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Gor D, Lee TA, Schumock GT, Walton SM, Gerber BS, Nutescu EA, Touchette DR. Adherence and Persistence with DPP-4 Inhibitors Versus Pioglitazone in Type 2 Diabetes Patients with Chronic Kidney Disease: A Retrospective Claims Database Analysis. J Manag Care Spec Pharm 2020; 26:67-75. [PMID: 31880221 PMCID: PMC10390941 DOI: 10.18553/jmcp.2020.26.1.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adherence and persistence with diabetes medication play an important role in glycemic control and may differ by medication class. However, there is a lack of research comparing diabetes medications in patients with renal impairment, despite the challenges and higher burden associated with managing this population. OBJECTIVE To compare adherence and persistence among patients with type 2 diabetes mellitus (T2DM) and nondialysis chronic kidney disease (CKD) treated with dipeptidyl peptidase-4 (DPP-4) inhibitors versus pioglitazone. METHODS This retrospective cohort study used Truven MarketScan administrative claims databases from 2009 to 2015. One-year adherence for patients with T2DM and nondialysis CKD who initiated therapy with either a DPP-4 inhibitor or pioglitazone was measured by proportion of days covered (PDC) following an initial dispensing, and PDC ≥ 0.80 was coded as adherent. Persistence was calculated as the days between the index date and last day with the index medication on hand, based on the end of the last days supply or the end of follow-up (i.e., 365 days), whichever occurred first. Multivariate logistic regression and Cox proportional hazards models were used to estimate confounder-adjusted differences between the groups for adherence and persistence. RESULTS The final cohort included 9,019 patients (DPP-4 inhibitors: 7,002; pioglitazone: 2,017). In the adjusted analysis, DPP-4 inhibitor users demonstrated a 1.41 (95% CI = 1.25-1.59) higher odds of being adherent compared with pioglitazone users. Overall adjusted HR for persistence was 0.74 (95% CI = 0.69-0.79), which favored DPP-4 inhibitors compared with pioglitazone. Relative to 2010, persistence with pioglitazone decreased in 2011-2012 and then increased in 2013-2014. In the subgroup analysis, DPP-4 inhibitors first had lower (2010: OR = 0.78, 95% CI = 0.70-0.87; 2011-2012: OR = 0.60, 95% CI = 0.54-0.66) and then similar (2013-2014: OR = 1.03, 95% CI = 0.88-1.19) hazards of nonpersistence compared with pioglitazone. CONCLUSIONS Among patients with T2DM and nondialysis CKD, the use of DPP-4 inhibitors was associated with better adherence compared with pioglitazone. However, following the approval of generic pioglitazone and associated lower cost sharing after 2012, the magnitude of difference in adherence between the medication classes reduced. Similarly, safety warnings in 2011 and approval of generic products in 2012 may have affected pioglitazone persistence, leading to first higher and then similar hazards for nonpersistence with pioglitazone as compared with DPP-4 inhibitors. These shifts in the results for pioglitazone warrant further investigation and close monitoring of the population initiating this medication. DISCLOSURES No funding was received for this study. The authors have no conflicts of interest to disclose. An abstract for this study was presented as a podium presentation at the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) 2019 Annual Meeting; May 18-22, 2019; New Orleans, LA.
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MESH Headings
- Administrative Claims, Healthcare
- Aged
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/epidemiology
- Dipeptidyl-Peptidase IV Inhibitors/adverse effects
- Dipeptidyl-Peptidase IV Inhibitors/therapeutic use
- Disease Progression
- Drug Substitution
- Drug Utilization
- Drugs, Generic/adverse effects
- Drugs, Generic/therapeutic use
- Female
- Humans
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Insurance, Pharmaceutical Services
- Male
- Medication Adherence
- Middle Aged
- Pioglitazone/adverse effects
- Pioglitazone/therapeutic use
- Practice Patterns, Physicians'
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/drug therapy
- Renal Insufficiency, Chronic/epidemiology
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Deval Gor
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago
| | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago
| | - Surrey M. Walton
- Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago
| | - Ben S. Gerber
- Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago
| | - Edith A. Nutescu
- Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago
| | - Daniel R. Touchette
- Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago
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Farmer A, Allen J, Bartlett K, Bower P, Chi Y, French D, Gudgin B, Holmes EA, Horne R, Hughes DA, Kenning C, Locock L, McSharry J, Miles L, Newhouse N, Rea R, Riga E, Tarassenko L, Velardo C, Williams N, Williams V, Yu LM. Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D Feasibility): a randomised feasibility trial protocol. BMJ Open 2019; 9:e033504. [PMID: 31888938 PMCID: PMC6937131 DOI: 10.1136/bmjopen-2019-033504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/30/2019] [Accepted: 12/04/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Type 2 diabetes is common, affecting over 400 million people worldwide. Risk of serious complications can be reduced through use of effective treatments and active self-management. However, people are often concerned about starting new medicines and face difficulties in taking them regularly. Use of brief messages to provide education and support self-management, delivered through mobile phone-based text messages, can be an effective tool for some long-term conditions. We have developed messages aiming to support patients' self-management of type 2 diabetes in the use of medications and other aspects of self-management, underpinned by theory and evidence. The aim of this trial is to determine the feasibility of a large-scale clinical trial to test the effectiveness and cost-effectiveness of the intervention, compared with usual care. METHODS AND ANALYSIS The feasibility trial will be a multicentre individually randomised, controlled trial in primary care recruiting adults (≥35 years) with type 2 diabetes in England. Consenting participants will be randomised to receive short text messages three times a week with messages designed to produce change in medication adherence or non-health-related messages for 6 months. The aims are to test recruitment methods, retention to the study, the feasibility of data collection and the mobile phone and web-based processes of a proposed definitive trial and to refine the text messaging intervention. The primary outcome is the rate of recruitment to randomisation of participants to the trial. Data, including patient reported measures, will be collected online at baseline and the end of the 6-month follow-up period. With 200 participants (100 in each group), this trial is powered to estimate 80% follow-up within 95% CIs of 73.8% to 85.3%. The analysis will follow a prespecified plan. ETHICS AND DISSEMINATION Ethics approval was obtained from the West of Scotland Research Ethics Committee 05. The results will be disseminated through conference presentations, peer-reviewed journals and will be published on the trial website: www.summit-d.org (SuMMiT-D (SUpport through Mobile Messaging and digital health Technology for Diabetes)). TRIAL REGISTRATION NUMBER ISRCTN13404264.
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Affiliation(s)
- Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kiera Bartlett
- The Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Yuan Chi
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - David French
- The Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | | | - Emily A Holmes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Robert Horne
- UCL School of Pharmacy, University College London, London, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Cassandra Kenning
- Institute of Population Health, The University of Manchester, Manchester, UK
| | - Louise Locock
- Health Service Research, University of Aberdeen, Aberdeen, UK
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Lisa Miles
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | | | - Rustam Rea
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Evgenia Riga
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Carmelo Velardo
- The Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Veronika Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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103
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du Pon E, Kleefstra N, Cleveringa F, van Dooren A, Heerdink ER, van Dulmen S. Effects of the Proactive interdisciplinary self-management (PRISMA) program on self-reported and clinical outcomes in type 2 diabetes: a pragmatic randomized controlled trial. BMC Endocr Disord 2019; 19:139. [PMID: 31829220 PMCID: PMC6907250 DOI: 10.1186/s12902-019-0466-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes self-management education can be helpful for patients with type 2 diabetes in managing their condition. We aimed to study the effects of the group-based PRoactive Interdisciplinary Self-MAnagement (PRISMA) training program on self-reported and clinical outcomes in patients with type 2 diabetes treated in general practice. METHODS Persons aged 18 years or older diagnosed with type 2 diabetes and treated in primary care were included. In a randomized controlled trial design (1:1), patients were followed for 6 months with an extension phase of 6 months. Block randomization was used. The patients with type 2 diabetes received either PRISMA in addition to usual care or usual care only. All patients completed a range of validated questionnaires (including knowledge, skills, and confidence for self-management [PAM], diabetes self-care behavior [SDSCA], health-related quality of life [EQ-5D], and emotional well-being [WHO-5]). In addition, clinical outcomes (HbA1c, body mass index, systolic blood pressure, and cholesterol levels) were collected during the routine diabetes checkups. RESULTS Of the total sample (n = 193), 60.1% were men. The mean age was 69.9 years (SD = 9.1). No significant differences were found on self-reported outcomes between the groups at 0, 6, and 12 months. The clinical outcomes were not reported due to a large number of missing values. CONCLUSION PRISMA did not improve self-reported outcomes in patients with type 2 diabetes treated in primary care. It was not possible to make a statement about the clinical effects. TRIAL REGISTRATION date: 16/07/2014, number: NL4550 (https://www.trialregister.nl/trial/4550).
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Affiliation(s)
- Esther du Pon
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501, AA, Utrecht, the Netherlands.
- Diabetes Centre, Isala, Zwolle, the Netherlands.
| | - Nanne Kleefstra
- Medical Research Group, Langerhans, Ommen, 7731, MX, the Netherlands
- Department of GGZ Drenthe research and High Intensive Care, GGZ Drenthe mental health services, Assen, 9404, LA, the Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, 9713, GZ, the Netherlands
| | - Frits Cleveringa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3584, CX, the Netherlands
| | - Ad van Dooren
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501, AA, Utrecht, the Netherlands
| | - Eibert R Heerdink
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501, AA, Utrecht, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, 3513, CR, the Netherlands
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, 6525, GA, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, 3045, Drammen, Norway
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104
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Fritzen K, Stautner C, Schnell O. Patient-centred care in type 2 diabetes mellitus - Key aspects of PDM-ProValue are reflected in the 2018 ADA/EASD consensus report. Diabetes Res Clin Pract 2019; 158:107897. [PMID: 31672502 DOI: 10.1016/j.diabres.2019.107897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022]
Abstract
In 2018, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a consensus report on the management of hyperglycaemia in type 2 diabetes, recommending, amongst others, a patient-centred decision cycle to prevent complications and optimise quality of life. The PDM-ProValue study program which focused on the assessment of integrated personalised diabetes management provided evidence for the efficacy of its implementation. In this comparative review, we identified the standardised decision cycle as well as individualised patient assessment as the overarching elements of the ADA/EASD consensus report and the PDM-ProValue study. The decision cycle, investigated in PDM-ProValue and similarly recommended by the 2018 ADA/EASD consensus report, can benefit diabetes management in persons with type 2 diabetes. This is reflected in improved glycaemic control as well as patient and physician communication and satisfaction.
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105
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Davis-Ajami ML, Pakyz A, Wu J, Baernholdt M. A Payer Perspective of the Costs of Urinary Tract and Skin and Soft Tissue Infections in Adults with Diabetes and the Relationship to Oral Antidiabetic Medication Nonadherence. J Manag Care Spec Pharm 2019; 25:1409-1419. [PMID: 31436479 PMCID: PMC10397633 DOI: 10.18553/jmcp.2019.19052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Controlling costs and improving quality outcomes are important considerations of the triple aim in health care. Medication adherence to oral antidiabetic (OAD) medications is an outcome measure for those with diabetes. However, there is little research reporting the costs associated with OAD medication adherence among adults with diabetes and comorbid infections. OBJECTIVE To provide nationally representative cost and utilization estimates from a payer perspective of 2 common comorbid infections: urinary tract infection (UTI) and skin and soft tissue infection (SSTI) among adults with diabetes in relation to OAD medication nonadherence to quantify cost per outcome. METHODS A retrospective observational study for years 2010-2015 used longitudinal panel data in the public domain from the Medical Expenditure Panel Survey (MEPS). The study included individuals aged ≥ 18 years with diabetes (excluding gestational diabetes) who were prescribed OAD medications and then stratified by infection status, that is, without infection versus with UTI and/or SSTI. Outcomes measured included medication adherence, defined as medication possession ratio (MPR); treated prevalence of UTI and SSTI; and associated direct medical costs paid by insurers. RESULTS 4,633 adults with diabetes were included; of those, 12% reported a UTI or SSTI, with the weighted sample representing 2.2 million U.S. residents. The mean MPR was 0.61 and 0.63 in the infection and noninfection groups, respectively. Less than 35% in each group were adherent to OAD medications. Having a UTI or SSTI increased the adjusted total health expenses by 53.7% (P < 0.001), but adherence to OAD medications did not significantly affect total health care costs. CONCLUSIONS In adults with diabetes, a UTI or SSTI diagnosis did not influence medication adherence to OAD medication but increased health care utilization and costs significantly. DISCLOSURES This study was supported by the Virginia Commonwealth University Presidential Research Quest Fund (PeRQ Fund). The authors have no financial conflicts of interest to disclose.
