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Chen M, Liu M, Pu Y, Wu J, Zhang M, Tang H, Kong L, Guo M, Zhu K, Xie Y, Li Z, Deng B, Xiong Z. The effect of health quotient and time management skills on self-management behavior and glycemic control among individuals with type 2 diabetes mellitus. Front Public Health 2024; 12:1295531. [PMID: 38633228 PMCID: PMC11021650 DOI: 10.3389/fpubh.2024.1295531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Objective The aim of this study was to evaluate the present status of self-management behavior and glycemic control in individuals diagnosed with Type 2 Diabetes Mellitus (T2D), as well as to examine the impact of health quotient (HQ) and time management skills on both self-management behavior and glycemic control. Methods Between October 2022 and March 2023, a purposive sampling method had been utilized to select 215 participants with type T2D. The survey concluded a general information questionnaire, an HQ scale, a diabetes time management questionnaire and a self-management behavior questionnaire. The health quotient(HQ)encompasses the individuals' knowledge, attitude toward health, and the ability to maintain their own well-being. The diabetes time management questionnaire was reverse-scored, with higher scores indicating an enhanced competence in time management. The path among variables was analyzed using structural equation modeling(SEM). Results SEM showed that the direct effect of HQ on time management was -0.566 (p < 0.05), the direct effect of time management on the effect of self-management was -0.617 (p < 0.05), the direct effect of HQ on self-management was 0.156, and the indirect effect was 0.349 (p < 0.05); the relationship between health quotient and self-management was partially mediated by time management, with a mediating effect size of 68.8%. In addition, self-management had a direct effect on HbAlc, with a size of -0.394 (p < 0.05); The impacts of both HQ and time management on HbAlc were found to be mediated by self-management, with HQ demonstrating an indirect effect of -0.199 (p < 0.05) and time management showing an indirect effect of 0.244 (p < 0.05). Conclusion Health quotient and time management in patients with T2D serve as catalysts for self-management behavior. They affect HbAlc level indirectly through self-management practices. The suggestion is to prioritize the cultivation of rational time organization and management skills in T2D patients, as well as enhance their health quotient level. This can facilitate a more effective improvement in patients' self-management behaviors, ultimately achieving the objective of maintaining optimal glycemic control.
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Affiliation(s)
- Mengjie Chen
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Man Liu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan, China
| | - Ying Pu
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Juan Wu
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Mingjiao Zhang
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Tang
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Laixi Kong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Maoting Guo
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Kexue Zhu
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Yuxiu Xie
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Bei Deng
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
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Giorgino F, Battelino T, Bergenstal RM, Forst T, Green JB, Mathieu C, Rodbard HW, Schnell O, Wilmot EG. The Role of Ultra-Rapid-Acting Insulin Analogs in Diabetes: An Expert Consensus. J Diabetes Sci Technol 2023:19322968231204584. [PMID: 37937585 DOI: 10.1177/19322968231204584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Ultra-rapid-acting insulin analogs (URAA) are a further development and refinement of rapid-acting insulin analogs. Because of their adapted formulation, URAA provide an even faster pharmacokinetics and thus an accelerated onset of insulin action than conventional rapid-acting insulin analogs, allowing for a more physiologic delivery of exogenously applied insulin. Clinical trials have confirmed the superiority of URAA in controlling postprandial glucose excursions, with a safety profile that is comparable to the rapid-acting insulins. Consequently, many individuals with diabetes mellitus may benefit from URAA in terms of prandial glycemic control. Unfortunately, there are only few available recommendations from authoritative sources for use of URAA in clinical practice. Therefore, this expert consensus report aims to define populations of people with diabetes mellitus for whom URAA may be beneficial and to provide health care professionals with concrete, practical recommendations on how best to use URAA in this context.
