications were documented at baseline (week 1); polypharmacy was defined as >5 medication types. Adherence was measured at weeks 1 and 8 using the standardized question, “Did you miss any doses this week?”; non-adherence was defined as missing any doses. Associations between adherence and participant characteristics (medication count, sex, race/ethnicity, age) were assessed using logistic regression. Change in medication adherence from weeks 1 to 8 was evaluated by McNemar’s test for paired nominal data.

Results: Baseline medication adherence was 86%. Adherence was lower among participants with polypharmacy (82% vs. 91%; p=.02), but did not differ by sex, race/ethnicity (white vs. non-white) or age group (>55 vs. <55 years). Non-adherence significantly improved from 14% to 8% at week 8 (-42%; p=.005). Improvements were observed in all subgroups and were statistically significant among participants with polypharmacy, females, and non-whites (p<.05).

Conclusion: Medication adherence was improved among participants in an 8-week virtual behavioral therapy program supporting the positive clinical impact of novel care delivery models for adults with diabetes and behavioral health conditions.


H.M. Greenberger: Employee; Self; AbleTo. E. Andreopoulos: None. S.A. Bell: None. R.L. Pande: Employee; Self; AbleTo, Inc. Stock/Shareholder; Self; AbleTo, Inc.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at