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Affiliation(s)
| | - Amy Pakyz
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond
| | - Jun Wu
- Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - Marianne Baernholdt
- Department of Global Initiatives, The University of North Carolina at Chapel Hill School of Nursing
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106
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Bennich BB, Munch L, Overgaard D, Konradsen H, Knop FK, Røder M, Vilsbøll T, Egerod I. Experience of family function, family involvement, and self‐management in adult patients with type 2 diabetes: A thematic analysis. J Adv Nurs 2019; 76:621-631. [DOI: 10.1111/jan.14256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/20/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Birgitte B. Bennich
- Clinical Metabolic Physiology Steno Diabetes Center Copenhagen Copenhagen University Hospital Gentofte Hospital Hellerup Denmark
- Institute of Nursing University College Copenhagen Copenhagen N Denmark
| | - Lene Munch
- Clinical Metabolic Physiology Steno Diabetes Center Copenhagen Copenhagen University Hospital Gentofte Hospital Hellerup Denmark
| | - Dorthe Overgaard
- Institute of Nursing University College Copenhagen Copenhagen N Denmark
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society NVS Huddinge Sweden
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen N Denmark
- Department of Gastroenterology Herlev and Gentofte University Hospital Herlev Denmark
| | - Filip K. Knop
- Clinical Metabolic Physiology Steno Diabetes Center Copenhagen Copenhagen University Hospital Gentofte Hospital Hellerup Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research Faculty of Health and Medical Sciences University of Copenhagen Copenhagen N Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen N Denmark
- Center for Clinical Metabolic Research Department of Medicine Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - Michael Røder
- Clinical Metabolic Physiology Steno Diabetes Center Copenhagen Copenhagen University Hospital Gentofte Hospital Hellerup Denmark
- Steno Diabetes Center Odense Odense University Hospital Odense C Denmark
| | - Tina Vilsbøll
- Clinical Metabolic Physiology Steno Diabetes Center Copenhagen Copenhagen University Hospital Gentofte Hospital Hellerup Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen N Denmark
| | - Ingrid Egerod
- Intensive Care Unit Copenhagen University Hospital Rigshospitalet Denmark
- Faculty of Health & Medical Sciences University of Copenhagen Copenhagen N Denmark
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107
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Vluggen S, Hoving C, Schaper NC, De Vries H. Psychological predictors of adherence to oral hypoglycaemic agents: an application of the ProMAS questionnaire. Psychol Health 2019; 35:387-404. [PMID: 31588778 DOI: 10.1080/08870446.2019.1672873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This study aimed to identify psychological predictors of oral hypoglycaemic agent (OHA) adherence and to compare adherence rates between a novel and well-known instrument, i.e. the Probabilistic Medication Adherence Scale (ProMAS) and Medication Adherence Report Scale (MARS-5).Design and main outcome measures: A longitudinal study design was applied with surveys at baseline and 6-month follow-up. At baseline, OHA adherence using the ProMAS and MARS-5, socio-cognitive determinants and demographics were assessed. At follow-up, the ProMAS was applied as outcome measure, on which socio-cognitive determinants and demographics were regressed using linear regression analysis.Results: The baseline and follow-up sample included 304 and 231 participants, respectively. When applying cut-off points of ≥15 for the ProMAS and ≥23 for the MARS-5, 47.4 and 89.5% adhered to their OHAs. Consistent predictors of better adherence comprised a low education, lower severity perceptions, and higher self-efficacy and intention. After correcting for baseline adherence, a low education and higher self-efficacy remained significant adherence predictors.Conclusions: Compared to the MARS-5, ProMAS data was less skewed, similar to objectively collected data, and yielded insights in a broader spectrum of (non)-adherence behaviours. Results stress the need for adherence improving interventions which particularly should target higher educated patients and patients with low self-efficacy, low intention and high severity perceptions.
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Affiliation(s)
- Stan Vluggen
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ciska Hoving
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Endocrinology and Internal Medicine, School CAPHRI, University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Hein De Vries
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
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108
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Dobbins JM, Elliott SW, Cordier T, Haugh G, Renda A, Happe L, Turchin A. Primary Care Provider Encounter Cadence and HbA1c Control in Older Patients With Diabetes. Am J Prev Med 2019; 57:e95-e101. [PMID: 31542146 DOI: 10.1016/j.amepre.2019.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Primary care provider encounters are associated with health and well-being; however, limited evidence guides optimal primary care provider rate of visit, referred to as encounter cadence. This study measures associations between primary care provider encounter cadence and diabetes outcomes among individuals newly diagnosed with type 2 diabetes mellitus. METHODS In this retrospective cohort study, 7,106 people enrolled in Medicare Advantage and newly diagnosed with type 2 diabetes mellitus between July 1, 2012 and June 30, 2013 were identified and followed for 36 months. Two methods measured primary care provider encounter cadence: total primary care provider encounters (frequency) and quarters with primary care provider encounter (regularity). Logistic regression measured relationships between primary care provider encounter cadence and non-insulin diabetes medication adherence, HbA1c control, emergency department visits, and inpatient admissions. Non-insulin diabetes medication adherence was defined according to the National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set specifications and measured using healthcare claims data. Post-hoc models examined adherence and diabetes control among those nonadherent (n=5,212) and with noncontrolled HbA1c (n=326) during the encounter/cadence period. Data were extracted and analyzed in 2017. RESULTS Adjusted models indicated that both frequency (AOR=1.08, 95% CI=1.06, 1.10) and regularity (AOR=1.18, 95% CI=1.13, 1.22) of primary care provider encounters were associated with increased odds of adherence. Post-hoc analyses indicated that more frequent (AOR=1.12, 95% CI=1.10, 1.15) and regular (AOR=1.27, 95% CI=1.22, 1.33) primary care provider encounters were associated significantly with adherence and were associated directionally with HbA1c control. CONCLUSIONS More frequent and regular primary care provider encounters are associated with an increased likelihood of non-insulin diabetes medication adherence. These findings contribute to data needed to establish evidence-based guidelines for primary care provider encounter cadence for those newly diagnosed with type 2 diabetes mellitus.
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Affiliation(s)
- Jessica M Dobbins
- Department of the Chief Medical Officer, Humana Inc., Louisville, Kentucky.
| | | | - Tristan Cordier
- Department of Clinical Data Science, Humana Inc., Louisville, Kentucky
| | - Gil Haugh
- Department of Clinical Data Science, Humana Inc., Louisville, Kentucky
| | - Andrew Renda
- Office of Population Health, Humana Inc., Louisville, Kentucky
| | - Laura Happe
- Healthcare Services, Humana Inc., Louisville, Kentucky
| | - Alexander Turchin
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
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109
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Edelman SV, Ermakova A, Xiong Y, Sieradzan R, Taylor SD. Persistence with Basal-Bolus Insulin Therapy in Patients with Type 2 Diabetes Mellitus and Effect on Clinical and Economic Outcomes: A Retrospective Claims Database Study. J Manag Care Spec Pharm 2019; 25:1420-1431. [PMID: 31550190 PMCID: PMC10398325 DOI: 10.18553/jmcp.2019.19097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Persistence with multiple daily insulin injections (MDI) may be challenging for patients with type 2 diabetes (T2DM). However, limited information is available regarding the effect of persistence with MDI on outcomes. OBJECTIVE To evaluate persistence with basal and bolus insulin therapy and assess its relationship with clinical and economic outcomes in a real-world setting. METHODS This retrospective matched cohort study used 2012-2015 data from multiple U.S. commercial health plans (IBM MarketScan). Patients with T2DM aged 18-64 years with ≥ 2 basal and ≥ 2 bolus insulin claims during a 12-month period were eligible for inclusion if they had 18 months of continuous health plan enrollment (6-month baseline and 12-month post-index). Persistence during 12 months post-index was defined using 2 methods: (a) method 1, ≤ 90-day gaps in both basal and bolus insulin claims and (b) method 2, ≥ 1 basal and ≥ 1 bolus insulin claim every quarter (every 90 days) for 4 consecutive quarters after index bolus claim. Propensity score matching was used to match persistent and nonpersistent method 2 cohorts. Mean per-patient all-cause and diabetes-related medical costs (2015 U.S. dollars, excluding outpatient drugs) and health care resource use (HCRU) were calculated. For patients with hemoglobin A1c (A1c) values during baseline and post-index months 10-12, treatment success was defined as (a) A1c decrease from baseline of ≥ 1% and/or (b) baseline A1c ≥ 7% with post-index A1c < 7%. Baseline characteristics of matched cohorts were compared using standardized mean differences (SMDs). Outcome variables were compared using t-tests, chi-square tests, and generalized linear models. RESULTS Characteristics of 12,882 eligible patients and 12-month persistence rates were similar as defined by method 1 (22.4%) and method 2 (21.1%). After matching, the method 2 cohorts included 2,723 and 8,169 persistent and nonpersistent patients, respectively, with well-balanced baseline characteristics (mean age 53 years; 58% men; all SMDs < 0.1). All-cause annual medical costs were lower for the persistent cohort (mean $13,499 vs. $17,362; P < 0.0001), as were annual diabetes-related costs (mean $6,392 vs. $8,376; P < 0.0001). In persistent versus nonpersistent cohorts, 11% versus 15% of patients, respectively, experienced ≥ 1 hospitalization; 21% versus 24%, respectively, had ≥ 1 ED visit; 9% versus 12%, respectively, experienced ≥ 1 diabetes-related hospitalization; and 13% versus 15%, respectively, had ≥ 1 diabetes-related ED visit (P ≤ 0.005 for all). Mean baseline A1c was similar in persistent and nonpersistent cohorts (9.7% vs. 9.6%, respectively; P = 0.63). Persistence with MDI was associated with greater mean reduction in A1c (-1.3% vs. -0.8%, respectively; P = 0.006) and greater percentages of patients achieving treatment success (55% vs. 39%, respectively, for nonpersistent; P = 0.009). CONCLUSIONS Poor persistence with basal-bolus insulin therapy over 12 months of follow-up was prevalent and was associated with greater medical costs, greater HCRU, and poorer glycemic control than for patients who were persistent. Interventions are needed to improve persistence with insulin therapy and aid patients with T2DM to achieve glycemic control. DISCLOSURES Funding for this study was provided by Becton, Dickinson and Company (BD). All authors except Edelman are employees and stockholders of BD. Edelman reports board membership at Senseonics and participation in advisory board/speakers bureau at Lilly USA, MannKind, Novo Nordisk, Sanofi-Aventis U.S., Merck, and AstraZeneca, all unrelated to this study. A poster for this study was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2018; April 23-26, 2018; Boston MA.
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Affiliation(s)
- Steven V Edelman
- Division of Endocrinology and Metabolism, University of California School of Medicine, San Diego; Veterans Affairs Medical Center, San Diego, California; and Taking Control of Your Diabetes, Del Mar, California
| | | | - Yan Xiong
- Becton, Dickinson and Co., Franklin Lakes, New Jersey
| | - Ray Sieradzan
- Becton, Dickinson and Co., Franklin Lakes, New Jersey
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Dhillon H, Nordin RB, Ramadas A. Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193561. [PMID: 31547629 PMCID: PMC6801549 DOI: 10.3390/ijerph16193561] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022]
Abstract
Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia’s unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8–18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3–8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5–39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1–32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.
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Affiliation(s)
- Hardesh Dhillon
- Barwon Health, University Hospital Geelong, Geelong, Victoria 3220, Australia.
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia.
| | - Rusli Bin Nordin
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor 47500, Malaysia.
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia.
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Caccavale LJ, Bernstein R, Yarbro JL, Rushton H, Gelfand KM, Schwimmer BA. Impact and Cost-Effectiveness of Integrated Psychology Services in a Pediatric Endocrinology Clinic. J Clin Psychol Med Settings 2019; 27:615-621. [PMID: 31325008 DOI: 10.1007/s10880-019-09645-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Including psychology services in pediatric endocrinology clinics may improve patients' adherence to diabetes management behaviors, and, subsequently, glycemic control; however, an evaluation of the impact and cost-effectiveness of this integration is needed. The change in HbA1c and cost-effectiveness of integrated psychology services, from the hospital and insurance provider perspectives, were evaluated using a linear effects model and Incremental Cost-Effectiveness Ratios (ICERs). Data from 378 patients with T1D (50% female; 65% Caucasian; M age = 12.0 years) were obtained via medical chart review (2241 appointments). Patients demonstrated significant improvements in HbA1c following clinic visits in which they met with psychology (b = - 0.16, p = 0.006). A larger proportion of the distribution of ICER values fall below the $1000/1% HbA1c threshold from both the insurance (89%) and hospital (94%) perspectives. These results indicate that providing integrated psychology services in the endocrinology clinic is highly beneficial from the patient, hospital, and insurance provider perspectives.
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Affiliation(s)
- Laura J Caccavale
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA, 23229-0140, USA.
| | - Ruth Bernstein
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Hilary Rushton
- Department of Pediatric Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Kenneth M Gelfand
- Department of Pediatric Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Bradley A Schwimmer
- Department of Pediatric Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
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Christofides EA. Practical Insights Into Improving Adherence to Metformin Therapy in Patients With Type 2 Diabetes. Clin Diabetes 2019; 37:234-241. [PMID: 31371854 PMCID: PMC6640881 DOI: 10.2337/cd18-0063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IN BRIEF Adherence to metformin-based treatment regimens for type 2 diabetes is currently suboptimal due to a complex array of patient-, treatment-, and physician-related barriers, including physical and psychological swallowing difficulties associated with large tablets and gastrointestinal disturbances. Patients often avoid discussing these issues with their primary care providers, and delays in addressing them can lead to reduced glycemic control. This article reviews the issues commonly responsible for poor adherence to metformin and presents strategies to improve compliance, including shared decision-making and the use of different metformin formulations, including liquid metformin.
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113
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Hamersky CM, Fridman M, Gamble CL, Iyer NN. Injectable Antihyperglycemics: A Systematic Review and Critical Analysis of the Literature on Adherence, Persistence, and Health Outcomes. Diabetes Ther 2019; 10:865-890. [PMID: 31054132 PMCID: PMC6531561 DOI: 10.1007/s13300-019-0617-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Improving real-world medication adherence to injectable antihyperglycemics in type 2 diabetes mellitus (T2DM) is a clinical challenge. Quantification of the level of adherence required to achieve a minimal clinically important difference (MCID) in glycemic control would assist in meeting this goal. The study objective was to review the literature regarding the relationships of medication adherence and persistence with health outcomes in adult T2DM patients using injectable antihyperglycemics. METHODS Systematic searches were conducted using electronic databases to identify publications over the last decade. Publications were screened against established eligibility criteria. Study data were extracted, evaluated, and used to identify strengths, limitations, and gaps in current evidence. RESULTS Eligibility criteria were met by 38 studies, and this report analyzed 34 studies related to glycemic control (n = 25), healthcare resource use (n = 9), and healthcare costs (n = 14). Eight of these studies examined adherence to glucagon-like peptide-1 receptor agonists (GLP-1 RA), including 1 study regarding adherence to GLP-1 RA or to insulin, and 1 study investigating a GLP-1 RA/insulin combination; the remaining studies involved insulin. Studies used a broad range of measures to classify adherence and persistence, and most measures were unable to reliably evaluate the complexities of patient behavior over time. Better adherence to injectable antihyperglycemic medications was generally found to be associated with improved glycemic control, although no studies attempted to identify a MCID. Although higher diabetes-related pharmacy and total healthcare costs were reported for adherent or persistent patients, these patients tended to have lower diabetes-related and all-cause medical costs. CONCLUSION Results of this review confirmed the effectiveness of injectable antihyperglycemic medications for glycemic control, suggesting that there are clinical and financial consequences to nonadherence. Although attempts were made to quantify the effects of nonadherence, the interpretation of study results was limited by the lack of a MCID and inadequate study design. FUNDING Novo Nordisk, Inc., Plainsboro Township, NJ, USA. Plain language summary available for this article.
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Farmer A, Bobrow K, Leon N, Williams N, Phiri E, Namadingo H, Cooper S, Prince J, Crampin A, Besada D, Daviaud E, Yu LM, Ngoma J, Springer D, Pauly B, Norris S, Tarassenko L, Nyirenda M, Levitt N. Mobile Messaging Support Versus Usual Care for People With Type 2 Diabetes on Glycemic Control: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12377. [PMID: 31199346 PMCID: PMC6592392 DOI: 10.2196/12377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/09/2019] [Accepted: 03/25/2019] [Indexed: 01/29/2023] Open
Abstract
Background Health outcomes for people treated for type 2 diabetes could be substantially improved in sub-Saharan Africa. Failure to take medicine regularly to treat diabetes has been identified as a major problem. Resources to identify and support patients who are not making the best use of medicine in low- and middle-income settings are scarce. Mobile phones are widely available in these settings, including among people with diabetes; linked technologies, such as short message service (SMS) text messaging, have shown promise in delivering low-cost interventions efficiently. However, evidence showing that these interventions will work when carried out at a larger scale and measuring the extent to which they will improve health outcomes when added to usual care is limited. Objective The objective of this trial is to test the effectiveness of sending brief, automated SMS text messages for improving health outcomes and medication adherence in patients with type 2 diabetes compared to an active control. Methods We will carry out a randomized trial recruiting from clinics in two contrasting settings in sub-Saharan Africa: Cape Town, South Africa, and Lilongwe, Malawi. Intervention messages will advise people about the benefits of their diabetes treatment and offer motivation and encouragement around lifestyle and use of medication. We allocated patients, using randomization with a minimization algorithm, to receive either three to four intervention messages per week or non-health-related messages every 6 weeks. We will follow up with participants for 12 months, measuring important risk factors for poor health outcomes and complications in diabetes. This will enable us to estimate potential health benefits, including the primary outcome of hemoglobin A1c (HbA1c) levels as a marker for long-term blood glucose control and a secondary outcome of blood pressure control. We will record the costs of performing these activities and estimate cost-effectiveness. We will also use process evaluation to capture the collection of medication and assess the reception of the intervention by participants and health care workers. Results Recruitment to the trial began in September 2016 and follow-up of participants was completed in October 2018. Data collection from electronic health records and other routinely collected sources is continuing. The database lock is anticipated in June 2019, followed by analysis and disclosing of group allocation. Conclusions The knowledge gained from this study will have wide applications and advance the evidence base for effectiveness of mobile phone-based, brief text messaging on clinical outcomes and in large-scale, operational settings. It will provide evidence for cost-effectiveness and acceptability that will further inform policy development and decision making. We will work with a wide network that includes patients, clinicians, academics, industry, and policy makers to help us identify opportunities for informing people about the work and raise awareness of what is being developed and studied. Trial Registration ISRCTN Registry ISRCTN70768808; http://www.isrctn.com/ISRCTN70768808 (Archived by WebCite at http://www.webcitation.org/786316Zqk) International Registered Report Identifier (IRRID) DERR1-10.2196/12377
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Affiliation(s)
- Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Kirsty Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Natalie Leon
- South African Medical Research Council, Cape Town, South Africa
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Enita Phiri
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Hazel Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Sara Cooper
- South African Medical Research Council, Cape Town, South Africa
| | - John Prince
- Institute of Biomedical Engineering, Oxford, United Kingdom
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Donela Besada
- South African Medical Research Council, Cape Town, South Africa
| | | | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | | | - Bruno Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johanesburg, South Africa
| | - Shane Norris
- South African Medical Research Council, Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | | | - Moffat Nyirenda
- Malawi Epidemiology and Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
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Marshall AC, Damstra M, Tuley M, Schifando EL. Assessment of Taste and Grittiness of Riomet ® ER Strawberry, Riomet ® ER Grape, Riomet ® Cherry, and Metformin Immediate-Release Tablets in Healthy Subjects. Drugs R D 2019; 19:57-66. [PMID: 30649711 PMCID: PMC6380966 DOI: 10.1007/s40268-018-0260-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective This study was conducted to evaluate the taste and grittiness of two formulations of Riomet® ER (metformin hydrochloride for extended release [ER] oral suspension 100 mg/mL) differing only in their flavoring agents (strawberry and grape) in comparison with two commercially available immediate-release (IR) formulations of metformin, Riomet® Cherry (metformin hydrochloride oral solution 500 mg/5 mL) and metformin IR tablets (metformin hydrochloride IR tablets 500 mg), in healthy human subjects aged 10–70 years. Methods Five comparison sets (i.e., Riomet® Cherry vs. Riomet® ER Strawberry; Riomet® Cherry vs. Riomet® ER Grape; metformin IR vs. Riomet® ER Strawberry; metformin IR vs. Riomet® ER Grape; and Riomet® Cherry vs. metformin IR) were evaluated. Riomet® ER was reconstituted as instructed on the label. Metformin IR tablets were crushed one at a time into a fine powder using a pharmaceutical pill crusher and mixed with 5 mL of water. A 2.5-mL dose of each product was administered to each subject. Subjects were instructed not to swallow any of the products. Each product in the comparison set was rated by the subjects for taste and grittiness according to a 7-point hedonic facial scale and a 5-point level of agreement scale. A comparison questionnaire was also completed by the subjects after evaluating each set. In all, 56 subjects were enrolled and 55 subjects completed the study. The taste preference was statistically evaluated. Results and Conclusions All Riomet® formulations were significantly preferred overall to metformin IR crushed tablets. Both the strawberry and the grape flavors of Riomet® ER tended to be preferred to Riomet® Cherry. Electronic supplementary material The online version of this article (10.1007/s40268-018-0260-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allyson C Marshall
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA.
| | - Maureen Damstra
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA
| | - Michael Tuley
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA
| | - Elena L Schifando
- Sun Pharmaceuticals Industries, Inc., 2 Independence Way, Princeton, NJ, 08540, USA
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Nishimura R, Kato H, Kisanuki K, Oh A, Onishi Y, Guelfucci F, Shimasaki Y. Comparison of persistence and adherence between fixed-dose combinations and two-pill combinations in Japanese patients with type 2 diabetes. Curr Med Res Opin 2019; 35:869-878. [PMID: 30460858 DOI: 10.1080/03007995.2018.1551192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare treatment patterns, persistence and adherence between fixed-dose combinations (FDCs) and two-pill combinations (TPCs) of oral antidiabetic drug (OAD) classes in Japanese patients with type 2 diabetes mellitus (T2DM) using administrative claims databases (Japan Medical Data Center [JMDC] and Medical Data Vision [MDV]). METHODS This was a retrospective, longitudinal cohort analysis conducted between 2011 and 2015, in patients with T2DM receiving OADs as FDC or TPC. Outcomes included prescribing patterns, treatment persistence and adherence. RESULTS Data from 3474 and 3066 patients receiving FDCs, and 4325 and 5192 patients receiving TPCs from the JMDC and MDV databases, respectively, was extracted. The most common OAD combination received by over half of all patients was dipeptidyl peptidase-4 inhibitor (DPP-4i) + thiazolidinediones (TZDs) (64.1% [JMDC] and 70.5% [MDV]). Overall, 12-month persistence rates were higher in patients receiving FDCs compared with TPCs (70.4 vs. 66.2% [JMDC], 75.6 vs. 55.7% [MDV]). In the JMDC population receiving FDCs or TPCs, persistence rates were highest with DPP-4i schedules (67.5-83.5%). Median time to discontinuation was significantly longer with biguanide + TZD, and DPP-4i + TZD FDC schedules (p < .05) than TPC; adherence rates were ≥80% across all antidiabetic drug classes in both database populations. CONCLUSIONS Persistence with and adherence to OADs in Japanese patients with T2DM were greater with FDCs than with TPCs, which may suggest increased patient satisfaction due to reduced treatment burden. Further studies are warranted to investigate the impact of adherence and persistence of FDCs of OADs on glycemic control.
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Affiliation(s)
| | - Haruka Kato
- b Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Koichi Kisanuki
- b Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Akinori Oh
- b Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
| | - Yoshie Onishi
- c Creativ-Ceutical , Japan Operations , Tokyo , Japan
| | | | - Yukio Shimasaki
- b Japan Medical Affairs , Takeda Pharmaceutical Company Limited , Tokyo , Japan
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Morgan SA, Ali MM, Channon AA, Al-Sabahi S, Al Suwaidi H, Osman N, Al Salameen M, Khoja T. Prevalence and correlates of diabetes and its comorbidities in four Gulf Cooperation Council countries: evidence from the World Health Survey Plus. J Epidemiol Community Health 2019; 73:630-636. [PMID: 30894421 DOI: 10.1136/jech-2018-211187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/31/2019] [Accepted: 02/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Gulf Cooperation Council countries are witnessing unprecedented changes due to fast economic development and population growth. The aims of this study were twofold: first, to estimate the prevalence of diabetes and its comorbidities; second, to examine the association of sociodemographic risk factors and healthcare service utilisation with diabetes. METHODS Data from the World Health Survey Plus (WHS+) from Kuwait, Oman, Saudi Arabia and the United Arab Emirates were used. The WHS+ is a nationally representative household survey of the adult population, conducted between 2008 and 2009. Both logistic regression and zero-inflated Poisson models were applied to examine the associations of risk factors, comorbidity and treatment with self-reported diabetes. RESULTS The highest level of diabetes was observed in Kuwait, with 40.8% among the oldest age group. High body mass index, older age and low education were all associated with diabetes in all settings. High levels of comorbidity existed within the diabetic population. Over 50% of diabetics in all countries reported having at least one chronic condition. In Kuwait and Saudi Arabia, one in five diabetics reported having two or more comorbidities. Treatment prevalence was above 80% across all sociodemographic categories. CONCLUSION The burden of diabetes, although high, is not uniform across populations in the four Gulf countries. Differential exposure to risk, such as unhealthy lifestyles, may be creating a disadvantage for certain populations and influencing the co-occurrence of chronic conditions. In response, a multifaceted and patient-centred approach is needed at all levels of healthcare to control and prevent non-communicable diseases.
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Affiliation(s)
- Sara Afshar Morgan
- Primary Care and Population Health, University of Southampton, Southampton, UK
| | - Mohamed Mahmoud Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Andrew Amos Channon
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | - Huda Al Suwaidi
- Vulnerable Group Department, Community Development Authority, Dubai, United Arab Emirates
| | - Nabil Osman
- General Director for Health Statistics and Information, Ministry of Health, Riyadh, Saudi Arabia
| | - Mostafa Al Salameen
- Department of Health Registration, National Center of Health Information, Ministry of Health, Kuwait City, State of Kuwait, Kuwait
| | - Tawfik Khoja
- Department of Primary Care & Public Health, School of Public Health, Imperial College, London, UK
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Marušić S, Meliš P, Lucijanić M, Grgurević I, Turčić P, Neto PRO, Bilić-Ćurčić I. Impact of pharmacotherapeutic education on medication adherence and adverse outcomes in patients with type 2 diabetes mellitus: a prospective, randomized study. Croat Med J 2019. [PMID: 30610771 PMCID: PMC6330775 DOI: 10.3325/cmj.2018.59.290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM To evaluate the impact of pharmacotherapeutic education on 30-day post-discharge medication adherence and adverse outcomes in patients with type 2 diabetes mellitus (T2DM). METHODS The prospective, randomized, single-center study was conducted at the Medical Department of University Hospital Dubrava, Zagreb, between April and June 2018. One hundred and thirty adult patients with T2DM who were discharged to the community were randomly assigned to either the intervention or the control group. Both groups during the hospital stay received the usual diabetes education. The intervention group received additional individual pre-discharge pharmacotherapeutic education about the discharge prescriptions. Medication adherence and occurrence of adverse outcomes (adverse drug reactions, readmission, emergency department visits, and death) were assessed at the follow-up visit, 30 days after discharge. RESULTS The number of adherent patients was significantly higher in the intervention group (57/64 [89.9%] vs 41/61 [67.2%]; χ2 test, P=0.003]. There was no significant difference between the groups in the number of patients who experienced adverse outcomes (31/64 [48.4%] vs 36/61 [59.0%]; χ2 test, P=0.236). However, higher frequencies of all adverse outcomes were consistently observed in the control group. CONCLUSION Pharmacotherapeutic education of patients with T2DM can significantly improve 30-day post-discharge medication adherence, without a significant reduction in adverse clinical outcomes. ClinicalTrial.gov identification number: NCT03438162.
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Affiliation(s)
- Srećko Marušić
- Srećko Marušić, Medical Department, University Hospital Dubrava, Av. Gojka Šuška 6, 10000 Zagreb, Croatia,
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Alqarni AM, Alrahbeni T, Qarni AA, Qarni HMA. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia - a cross-sectional survey. Patient Prefer Adherence 2019; 13:63-71. [PMID: 30636871 PMCID: PMC6309134 DOI: 10.2147/ppa.s176355] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients' non-adherence to diabetes medication is associated with poor glycemic control and suboptimal benefits from their prescribed medication, which can lead to worsening of medical condition, development of comorbidities, reduced quality of life, elevated health care costs, and increased mortality. OBJECTIVE This study aimed to assess medication adherence among patients with diabetes and associated factors in Bisha primary health care centers (PHCCs) in Saudi Arabia. PATIENTS AND METHODS A cross-sectional study was conducted with a sample of 375 type 1 and 2 Saudi diabetic patients attending PHCCs under the Health Affairs of the Bisha governorate. The participants were aged 18 years and above, and had been taking diabetes medications for at least 3 months. Pregnant women, patients with mental illnesses, and those who were not willing to participate were excluded. Adherence to diabetes medications was measured using the four-item Morisky Green Levine Medication Adherence Scale (MGLS). All participants completed a self-report questionnaire including sociodemographic and clinical variables. Univariate and multivariate analyses were carried out using SPSS version 22. RESULTS Of all the respondents, 134 (35.7%), 161 (42.9%), and 80 (21.4%), patients had high (MGLS score 0), intermediate (MGLS score 1 or 2), and low adherence (MGLS score ≥3), respectively. Factors associated with the level of adherence in univariate analysis were occupational status (P=0.037), current medication (P<0.001), glycated hemoglobin (A1c) (P<0.001), and number of associated comorbidities (P<0.001). In multivariable analyses, A1c <7 (P<0.001) and no associated comorbidities (P<0.003) variables remained significantly associated with adherence. CONCLUSION The level of adherence to medication in diabetes mellitus patients in the Bisha PHCCs was found to be suboptimal. The findings point toward the need for better management of primary health care providers' approaches to individual patients, by taking into account their medication adherence levels. Better identification of patients' level of adherence remains essential for successful diabetes treatment.
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Affiliation(s)
- Abdullah M Alqarni
- Clinical Pharmacy Department, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia,
- Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh, Saudi Arabia,
| | - Tahani Alrahbeni
- Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh, Saudi Arabia,
| | - Ayidh Al Qarni
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Physical Therapy, King Abdullah Hospital, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia
| | - Hassan M Al Qarni
- Clinical Pharmacy Department, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia,
- Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh, Saudi Arabia,
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Abstract
IMPORTANCE Among adults with chronic illness, 30% to 50% of medications are not taken as prescribed. In the United States, it is estimated that medication nonadherence is associated with 125 000 deaths, 10% of hospitalizations, and $100 billion in health care services annually. OBSERVATIONS PubMed was searched from January 1, 2000, to September 6, 2018, for English-language randomized clinical trials of interventions to improve medication adherence. Trials of patients younger than 18 years, trials that used self-report as the primary adherence outcome, and trials with follow-up periods less than 6 months were excluded; 49 trials were included. The most common methods of identifying patients at risk for nonadherence were patient self-report, electronic drug monitors (pill bottles), or pharmacy claims data to measure gaps in supply. Patient self-report is the most practical method of identifying nonadherent patients in the context of clinical care but may overestimate adherence compared with objective methods such as electronic drug monitors and pharmacy claims data. Six categories of interventions, and characteristics of successful interventions within each category, were identified: patient education (eg, recurrent and personalized telephone counseling sessions with health educators); medication regimen management (using combination pills to reduce the number of pills patients take daily); clinical pharmacist consultation for chronic disease co-management (including education, increased frequency of disease monitoring via telephone or in-person follow-up visits, and refill reminders); cognitive behavioral therapies (such as motivational interviewing by trained counselors); medication-taking reminders (such as refill reminder calls or use of electronic drug monitors for real-time monitoring and reminding); and incentives to promote adherence (such as reducing co-payments and paying patients and clinicians for achieving disease management goals). The choice of intervention to promote adherence will depend on feasibility and availability within a practice or health system. Successful interventions that are also clinically practical include using combination pills to reduce daily pill burden, clinical pharmacist consultation for disease co-management, and medication-taking reminders such as telephone calls to prompt refills (maximum observed absolute improvements in adherence of 10%, 15%, and 33%, respectively). CONCLUSIONS AND RELEVANCE Adherence can be assessed and improved within the context of usual clinical care, but more intensive and costly interventions that have demonstrated success will require additional investments by health systems.
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Affiliation(s)
- Vinay Kini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | - P Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora
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Gatwood JD, Chisholm-Burns M, Davis R, Thomas F, Potukuchi P, Hung A, Kovesdy CP. Differences in health outcomes associated with initial adherence to oral antidiabetes medications among veterans with uncomplicated Type 2 diabetes: a 5-year survival analysis. Diabet Med 2018; 35:1571-1579. [PMID: 29978496 DOI: 10.1111/dme.13775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine the association of adherence to oral antidiabetes medication with macrovascular and microvascular complications, time to insulin therapy, revascularization, admissions, and death among veterans with uncomplicated diabetes. METHODS This was a retrospective cohort study using the Veterans Affairs Corporate Data Warehouse to examine 159 032 veterans diagnosed with uncomplicated diabetes during 2002-2014 and starting oral antidiabetes therapy for the first time. The first uncomplicated diabetes diagnosis was identified and confirmed by subsequent oral antidiabetes therapy initiation. Adherence was calculated from outpatient pharmacy records using the proportion of days covered over the first year of therapy. Health outcomes were observed up to 5 years beyond the first oral antidiabetes agent fill, and compared according to adherence status using Cox proportional hazards models adjusted for baseline demographic and clinical characteristics. RESULTS During the first 5 years of oral antidiabetes treatment, people initially non-adherent to oral antidiabetes therapy were more likely to experience myocardial infarction (hazard ratio 1.14, 95% CI 1.03-1.27) and ischaemic stroke (hazard ratio 1.22, 95% CI 1.05-0.1.42), or to die (hazard ratio 1.21; 95% CI 1.15-1.28). Veterans with <20% adherence to oral antidiabetes therapy in the first year had particularly high hazards for ischaemic stroke (hazard ratio 1.78, 95% CI 1.27-2.49) and all-cause death (hazard ratio 1.33, 95% CI 1.17-151). Adherent people were more likely to be diagnosed with a microvascular complication or chronic kidney disease. CONCLUSIONS People who are non-adherent to treatment were more likely to experience detrimental health outcomes within the first 5 years of antidiabetes therapy. Adherence is paramount to disease management and this should be stressed from the time at which treatment is initiated.
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Affiliation(s)
- J D Gatwood
- College of Pharmacy, University of Tennessee Health Science Centre, Memphis, TN, USA
| | - M Chisholm-Burns
- College of Pharmacy, University of Tennessee Health Science Centre, Memphis, TN, USA
| | - R Davis
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - F Thomas
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - P Potukuchi
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Memphis VA Medical Center, Memphis, TN, USA
| | - A Hung
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Nashville VA Medical Center, Nashville, TN, USA
| | - C P Kovesdy
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Memphis VA Medical Center, Memphis, TN, USA
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122
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Vluggen S, Hoving C, Schaper NC, de Vries H. A web-based program to improve treatment adherence in patients with type 2 diabetes: Development and study protocol. Contemp Clin Trials 2018; 74:38-45. [PMID: 30290275 DOI: 10.1016/j.cct.2018.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many patients with type 2 diabetes mellitus (T2DM) sub-optimally adhere to core treatment recommendations, such as healthy diets, sufficient physical activity and pharmacological support. This paper describes the development of the web-based computer-tailored program My Diabetes Profile (MDP), incorporating identified success factors of web-based interventions, and the protocol for testing the effectiveness of this program in a randomized multicentre trial. METHODS Formative research - including the input of a program committee, qualitative and quantitative studies with patients and health professionals and a literature search - yielded input for the development of the MDP program. MDP provides video and text tailored advice, based on determinants and salient beliefs derived from the I-Change Model, on decreasing unhealthy snack intake, increasing physical activity, and improving adherence to both oral blood glucose lowering drugs and self-administered insulin therapy. Patients with T2DM recruited by practice nurses and diabetes nurses across the Netherlands fill in online questionnaires at baseline and six-months follow-up. Participants are randomized on patient level to the intervention group (access to the MDP program) or control group (receiving care as usual). DISCUSSION The formative research using co-creation principles proved essential in the development of the MDP program and involved various disciplines in T2DM management including target group representatives. Co-creation revealed clearly that patients needed short and attractive messages. Consequently, a mix of video and short text messages were chosen for the ultimate program format. Pilot testing was useful to further shape the program to needs of patients and professionals. TRIAL REGISTRATION Dutch Trial Register NTR6840; Archived program website: http://www.webcitation.org/6xXz01S7X.
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Affiliation(s)
- S Vluggen
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - C Hoving
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - N C Schaper
- Department of Endocrinology and Internal Medicine, School CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
| | - H de Vries
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands.
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Alvarenga MA, Komatsu WR, de Sa JR, Chacra AR, Dib SA. Clinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from an upper-middle income country. Diabetol Metab Syndr 2018; 10:77. [PMID: 30386438 PMCID: PMC6206856 DOI: 10.1186/s13098-018-0382-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/25/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. It has been extensively studied the delay of the period to insulin introduction in type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate clinical inertia of insulin treatment intensification in a group of T2DM patients followed at a tertiary public Diabetes Center with limited pharmacologic armamentarium (Metformin, Sulphonylurea and Human Insulin). METHODS This is a real life retrospective record based study with T2DM patients. Demographic, clinical and laboratory characteristics were reviewed. Clinical inertia was considered when the patients did not achieve the individualized glycemic goals and there were no changes on insulin daily dose in the period. RESULTS We studied 323 T2DM patients on insulin therapy (plus Metformin and or Sulphonylurea) for a period of 2 years. The insulin daily dose did not change in the period and the glycated hemoglobin (A1c) ranged from 8.8 + 1.8% to 8.7 ± 1.7% (basal vs 1st year; ns) and to 8.5 ± 1.8% (basal vs 2nd year; p = 0.035). The clinical inertia prevalence was 65.8% (basal), 61.9% (after 1 year) and 58.2% (after 2 years; basal vs 1st year vs 2nd year; ns). In a subgroup of 100 patients, we also studied the first 2 years after insulin introduction. The insulin daily dose ranged from 0.22 ± 0.12 to 0.32 ± 0.24 IU/kg of body weight/day (basal vs 1st year; p < 0.001) and to 0.39 ± 0.26 IU/kg of body weight/day (basal vs 2nd year; p < 0.05). The A1c ranged from 9.6 + 2.1% to 8.6 + 2% (basal vs 1st year; p < 0.001) and to 8.7 + 1.7% (1st year vs 2nd year; ns). The clinical inertia prevalence was 78.5% (at the moment of insulin therapy introduction), 56.2% (after 1 year; p = 0.001) and 62.2% (after 2 years; ns). CONCLUSION Clinical inertia prevalence ranged from 56.2 to 78.5% at different moments of the insulin therapy (first 2 years and long term) of T2DM patients followed at a tertiary public Diabetes Center from an upper-middle income country with limited pharmacologic armamentarium.
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Affiliation(s)
- Marcelo Alves Alvarenga
- Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal University of São Paulo), Rua Estado de Israel, 639 Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
| | - William Ricardo Komatsu
- Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal University of São Paulo), Rua Estado de Israel, 639 Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
| | - Joao Roberto de Sa
- Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal University of São Paulo), Rua Estado de Israel, 639 Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
| | - Antonio Roberto Chacra
- Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal University of São Paulo), Rua Estado de Israel, 639 Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
| | - Sergio Atala Dib
- Department of Medicine, Endocrinology Division, Diabetes Center, UNIFESP (Federal University of São Paulo), Rua Estado de Israel, 639 Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
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Sapkota S, Brien JAE, Aslani P. Nepalese patients' anti-diabetic medication taking behaviour: an exploratory study. ETHNICITY & HEALTH 2018; 23:718-736. [PMID: 28277019 DOI: 10.1080/13557858.2017.1294659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore anti-diabetic medication taking behaviour in Nepalese patients with type 2 diabetes and investigate the factors impacting medication taking in this population. DESIGN Face-to-face interviews (n = 48) were conducted with Nepalese patients with type 2 diabetes in Sydney (Australia) and Kathmandu (Nepal). All interviews were audio-recorded, transcribed verbatim and thematically analysed. Participants' medication adherence was also assessed quantitatively using the summary of diabetes self-care activity (SDSCA) questionnaire. RESULTS The medication taking behaviour of Nepalese participants aligned with the Stages of Change Model, with some notable patterns of behaviour. Most participants initiated and implemented anti-diabetic medications soon after obtaining their prescription. However, a few, delayed initiation and/or ceased medications after initiation to recommence later. Nonetheless, upon recommencement, participants persisted fairly well with their medications. The self-reported medication adherence was high (97.3%). Although some participants expressed adherence as a challenge at the start of therapy, medication taking on a day-to-day basis was not reported as difficult. Factors such as participants' reluctance towards using medications and preference for natural methods of treatment, together with inadequate understanding about diabetes and treatment resulted in the delay in initiating therapy, and contributed to cessation of therapy. On the other hand, ooccasional non-adherence in daily medication taking was mostly related to inconsistency in meal practices and forgetfulness. Encouragement from doctors and increased awareness about the disease and treatment facilitated medication adherence, including initiation of therapy. CONCLUSION This study demonstrates that Nepalese patients are likely to delay or cease anti-diabetic medications until they fully accept and acknowledge the benefits and necessity of medications for effective diabetes management. Thus, educating patients about the need for medications, as well as implementing strategies to address patients' psychological resistance towards medications will be essential for effective medication management.
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Affiliation(s)
- Sujata Sapkota
- a Faculty of Pharmacy , The University of Sydney , Sydney , Australia
| | - Jo-Anne E Brien
- a Faculty of Pharmacy , The University of Sydney , Sydney , Australia
- b St. Vincent's Hospital Clinical School , UNSW , Sydney , Australia
| | - Parisa Aslani
- a Faculty of Pharmacy , The University of Sydney , Sydney , Australia
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Pawaskar MD, Xu L, Tang Y, Puckrein GA, Rajpathak SN, Stuart B. Effect of Medication Copayment on Adherence and Discontinuation in Medicare Beneficiaries with Type 2 Diabetes: A Retrospective Administrative Claims Database Analysis. Diabetes Ther 2018; 9:1979-1993. [PMID: 30143964 PMCID: PMC6167308 DOI: 10.1007/s13300-018-0489-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Nonadherence to antihyperglycemic agents (AHAs) increases the incidence of morbidity and mortality, as well as healthcare-related costs, in patients with type 2 diabetes (T2D). This study examined the association between medication copayment and adherence and discontinuation among elderly patients with T2D who use generic versus branded AHAs. METHODS A retrospective, observational cohort study used Medicare administrative claims data (index period: 1 June 2012 to 31 December 2013). Drug copayments were measured as the copayment of the index medication for a 30-day supply after patients met their plan deductible. Patients were stratified into a branded or generic cohort based on the index medication. Adherence was measured by the proportion of days covered (≥ 80%) and discontinuation by a treatment gap of > 60 days in 10 months during the follow-up period. Poisson regressions were conducted for medication adherence and discontinuation, while controlling for demographic, clinical, and comorbid conditions. RESULTS Overall, 160,250 patients on AHA monotherapy were included in the analysis; 131,594 (82%) were prescribed a generic and 28,656 (18%) a branded AHA with a mean copay of $6 and $41, respectively. Increases in copayment increased nonadherence and discontinuation for branded medications but not for generic AHA medications. In both cohorts, elderly patients (≥ 75 years of age) had a lower risk of nonadherence and discontinuation. Black patients had a higher risk of nonadherence or discontinuing medication. Patients having more frequent inpatient, emergency room, and/or physician visits were at higher risk of nonadherence or discontinuing therapy in the branded and generic cohorts (P < 0.001). CONCLUSION The impact of drug copayment on adherence and discontinuation varied considerably between branded and generic AHAs. Medicare patients taking branded AHAs had a higher risk of nonadherence with increasing copayment and were more likely to discontinue medication, whereas this association was not observed in patients taking generic medications. FUNDING Merck & Co, Inc., Kenilworth, NJ, USA. Plain language summary available for this article.
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Affiliation(s)
| | - Liou Xu
- National Minority Quality Forums, Washington, DC, USA
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126
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Joiner KL, Holland ML, Grey M. Stressful Life Events in Young Adults With Type 1 Diabetes in the U.S. T1D Exchange Clinic Registry. J Nurs Scholarsh 2018; 50:676-686. [PMID: 30246919 DOI: 10.1111/jnu.12428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose was to test associations among stressful life events, frequency of missed insulin doses, and glycemic control in young adults with type 1 diabetes (T1D). DESIGN The study was a cross-sectional descriptive secondary analysis. METHODS Data from 2,921 participants (ages 18-26 years) in the U.S. T1D Exchange Clinic Registry were analyzed. Report of a stressful life event was defined as one or more positive responses on a 17-item stressful life events index and defined as a dichotomous variable (yes or no). Frequency of missed insulin doses was measured using a single self-report item and collapsed into two levels (fewer than three times a week, three or more times a week). The glycosylated hemoglobin (A1c) level recorded at the time of enrollment was used to assess glycemic control. FINDINGS Nearly half (48.6%) of the participants reported having a stressful life event during the previous year. The most frequently reported stressful life events were problems at work or school (16.1%), serious arguments with family members or a close friend (15.2%), and financial problems in the family (13.8%). Compared to the participants not reporting stressful life events, those who reported stressful life events were more likely to be older, female, with a higher educational attainment level, and not working or unemployed. Those who reported a stressful life event were more likely than those who did not to say they typically missed insulin doses at least three times a week and less likely to say they typically missed insulin doses fewer than three times a week (p < .001 adjusted for age, sex, race or ethnicity, educational attainment level, duration of T1D diagnosis, and insulin delivery method). Mean A1c level was higher for the group who reported having a stressful life event in the past 12 months compared to the group who did not (8.7 ± 1.8% vs. 8.2 ± 1.6%; adjusted p < .001). The results of a mediation analysis suggest that the measure of frequency of missed insulin doses may be a mediator of the relationship between recent stressful life events and glycemic control (Sobel test: ab = .841, 95% confidence interval = 0.064-1.618). CONCLUSIONS These findings suggest that, for young adults with T1D, the experience of stressful life events may increase their risk for poorer glycemic control, possibly by disrupting adherence with insulin doses. CLINICAL RELEVANCE Further exploration of these relationships may allow for the potential for identifying those at risk and assisting them with more positive approaches to managing stressful events.
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Affiliation(s)
- Kevin L Joiner
- Rho, Research Fellow, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Margaret L Holland
- Associate Research Scientist in Nursing, Yale University School of Nursing, Orange, CT, USA
| | - Margaret Grey
- Delta Mu , Annie Goodrich Professor of Nursing, Yale University School of Nursing, Orange, CT, USA
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Nichols GA, Raebel MA, Dyer W, Schmittdiel JA. The Effect of Age and Comorbidities on the Association Between the Medicare STAR Oral Antihyperglycemic Adherence Metric and Glycemic Control. J Manag Care Spec Pharm 2018; 24:856-861. [PMID: 30156449 PMCID: PMC10398005 DOI: 10.18553/jmcp.2018.24.9.856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Medicare STAR program for Medicare Advantage Plans that include drug benefits provides monetary incentives for health plans to achieve good adherence to oral antihyperglycemic (OAH) agents but does not account for differential case mix that could affect the ability of health plans to achieve the required quality metrics. OBJECTIVE To determine whether OAH adherence varies by age and comorbidities among patients aged 65 years or older and the extent to which adherence affects glycemic control across age and comorbidity strata. METHODS We studied 54,480 patients with diabetes aged > 65 years from the Colorado, Northwest, and Northern California regions of Kaiser Permanente who received OAH agents but not insulin in 2010. We calculated adherence using the proportion of days covered (PDC) method. Per the STAR program, hemoglobin A1c < 8% defined good glycemic control. We also defined poor control as A1c > 9%. We used modified Poisson regression to identify predictors of adherence and to determine its effects on A1c across age and comorbidity strata, adjusting for sociodemographics and medication-related variables. RESULTS The risk of being adherent to OAH declined moderately with an increasing number of comorbidities (risk ratio [RR] = 0.99, 95% CI = 0.98-1.00 for 1 comorbidity and RR = 0.90, 95% CI = 0.88-0.91 for 4 or more comorbidities). Adherence to OAH agents was associated with a 0%-3% increased risk of A1c < 8% across age and comorbidity categories, as well as a large decreased risk (RR = 0.55-0.73) of A1c > 9% for patients aged < 80 years or with < 3 comorbidities. CONCLUSIONS Among patients with diabetes aged > 65 years, having multiple comorbidities affects adherence. Adherence reduces the risk of poor A1c control among patients aged 65-79 years or with 2 or fewer comorbidities. Our results suggest that health plan case mix minimally influenced the Medicare STAR OAH adherence metric, but it may affect glycemic control quality measures, especially if a HEDIS-like measure of poor control were adopted. DISCLOSURES This study was supported by grant number 1R21DK103146-01A1 from the National Institute of Diabetes and Digestive and Kidney Disorders. Nichols currently receives grant funding from Boehringer-Ingelheim, Sanofi, Amarin Pharma, and Janssen Pharmaceuticals for other unrelated research projects. The other authors declare no conflicts of interest. This study was presented at the American Diabetes Association's 77th Scientific Sessions; June 9-13, 2017; San Diego, CA.
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Affiliation(s)
- Gregory A Nichols
- 1 Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Marsha A Raebel
- 2 Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Wendy Dyer
- 3 Kaiser Permanente Northern California Division of Research, Oakland
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Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65,067 newly diagnosed type 2 diabetes patients. Sci Rep 2018; 8:12190. [PMID: 30111867 PMCID: PMC6093904 DOI: 10.1038/s41598-018-30740-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 08/02/2018] [Indexed: 01/16/2023] Open
Abstract
This study determined the effects of anti-diabetic medication adherence on the long-term all-cause mortality and hospitalization for cerebrovascular disease and myocardial infarction among newly diagnosed patients. The study used retrospective cohort from the National Health Insurance Service. Study participants were 65,076 newly diagnosed type 2 diabetes mellitus patients aged ≥40 years. The medication adherence was evaluated from the proportion of days covered (PDC) between 2006 and 2007. Outcome variables were mortality, newly diagnosed cerebrovascular disease (CVD) and myocardial infarction (MI) in 2008–2017. Cox-proportional hazard regression analysis was performed. After adjusting for sex, age, monthly contribution, insurance type, medical institution type, Charlson comorbidity index score, disability, hypertension, and active ingredients of oral hypoglycemic agents, the adjusted hazard ratio (aHR) for all-cause-mortality of the lowest PDC group (<0.20) was 1.45 (95% confidence interval [CI] = 1.36–1.54) as compared to the highest PDC (≥0.8). The aHR for all-cause-mortality associated with PDC levels of 0.60–0.79, 0.40–0.59, and 0.20–0.39 were 1.19, 1.26, and 1.34, respectively (Ptrend < 0.001). Compared to the highest PDC group, diabetic patients with the lowest PDC had elevated risk for CVD (aHR = 1.41; 95% CI = 1.30–1.52; Ptrend < 0.001). Improving anti-diabetic medication adherence among newly diagnosed type 2 diabetes mellitus patients is essential to the reduce risk for cardiovascular disease and long-term all-cause mortality.
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Wang X, Li X, Qie S, Zheng Y, Liu Y, Liu G. The efficacy and safety of once-weekly DPP-4 inhibitor omarigliptin in patients with type 2 diabetes mellitus: A systemic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11946. [PMID: 30142816 PMCID: PMC6112932 DOI: 10.1097/md.0000000000011946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The efficacy and safety of once-weekly dipeptidyl peptidase-4 inhibitor (DPP-4i) omarigliptin as monotherapy or add on to other antihyperglycemic agents (AHAs) in patients with type 2 diabetes mellitus (T2DM) is unclear. METHODS PubMed, EMBASE, Cochrane library, and ClinicalTrials.gov were searched from the inception to January 24, 2018. Randomized controlled trials comparing omarigliptin with placebo or other AHAs in T2DM patients were included in our meta-analysis. Risk ratio (RR) and mean difference (MD) were used to evaluate the outcomes. RESULTS Totally, 11 trials involving 8276 patients were satisfied with our inclusion criteria. Compared with control group, omarigliptin was associated with a significantly stronger reduction in hemoglobin A1c (HbA1c) (MD 0.38%, 95% confidence interval [CI] [0.18, 0.58], P = .0002) and fasting plasma glucose (MD 0.48 mmol/L, 95% CI [0.14 mmol/L, 0.82 mmol/L], P = .006). Omarigliptin increased the number of participants who achieved HbA1c < 7.0% compared with control group (RR 2.03, 95% CI [1.38, 2.98], P = .0003). No significant difference was found in the aspect of adverse events (RR 1.00, 95% CI [0.97, 1.03], P = .99), serious adverse events (RR 1.02, 95% CI [0.91, 1.13], P = .75), hypoglycemic events (RR 0.86, 95% CI [0.48, 1.54], P = .61) between omarigliptin and control group. Omarigliptin has a homologous efficacy and safety background to other AHAs according to the results of subgroup analysis. CONCLUSIONS This review revealed that omarigliptin had a favorable efficacy and safety as monotherapy or add on to other AHAs in treating T2DM patients. It is a superior choice for T2DM patients who have a poor adherence to daily AHAs.
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130
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Kunasegaran S, Beig J, Khanolkar M, Cundy T. Adherence to medication, glycaemic control and hospital attendance in young adults with type 2 diabetes. Intern Med J 2018; 48:728-731. [DOI: 10.1111/imj.13808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/07/2018] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shalini Kunasegaran
- Department of Diabetes; Greenlane Clinical Centre, Auckland Diabetes Centre; Auckland New Zealand
| | - Junaid Beig
- Department of Diabetes; Greenlane Clinical Centre, Auckland Diabetes Centre; Auckland New Zealand
| | - Manish Khanolkar
- Department of Diabetes; Greenlane Clinical Centre, Auckland Diabetes Centre; Auckland New Zealand
| | - Tim Cundy
- Department of Diabetes; Greenlane Clinical Centre, Auckland Diabetes Centre; Auckland New Zealand
- Department of Medicine, FMHS; University of Auckland; Auckland New Zealand
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Perez-Nieves M, Boye KS, Kiljanski J, Cao D, Lage MJ. Adherence to Basal Insulin Therapy Among People with Type 2 Diabetes: A Retrospective Cohort Study of Costs and Patient Outcomes. Diabetes Ther 2018; 9:1099-1111. [PMID: 29644618 PMCID: PMC5984924 DOI: 10.1007/s13300-018-0421-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION This research compares costs, resource utilization, and complications between adherent and nonadherent patients over the 3-year period post initiation on basal insulin therapy. METHODS The study utilized the US-based Truven Health MarketScan® Research Databases from 2011 through 2015. Adults aged 18 years or older and identified with type 2 diabetes (T2D) who initiated therapy on basal insulin in 2012 were included. Patients were excluded if they were pregnant, filled their index basal insulin prescription via mail order, or were not continuously insured from 1 year before through 3 years following initiation of treatment with basal insulin. Instrumental variables were used to control for selection bias, and multivariable analyses were used to examine the associations between adherence to basal insulin therapy and costs, resource utilization, and acute complications. RESULTS A total of 21,363 individuals were included in the study. Three years after initiating therapy on basal insulin, patients who were adherent over time to basal insulin treatment therapy (33.8% of patients) had significantly higher diabetes-related drug costs. However, patients' adherence was associated with significantly lower diabetes-related outpatient, acute care, and total costs. Results for all-cause costs were similar. Adherent patients also had significantly fewer all-cause and diabetes-related hospitalizations and emergency room visits and were significantly less likely to be diagnosed with an acute complication. CONCLUSIONS Results of this study illustrate that despite higher drug costs, there are disease-specific and all-cause cost offsets and improved patient outcomes associated with adherence to basal insulin therapy for people with T2D. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | | | - Dachung Cao
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Maureen J Lage
- HealthMetrics Outcomes Research, LLC, Bonita Springs, FL, USA.
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Sun Q, Zhang Z, Zhang R, Gao R, McClements DJ. Development of Functional or Medical Foods for Oral Administration of Insulin for Diabetes Treatment: Gastroprotective Edible Microgels. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2018; 66:4820-4826. [PMID: 29701967 DOI: 10.1021/acs.jafc.8b00233] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Insulin and an antacid [Mg(OH)2] were co-encapsulated inside calcium alginate microgels (diameter = 280 μm) using a vibrating nozzle injector. Confocal microscopy indicated that insulin was successfully encapsulated inside the microgels and remained inside them after they were exposed to simulated gastric conditions. Localized fluorescence intensity measurements indicated that the internal pH of the antacid-loaded microgels was around pH 7.4 after incubation in acidic gastric fluids but below the limit of detection (pH < 4) in the antacid-free microgels. After incubation in small intestine conditions, around 30% of the insulin was released from the antacid-loaded microgels over a 2 h period. Encapsulation of insulin within the antacid-loaded microgels increased its biological activity after exposure to simulated gastric conditions. In particular, the encapsulated insulin significantly increased Akt phosphorylation at both Thr308 and Ser473 in L6 myotubes when compared to free insulin.
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Affiliation(s)
- Quancai Sun
- School of Food and Biological Engineering , Jiangsu University , Zhenjiang , Jiangsu 212001 , People's Republic of China
| | - Zipei Zhang
- Department of Food Science , University of Massachusetts Amherst , Amherst , Massachusetts 01003 , United States
| | - Ruojie Zhang
- Department of Food Science , University of Massachusetts Amherst , Amherst , Massachusetts 01003 , United States
| | - Ruichang Gao
- School of Food and Biological Engineering , Jiangsu University , Zhenjiang , Jiangsu 212001 , People's Republic of China
| | - David Julian McClements
- Department of Food Science , University of Massachusetts Amherst , Amherst , Massachusetts 01003 , United States
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Giorgino F, Penfornis A, Pechtner V, Gentilella R, Corcos A. Adherence to antihyperglycemic medications and glucagon-like peptide 1-receptor agonists in type 2 diabetes: clinical consequences and strategies for improvement. Patient Prefer Adherence 2018; 12:707-719. [PMID: 29765207 PMCID: PMC5944456 DOI: 10.2147/ppa.s151736] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adherence to antihyperglycemic medications is often suboptimal in patients with type 2 diabetes, and this can contribute to poor glycemic control, increased hospitalization, and the development of diabetic complications. Reported adherence rates to antihyperglycemics vary widely among studies, and this may be related to differences in methodology for measuring adherence, patient populations, and other factors. Poor adherence may occur regardless of the specific regimen used and whether therapy is oral or injectable, and can be especially common in chronic, asymptomatic conditions, such as type 2 diabetes. More convenient drug-administration regimens and advances in formulations and delivery devices are among strategies shown to improve adherence to antihyperglycemic therapy, especially for injectable therapy. This is exemplified by technological developments made in the drug class of glucagon-like peptide 1-receptor agonists, which are a focus of this narrative review. Dulaglutide, albiglutide, and prolonged-release exenatide have an extended duration of action and can be administered once weekly, whereas such agents as liraglutide require once-daily administration. The convenience of once-weekly versus once-daily administration is associated with better adherence in real-world studies involving this class of agent. Moreover, provision of a user-friendly delivery device has been shown to overcome initial resistance to injectable therapy among patients with type 2 diabetes. This suggests that recent innovations in drug formulation (eg, ready-to-use formulations) and delivery systems (eg, single-dose prefilled pens and hidden, ready-attached needles) may be instrumental in encouraging patient acceptance. For physicians who aim to improve their patients' adherence to antihyperglycemic medications, it is thus important to consider the patient's therapeutic experience (treatment frequency, drug formulation, delivery device). Better adherence, powered by recent technological advances in the delivery of glucagon-like peptide 1-receptor agonists, may thus lead to improved clinical outcomes in type 2 diabetes.
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Affiliation(s)
- Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Alfred Penfornis
- Service d’Endocrinologie, Diabétologie, et Maladies Métaboliques, Centre Hospitalier Sud-Francilien de Corbeil-Essonnes, Université Paris-Sud, Orsay, France
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McGovern A, Tippu Z, Hinton W, Munro N, Whyte M, de Lusignan S. Comparison of medication adherence and persistence in type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2018; 20:1040-1043. [PMID: 29135080 DOI: 10.1111/dom.13160] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
Abstract
Limited medication adherence and persistence with treatment are barriers to successful management of type 2 diabetes (T2D). We searched MEDLINE, EMBASE, the Cochrane Library, the Register of Controlled Trials, PsychINFO and CINAHL for observational and interventional studies that compared the adherence or persistence associated with 2 or more glucose-lowering medications in people with T2D. Where 5 or more studies provided the same comparison, a random-effects meta-analysis was performed, reporting mean difference (MD) or odds ratio (OR) for adherence or persistence, depending on the pooled study outcomes. We included a total of 48 studies. Compared with metformin, adherence (%) was better for sulphonylureas (5 studies; MD 10.6%, 95% confidence interval [CI] 6.5-14.7) and thiazolidinediones (TZDs; 6 studies; MD 11.3%, 95% CI 2.7%-20.0%). Adherence to TZDs was marginally better than adherence to sulphonylureas (5 studies; MD 1.5%, 95% CI 0.1-2.9). Dipeptidyl peptidase-4 inhibitors had better adherence than sulphonylureas and TZDs. Glucagon-like peptide-1 receptor agonists had higher rates of discontinuation than long-acting analogue insulins (6 studies; OR 1.95; 95% CI 1.17-3.27). Long-acting insulin analogues had better persistence than human insulins (5 studies; MD 43.1 days; 95% CI 22.0-64.2). The methods used to define adherence and persistence were highly variable.
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Affiliation(s)
- Andrew McGovern
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Zayd Tippu
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - William Hinton
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Neil Munro
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Martin Whyte
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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135
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Inagaki N, Sano H, Seki Y, Kuroda S, Kaku K. Efficacy and safety of once-weekly oral trelagliptin switched from once-daily dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes mellitus: An open-label, phase 3 exploratory study. J Diabetes Investig 2018; 9:354-359. [PMID: 28836351 PMCID: PMC5835476 DOI: 10.1111/jdi.12730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/25/2017] [Accepted: 08/13/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Trelagliptin, a novel once-weekly oral dipeptidyl peptidase-4 (DPP-4) inhibitor, has shown favorable efficacy and safety in type 2 diabetes mellitus patients. Trelagliptin was launched in Japan, and is expected to be initially used for switchover from a daily DPP-4 inhibitor in the clinical setting. Thus, the present study was carried out to explore the efficacy and safety of trelagliptin after a daily DPP-4 inhibitor was switched to it. MATERIALS AND METHODS This was an open-label, phase 3 exploratory study to evaluate the efficacy and safety of trelagliptin in Japanese type 2 diabetes mellitus patients who had stable glycemic control on once-daily sitagliptin therapy. Eligible patients received trelagliptin 100 mg orally before breakfast once a week for 12 weeks. The primary end-point was blood glucose by the meal tolerance test, and additional end-points were glycemic control (efficacy) and safety. RESULTS Altogether, 14 patients received the study drug. The blood glucose did not markedly change from baseline at major assessment points in the meal tolerance test, and a decrease in blood glucose was observed at several other assessment points. Adverse events were reported in 42.9% (6/14) of patients, but all adverse events were mild or moderate in severity, and most were not related to the study drug. No cases of death, serious adverse events or hypoglycemia were reported. DISCUSSION It is considered possible to switch a once-daily DPP-4 inhibitor to trelagliptin in type 2 diabetes mellitus patients with stable glycemic control in combination with diet and exercise therapy without any major influences on glycemic control or safety.
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Affiliation(s)
- Nobuya Inagaki
- Department of Diabetes, Endocrinology and NutritionKyoto University Graduate School of MedicineKyotoJapan
| | - Hiroki Sano
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
| | - Yoshifumi Seki
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
| | - Shingo Kuroda
- Takeda Development Center JapanTakeda Pharmaceutical Company LimitedOsakaJapan
| | - Kohei Kaku
- Department of Internal MedicineKawasaki Medical SchoolOkayamaJapan
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Henry R, Rosenstock J, McCarthy JF, Carls G, Alessi T, Yee J, Baron M. Treatment satisfaction with ITCA 650, a novel drug-device delivering continuous exenatide, versus twice-daily injections of exenatide in type 2 diabetics using metformin. Diabetes Obes Metab 2018; 20:638-645. [PMID: 29053202 DOI: 10.1111/dom.13133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/29/2017] [Accepted: 10/09/2017] [Indexed: 01/28/2023]
Abstract
AIMS To evaluate treatment satisfaction in patients with type 2 diabetes (T2D) not adequately controlled by metformin, randomized to ITCA 650 (continuous exenatide in osmotic mini-pump) vs twice-daily exenatide injections (Ex-BID). MATERIALS AND METHODS The Diabetes Medication Satisfaction Tool (DM-SAT) was administered and assessments were made at baseline, Week 8 and Week 20 during a 24-week open-label phase 2 trial. In Stage I (Weeks 1-12), 155 patients, comprising the ITT population, were randomized to 3 groups: ITCA 650 20 μg/day, ITCA 650 40 μg/day and Ex-BID 10 μg BID. In Stage II (Weeks 13-24), ITCA 650 groups were re-randomized to either remain on the Stage I dose or receive a higher dose. Patients treated with Ex-BID were randomized to 40 or 60 μg/day ITCA 650. RESULTS Patients using ITCA 650 reported significant increases in overall treatment satisfaction by Week 8 vs those using Ex-BID (P < .01), despite similar clinical efficacy and overall rates of nausea. During Stage II, further improvement in HbA1c and weight were seen after 3-fold dose escalation of ITCA 650 and treatment satisfaction was maintained. When patients using Ex-BID were switched to ITCA 650, treatment satisfaction increased and reached levels similar to those initially treated with ITCA 650. Neither GI side effects of nausea and/or vomiting, nor the procedure to sub-dermally place ITCA 650, significantly impacted treatment satisfaction scores. CONCLUSION ITCA 650 added to metformin for patients with T2D, and for those who switched to ITCA 650 from Ex-BID, meaningfully improved glucose control and significantly increased overall treatment satisfaction.
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Affiliation(s)
- Robert Henry
- Division of Endocrinology and Metabolism, Department of Medicine, University of California at San Diego, La Jolla, California
| | | | - John F McCarthy
- Intarcia Therapeutics, Inc., Boston, Massachusetts and Hayward, Hayward, California
| | | | - Tom Alessi
- Intarcia Therapeutics, Inc., Boston, Massachusetts and Hayward, Hayward, California
| | - John Yee
- Intarcia Therapeutics, Inc., Boston, Massachusetts and Hayward, Hayward, California
| | - Michelle Baron
- Intarcia Therapeutics, Inc., Boston, Massachusetts and Hayward, Hayward, California
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137
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Kopp C, Linz P, Maier C, Wabel P, Hammon M, Nagel AM, Rosenhauer D, Horn S, Uder M, Luft FC, Titze J, Dahlmann A. Elevated tissue sodium deposition in patients with type 2 diabetes on hemodialysis detected by 23Na magnetic resonance imaging. Kidney Int 2018; 93:1191-1197. [PMID: 29455909 DOI: 10.1016/j.kint.2017.11.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 12/25/2022]
Abstract
Long-term elevated blood sugar levels result in tissue matrix compositional changes in patients with diabetes mellitus type 2 (T2DM). We hypothesized that hemodialysis patients with T2DM might accumulate more tissue sodium than control hemodialysis patients. To test this, 23Na magnetic resonance imaging (23Na MRI) was used to estimate sodium in skin and muscle tissue in hemodialysis patients with or without T2DM. Muscle fat content was estimated by 1H MRI and tissue sodium content by 23Na MRI pre- and post-hemodialysis in ten hemodialysis patients with T2DM and in 30 matched control hemodialysis patients. We also assessed body fluid distribution with the Body Composition Monitor. 1H MRI indicated a tendency to higher muscle fat content in hemodialysis patients with T2DM compared to non-diabetic hemodialysis patients. 23Na MRI indicated increased sodium content in muscle and skin tissue of hemodialysis patients with T2DM compared to control hemodialysis patients. Multi-frequency bioimpedance was used to estimate extracellular water (ECW), and excess ECW in T2DM hemodialysis patients correlated with HbA1c levels. Sodium mobilization during hemodialysis lowered muscle sodium content post-dialysis to a greater degree in T2DM hemodialysis patients than in control hemodialysis patients. Thus, our findings provide evidence that increased sodium accumulation occurs in hemodialysis patients with T2DM and that impaired serum glucose metabolism is associated with disturbances in tissue sodium and water content.
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Affiliation(s)
- Christoph Kopp
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
| | - Peter Linz
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin Maier
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Wabel
- Fresenius Medical Care, Bad Homburg, Germany
| | - Matthias Hammon
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Daniela Rosenhauer
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich C Luft
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany; Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jens Titze
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Anke Dahlmann
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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138
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Sarayani A, Mashayekhi M, Nosrati M, Jahangard-Rafsanjani Z, Javadi M, Saadat N, Najafi S, Gholami K. Efficacy of a telephone-based intervention among patients with type-2 diabetes; a randomized controlled trial in pharmacy practice. Int J Clin Pharm 2018; 40:345-353. [PMID: 29435911 DOI: 10.1007/s11096-018-0593-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/16/2018] [Indexed: 12/21/2022]
Abstract
Background Pharmacists' interventions to improve outcomes of diabetes management have been promising. However, evidence on using telephone-based interventions in pharmacy practice are limited, particularly in developing countries. Objective To evaluate the efficacy of a telephone-based intervention to improve care and clinical outcomes in type-2 diabetes. Setting A referral community pharmacy and drug information center. Method We conducted a two-armed randomized controlled trial on 100 patients with type-2 diabetes. The intervention consisted of 16 telephone calls in 3 month by a trained pharmacist working in an academic drug information center, while the control group received usual care. Before random allocation, patients attended a live education session delivered by pharmacists to learn the basics of diabetes care and to confirm the eligibility criteria. Assessments were performed at baseline, month-3 (after intervention), and month-9 (follow-up). Main outcome measure Hemoglobin A1c (HbA1c). Results Eighty four patient completed the trial. Baseline variables were comparable between the two groups and the baseline value of hemoglobin A1c was 8.00 ± 1.44 in the study population. HbA1c was significantly improved in both groups at month-3 (6.97 ± 1.41 vs. 7.09 ± 1.78) and remained steady at month-9 (6.96 ± 1.44 vs. 7.26 ± 1.85). Lipid profile showed small improvements in the intervention group but was not significant. The adherence score and self-care score improvement was significantly higher in the intervention group at month-3 and were maintained at month-9. Conclusion Medication adherence and self-care significantly improved in the telephone-based intervention group. However, the improvement of clinical outcomes might have been diluted due to the live diabetes education session.
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Affiliation(s)
- Amir Sarayani
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Mojgan Mashayekhi
- Community Pharmacies, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nosrati
- Community Pharmacies, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Jahangard-Rafsanjani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Javadi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.,Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Saadat
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sheyda Najafi
- Community Pharmacies, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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139
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Buysman EK, Sikirica MV, Thayer SW, Bogart M, DuCharme MC, Joshi AV. Real-world comparison of treatment patterns and effectiveness of albiglutide and liraglutide. J Comp Eff Res 2018; 7:89-100. [DOI: 10.2217/cer-2017-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare medication adherence, discontinuation and glycemic control in patients receiving albiglutide versus liraglutide. Patients & methods: Administrative claims data and glycated hemoglobin (HbA1c) results were analyzed from a sample of adult health plan members with Type 2 diabetes. Results: Patients were matched 1:1 in the albiglutide (n = 2213) and liraglutide (n = 2213) overall cohorts and in 244 patients with HbA1c results from each treatment group. Mean HbA1c change from baseline was −1.0% for both groups. At 6 months, mean ± standard deviation adherence was 0.69 ± 0.29 versus 0.64 ± 0.29 (p < 0.001), and discontinuation was 33.2 versus 37.8% (p = 0.002) with albiglutide versus liraglutide, but these were not statistically or clinically different at 12 months. Conclusion: Similar treatment patterns and clinically meaningful reductions in HbA1c were observed for both treatments in this real-world comparison.
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140
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VanEpps EM, Troxel AB, Villamil E, Saulsgiver KA, Zhu J, Chin JY, Matson J, Anarella J, Roohan P, Gesten F, Volpp KG. Financial Incentives for Chronic Disease Management: Results and Limitations of 2 Randomized Clinical Trials With New York Medicaid Patients. Am J Health Promot 2018; 32:1537-1543. [PMID: 29390862 DOI: 10.1177/0890117117753986] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To identify whether financial incentives promote improved disease management in Medicaid recipients diagnosed with hypertension or diabetes, respectively. DESIGN Four-group, multicenter, randomized clinical trials. SETTING AND PARTICIPANTS Between 2013 and 2016, New York State Medicaid managed care members diagnosed with hypertension (N = 920) or with diabetes (N = 959). INTERVENTION Participants in each 6-month trial were randomly assigned to 1 of 4 arms: (1) process incentives-earned by attending primary care visits and/or receiving prescription medication refills, (2) outcome incentives-earned by reducing systolic blood pressure (hypertension) or hemoglobin A1c (HbA1c; diabetes) levels, (3) combined process and outcome incentives, and (4) control (no incentives). MEASURES Systolic blood pressure (hypertension) and HbA1c (diabetes) levels, primary care visits, and medication prescription refills. Analysis and Results: At 6 months, there were no statistically significant differences between intervention arms and the control arm in the change in systolic blood pressure, P = .531. Similarly, there were no significant differences in blood glucose control (HbA1c) between the intervention arms and control after 6 months, P = .939. The majority of participants had acceptable systolic blood pressure (<140 mm Hg) or blood glucose (<8.0%) levels at baseline and throughout the study. CONCLUSION Financial incentives-regardless of whether they were delivered based on disease-relevant outcomes, process activities, or a combination of the two-have a negligible impact on health outcomes for Medicaid recipients diagnosed with either hypertension or diabetes in 2 studies in which, among other design and operational limitations, the majority of recipients had relatively well-controlled diseases at the time of enrollment.
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Affiliation(s)
- Eric M VanEpps
- 1 David Eccles School of Business, University of Utah, Salt Lake City, UT, USA
| | - Andrea B Troxel
- 2 Department of Population Health, New York University School of Medicine, New York, NY, USA
| | | | - Kathryn A Saulsgiver
- 4 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,5 Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jingsan Zhu
- 4 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jo-Yu Chin
- 3 New York State Department of Health, Albany, NY, USA
| | | | | | | | - Foster Gesten
- 3 New York State Department of Health, Albany, NY, USA
| | - Kevin G Volpp
- 4 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,8 Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.,9 Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,10 Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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141
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[Why don't doctors use early insulinization therapy in patients with diabetes mellitus type 2?: A qualitative approach in a Mexican city]. Salud Colect 2018; 13:693-712. [PMID: 29340447 DOI: 10.18294/sc.2017.1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022] Open
Abstract
Early insulinization therapy is regarded as an efficient aid to improve long term control and quality of life in patients with diabetes mellitus type 2 (DM2). Nevertheless, both patients and medical staff confront barriers in using this therapeutic tool. This study employs a qualitative approach to explore the barriers to early insulinization among medical staff from the public sector in the city of Xalapa, Veracruz, México. Between 2015 and 2016, in-depth interviews were conducted with general and specialist physicians offering primary health care to patients with DM2. The transcribed interviews were analyzed to extract and organize categories and subcategories of barriers among medical staff. These barriers were then grouped into three categories and exemplified with interview excerpts: barriers coming from the medical staff itself, barriers emerging from the doctor-patient interaction, and institutional barriers. Uses for the classification obtained are discussed, as are some of the solutions proposed by study participants.
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142
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Hussein Z, Taher SW, Gilcharan Singh HK, Chee Siew Swee W. Diabetes Care in Malaysia: Problems, New Models, and Solutions. Ann Glob Health 2018; 81:851-62. [PMID: 27108152 DOI: 10.1016/j.aogh.2015.12.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Diabetes is a major public health concern in Malaysia, and the prevalence of type 2 diabetes (T2D) has escalated to 20.8% in adults above the age of 30, affecting 2.8 million individuals. The burden of managing diabetes falls on primary and tertiary health care providers operating in various settings. OBJECTIVES This review focuses on the current status of diabetes in Malaysia, including epidemiology, complications, lifestyle, and pharmacologic treatments, as well as the use of technologies in its management and the adoption of the World Health Organization chronic care model in primary care clinics. METHODS A narrative review based on local available health care data, publications, and observations from clinic experience. FINDINGS The prevalence of diabetes varies among the major ethnic groups in Malaysia, with Asian Indians having the highest prevalence of T2D, followed by Malays and Chinese. The increase prevalence of overweight and obesity has accompanied the rise in T2D. Multidisciplinary care is available in tertiary and primary care settings with integration of pharmacotherapy, diet, and lifestyle changes. Poor dietary adherence, high consumption of carbohydrates, and sedentary lifestyle are prevalent in patients with T2D. The latest medication options are available with increasing use of intensive insulin regimens, insulin pumps, and continuous glucose monitoring systems for managing glycemic control. A stepwise approach is proposed to expand the chronic care model into an Innovative Care for Chronic Conditions framework to facilitate implementation and realize better outcomes in primary care settings. CONCLUSIONS A comprehensive strategy and approach has been established by the Malaysian government to improve prevention, treatment, and control of diabetes as an urgent response to this growing chronic disease.
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Affiliation(s)
- Zanariah Hussein
- Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya, Malaysia
| | | | | | - Winnie Chee Siew Swee
- Division of Nutrition & Dietetics, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia.
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143
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Caruso R, Magon A, Baroni I, Dellafiore F, Arrigoni C, Pittella F, Ausili D. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol 2018; 55:1-12. [PMID: 29129000 DOI: 10.1007/s00592-017-1071-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/03/2017] [Indexed: 01/08/2023]
Abstract
Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.
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Affiliation(s)
- Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Cristina Arrigoni
- Hygiene Section, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Francesco Pittella
- Nursing Degree Course, University of Milan, Section of IRCCS Policlinico San Donato University Hospital, San Donato Milanese, MI, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
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Ratzki-Leewing A, Harris SB, Mequanint S, Reichert SM, Belle Brown J, Black JE, Ryan BL. Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada. BMJ Open Diabetes Res Care 2018; 6:e000503. [PMID: 29713480 PMCID: PMC5922478 DOI: 10.1136/bmjdrc-2017-000503] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/23/2018] [Accepted: 03/10/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Very few real-world studies have been conducted to assess the incidence of diabetes-related hypoglycemia. Moreover, there is a paucity of studies that have investigated hypoglycemia among people taking secretagogues as a monotherapy or in combination with insulin. Accordingly, our research team developed and validated the InHypo-DM Person with Diabetes Mellitus Questionnaire (InHypo-DMPQ) with the aim of capturing the real-world incidence of self-reported, symptomatic hypoglycemia. The questionnaire was administered online to a national sample of Canadians (≥18 years old) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) treated with insulin and/or insulin secretagogues. RESEARCH DESIGN AND METHODS Self-report data obtained from the InHypo-DMPQ were descriptively analyzed to ascertain the crude incidence proportions and annualized incidence densities (rates) of 30-day retrospective non-severe and 1-year retrospective severe hypoglycemia, including daytime and nocturnal events. RESULTS A total of 552 people (T2DM: 83%; T1DM: 17%) completed the questionnaire. Over half (65.2%) of the total respondents reported experiencing at least one event (non-severe or severe) at an annualized crude incidence density of 35.1 events per person-year. The incidence proportion and rate of non-severe events were higher among people with T1DM versus T2DM (77% and 55.7 events per person-year vs 54% and 28.0 events per person-year). Severe hypoglycemia was reported by 41.8% of all respondents, at an average rate of 2.5 events per person-year. CONCLUSIONS The results of the InHypo-DMPQ, the largest real-world investigation of hypoglycemia epidemiology in Canada, suggest that the incidence of hypoglycemia among adults with diabetes taking insulin and/or insulin secretagogues is higher than previously thought.
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Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Selam Mequanint
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sonja M Reichert
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason Edward Black
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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145
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Jaam M, Hadi MA, Kheir N, Mohamed Ibrahim MI, Diab MI, Al-Abdulla SA, Awaisu A. A qualitative exploration of barriers to medication adherence among patients with uncontrolled diabetes in Qatar: integrating perspectives of patients and health care providers. Patient Prefer Adherence 2018; 12:2205-2216. [PMID: 30410316 PMCID: PMC6200070 DOI: 10.2147/ppa.s174652] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To develop an in-depth understanding of the barriers to medication adherence among patients with uncontrolled diabetes attending primary health care (PHC) centers in Qatar by exploring and integrating patients' and health care providers' perspectives. PARTICIPANTS AND METHODS A descriptive qualitative methodology was used in this study. A trained researcher conducted semi-structured face-to-face interviews at two PHC centers. Patients with uncontrolled diabetes (with varied sociodemographic characteristics) and their respective health care providers (physicians, pharmacists, nurses, dieticians, and others) were purposively selected from the two PHC centers. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic content analysis. RESULTS Thirty interviews (14 patients and 16 health care providers) were conducted. A number of barriers to medication adherence were identified and classified broadly under three main themes: 1) patient-related factors, which included patients' individual characteristics and patients' perception, attitude, and behavior; 2) patient-provider factors, which included communication and having multiple health care providers caring for the patient; and 3) societal and environmental factors, which included social pressure and traveling to visit friends and relatives. CONCLUSION Patients with uncontrolled diabetes face multiple barriers to medication adherence. Similar themes emerged from both patients and their care providers. This research highlights the need for concerted multidimensional efforts and series of interventions to overcome these barriers. One vital intervention is expanding the scope of pharmacists' role within the PHC centers through providing medication reconciliation, patient-tailored medication counseling, and medicines use review, which may improve treatment outcomes among patients with diabetes.
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Affiliation(s)
- Myriam Jaam
- College of Pharmacy, Qatar University, Doha, Qatar,
| | | | - Nadir Kheir
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | | | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar,
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146
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Radwan M, Elsous A, Al-Sharif H, Abu Mustafa A. Glycemic control among primary care patients with type 2 diabetes mellitus in the Gaza Strip, Palestine. Ther Adv Endocrinol Metab 2018; 9:3-14. [PMID: 29344335 PMCID: PMC5761953 DOI: 10.1177/2042018817742070] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/19/2017] [Indexed: 11/15/2022] Open
Abstract
AIM In this study, we aimed to assess the level of good glycemic control, to determine association between adherence to antidiabetic medications and glycosylated hemoglobin (HbA1c) and to examine factors influencing good glycemic control. MATERIALS AND METHODS A cross-sectional design was employed among 369 patients with type 2 diabetes mellitus (T2DM) from four Ministry of Health health centers in 2016. A sample of 3 ml blood was taken to measure the HbA1c, and patients were asked to fill out a pretested questionnaire. Univariate and multivariate logistic regressions, to identify independent factors associated with good glycemic control, were conducted using SPSS software version 22 (IBM Corp, Armonk, NY, USA). RESULTS Mean [±standard deviation (SD)] of HbA1c was 8.97 (2.02) and one fifth of patients had good glycemic control (HbA1c ⩽ 7%). Factors associated with good glycemic control were: older age [odds ratio (OR) = 0.96, 95% confidence interval (CI): 0.933-0.988), high medication adherence (OR: 2.757, 95% CI: 1.308-4.693), and better health literacy (OR= 2.124, 95% CI: 1.917-4.921). Duration of diabetes mellitus (DM > 7 years) was inversely related to good glycemic control (OR = 2.255, 95% CI: 1.189-4.276). CONCLUSION Our study showed that glycemic control was suboptimal, and factors associated with that were: older age, high medication adherence, and better health literacy. Knowledge of these factors could be an entry toward helping patients and targeting interventions to improve glycemic control and prevent diabetes-related complications.
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Affiliation(s)
- Mahmoud Radwan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences - International campus, Tehran, Iran Islamic Republic; and International Cooperation Department, Ministry of Health, Gaza Strip, Palestinian Territory, Occupied
| | - Aymen Elsous
- Assistant Professor, Faculty of Health Sciences, Israa University, Gaza Strip, Palestinian Territory, Occupied; and Quality Improvement and Infection Control, Shifa Medical Complex, Gaza Strip, Palestinian Territory, Occupied
| | - Hasnaa Al-Sharif
- Department of Chronic Diseases, Directorate of Primary Healthcare, Ministry of Health, Gaza Strip, Palestinian Territory, Occupied
| | - Ayman Abu Mustafa
- Palestine College of Nursing, Ministry of Health, Gaza Strip, Palestinian Territory, Occupied
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147
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Vluggen S, Hoving C, Schaper NC, de Vries H. Exploring beliefs on diabetes treatment adherence among Dutch type 2 diabetes patients and healthcare providers. PATIENT EDUCATION AND COUNSELING 2018; 101:92-98. [PMID: 28729129 DOI: 10.1016/j.pec.2017.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/21/2017] [Accepted: 07/08/2017] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Despite well-known beneficial effects, adherence to core elements of diabetes treatment is suboptimal. This study, conducted in the Netherlands, aimed to explore if and how treatment adherence success factors are applied in diabetes consultations, and to explore salient personal beliefs about type 2 diabetes treatment including both healthy lifestyle adaptations and pharmacotherapy. METHODS A qualitative study using semi-structured interviews among nine Dutch healthcare providers predominantly involved in diabetes management and 19 Dutch type 2 diabetes patients. Data was systematically analysed through deductive coding analysis using Nvivo. RESULTS Most patients visited their consultations unprepared. Patients did not or vaguely experience goal-setting in consultations, whereas healthcare providers indicated to set treatment goals. Shared-decision making was applied, however patients were rather passive collaborators as mostly healthcare providers were in charge of making treatment decisions. Despite suboptimal treatment adherence, many advantages and few disadvantages of treatment strategies were reported. Adherence self-efficacy was lower in situations outside daily routine. CONCLUSION Treatment adherence success factors are not optimally applied, and in particular treatment adherence self-efficacy could be improved. PRACTICE IMPLICATIONS The application of treatment adherence success factors in consultations could be improved, and personal beliefs should be addressed to improve treatment adherence and optimize counselling.
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Affiliation(s)
- S Vluggen
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
| | - C Hoving
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
| | - N C Schaper
- Department of Endocrinology and Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - H de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
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148
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Owiredua C, Quarshie ENB, Atorkey P. Living with diabetes: An exploratory study of illness representation and medication adherence in Ghana. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1463599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Christiana Owiredua
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Accra, Ghana
| | | | - Prince Atorkey
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Accra, Ghana
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Emmerick ICM, Campos MR, Luiza VL, Chaves LA, Bertoldi AD, Ross-Degnan D. Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmácia Popular' programme in Brazil. BMJ Open 2017; 7:e017308. [PMID: 29101135 PMCID: PMC5695305 DOI: 10.1136/bmjopen-2017-017308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES 'Farmácia Popular' (FP) programme was launched in 2004, expanded in 2006 and changed the cost sharing for oral hypoglycaemic (OH) and antihypertensive (AH) medicines in 2009 and in 2011. This paper describes patterns of usage and continuity of coverage for OH and AH medicines following changes in patient cost sharing in the FP. STUDY DESIGN Interrupted time series study using retrospective administrative data. METHODS Monthly programme participation (PP) and proportion of days covered (PDC) were the two outcome measures. The open cohort included all patients with two or more dispensings for a given study medicine in 2008-2012. The interventions were an increase in patient cost sharing in 2009 and zero patient cost sharing for key medicines in 2011. RESULTS A total of 3.6 and 9.5 million patients receiving treatment for diabetes and hypertension, respectively, qualified for the study. Before the interventions, PP was growing by 7.3% per month; median PDC varied by medicine from 50% to 75%. After patient cost sharing increased in 2009, PP reduced by 56.5% and PDC decreased for most medicines (median 60.3%). After the 2011 free medicine programme, PP surged by 121 000 new dispensings per month and PDC increased for all covered medicines (80.7%). CONCLUSION Cost sharing was found to be a barrier to continuity of treatment in Brazil's private sector FP programme. Making essential medicines free to patients appear to increase participation and continuity of treatment to clinically beneficial levels (PDC >80%).
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Affiliation(s)
| | - Monica Rodrigues Campos
- Department of Social Sciences, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Vera Lucia Luiza
- Department of Medicines Policy and Pharmaceutical Services, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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150
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Carls GS, Tuttle E, Tan RD, Huynh J, Yee J, Edelman SV, Polonsky WH. Understanding the Gap Between Efficacy in Randomized Controlled Trials and Effectiveness in Real-World Use of GLP-1 RA and DPP-4 Therapies in Patients With Type 2 Diabetes. Diabetes Care 2017; 40:1469-1478. [PMID: 28801475 DOI: 10.2337/dc16-2725] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/27/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to estimate and explain the gap between clinical efficacy and real-world (RW) effectiveness of type 2 diabetes medications. RESEARCH DESIGN AND METHODS This mixed-methods quasi-experimental study used retrospective claims (Optum/Humedica) to compare the change in HbA1c of RW patients with type 2 diabetes 12 months after starting a glucagon-like peptide 1 receptor agonist (GLP-1 RA) or dipeptidyl peptidase 4 (DPP-4) inhibitor with published findings from randomized controlled trials (RCTs) evaluating these drugs. Selected RW patients were similar to RCT patients, and regression analysis was used in the RW data to adjust for differences between poorly adherent and adherent patients to explain why RCT and RW findings may differ. RESULTS RW patients initiating a GLP-1 RA (n = 221) or a DPP-4 (n = 652) experienced smaller reductions in HbA1c (GLP-1 RA: -0.52% [-6 mmol/mol], DPP-4: -0.51% [-6 mmol/mol])than reported in RCTs (-1.30% [-14 mmol/mol] from seven GLP-1 RA RCTs, n = 2,600; -0.68% [-8 mmol/mol] from four DPP-4 RCTs, n = 1,889). Baseline HbA1c, additional medications, and adherence were significant explanatory factors in the RW HbA1c change. Modeled estimates of RCT efficacy (-1.04% GLP-1 RA [-12 mmol/mol], -0.69% DPP-4 [-8 mmol/mol]) were within the RCTs' reported range (GLP-1 RA: -0.84% to -1.60% [-9 to -18 mmol/mol], DPP-4: -0.47% to -0.90% [-5 to -10 mmol/mol]). Poor medication adherence accounted for approximately three-fourths of the gap between RW and expected RCT results (gap = 0.51% [6 mmol/mol] GLP-1 RA; 0.18% [3 mmol/mol] DPP-4). CONCLUSIONS Poor medication adherence is primarily why RW effectiveness is significantly less than RCT efficacy, suggesting an urgent need to effectively address adherence among patients with type 2 diabetes.
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Affiliation(s)
| | | | | | | | - John Yee
- Intarcia Therapeutics, Boston, MA
| | - Steven V Edelman
- Division of Endocrinology and Metabolism, School of Medicine, University of California, San Diego, San Diego, CA.,Taking Control of Your Diabetes, Del Mar, CA.,Veterans Affairs Medical Center, San Diego, CA
| | - William H Polonsky
- Department of Psychiatry, University of California, San Diego, San Diego, CA.,Behavioral Diabetes Institute, San Diego, CA
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