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Affiliation(s)
- Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, UCH-University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Thomas Forst
- Department of Endocrinology and Metabolic Diseases, Johannes Gutenberg University Medical Center, Mainz, Germany
- Clinical Research Services, Mannheim, Germany
| | - Jennifer B Green
- Division of Endocrinology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Oliver Schnell
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Academic Unit for Translational Medical Sciences, University of Nottingham, Nottingham, England, UK
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Mavragani A, Kim D, Hwang J, Kang JH, Kwon Y, Kwon JW. Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study. JMIR Public Health Surveill 2023; 9:e42190. [PMID: 36735297 PMCID: PMC9938442 DOI: 10.2196/42190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/27/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time. OBJECTIVE We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause. METHODS This population-based retrospective study was conducted using data from the Korean National Health Insurance Service-National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used. RESULTS Among the total cohort of 440,249 patients, 155,765 (35.38%) were in the uncontrolled HT or DM group. More than 60% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95% CI 1.12-1.23) for the uncontrolled HT and DM group. CONCLUSIONS This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology.
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Affiliation(s)
| | - Dohyang Kim
- Department of Statistics, Daegu University, Gyeongbuk, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics, Daegu University, Gyeongbuk, Republic of Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Yeongkeun Kwon
- Centre for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, Bernal-Ceballos F, Torre-Saldaña VDL, Galindez-Fuentes A, Castillo-Martínez L. Adherence to antidiabetic treatment in primary health care in individuals with type 2 diabetes. A survey including socio-demographic, patient related and clinical factors. Prim Care Diabetes 2022; 16:780-785. [PMID: 36127243 DOI: 10.1016/j.pcd.2022.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adherence to medications is a critical element in diabetes management. OBJECTIVE To investigate patient-related factors associated with adherence to antidiabetic treatment in patients with type 2 diabetes in primary health-care units. METHODS A cross-sectional study among patients receiving diabetes care in 18 primary care units in Mexico City was conducted. Data were collected from medical records and medical interviews. Adherence to antidiabetic therapy and patient-related factors associated with adherence were evaluated through a self-administered questionnaire. Socio-demographic, clinical, behavioral (self-care activities including a healthy diet, exercise or physical activity, self-monitoring of blood glucose testing, and foot care), and patients-adherence-related factors (health-care provider-patient communication; daily and social activities, and support network; alternative treatment beliefs; comorbidity, diabetes symptoms, and treatment; side effects and treatment access) were compared between the adherent and non-adherent group. RESULTS Of 319 outpatients, 48.3% were adherent to their antidiabetic therapy. In the adjusted analysis, patient-related factors associated to adherence were exercise and physical activity self-care behavior (OR=1.26; 95%CI 1.09-1.46), treatment interference with daily activities (OR=0.27; 95%CI 0.14-0.52), not satisfied with resolution of questions by the physician (OR=0.42; 95%CI 0.19-0.94), independently to increased cardiovascular risk and insulin treatment. CONCLUSION A low proportion of outpatients with T2D with regular primary care were adherent to diabetes treatment and this was associated with patient-related factors like answering patients' treatment-related questions by the physician. This information may be useful to identify patients at risk for low adherence, and to guide the design of quality-of-care strategies, like diabetes education programs to address suboptimal adherence in patients, and health-care professional communication skills training, particularly in primary care health systems.
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Affiliation(s)
- Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | - Teresa Cuatecontzi-Xochitiotzi
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | | | - Viridiana de la Torre-Saldaña
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | - Ana Galindez-Fuentes
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | - Lilia Castillo-Martínez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México; Facultad de Medicina, Universidad Nacional Autónoma de México, México.
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Choi HY, Kim EY, Kim J. Prognostic factors in diabetes: Comparison of Chi-square automatic interaction detector (CHAID) decision tree technology and logistic regression. Medicine (Baltimore) 2022; 101:e31343. [PMID: 36281142 PMCID: PMC9592288 DOI: 10.1097/md.0000000000031343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study aimed to develop a diabetes prediction model. The model performance was compared with logistic regression, and the decision tree Chi-square automatic interaction detection (CHAID) was used to predict diabetes. In total, 3233 patients were included in the analysis. Of these, 589 patients with diabetes and 2644 patients without diabetes were included after analyzing the study sample from the Korean Genome and Epidemiology Study (KoGES)-8 data. In this study, Diabetes Mellitus (DM) diagnosis prediction was compared with logistic regression and prediction through machine learning (ML) using the CHAID decision classification tree. We performed statistical analysis using the CHAID method with International Business Machine (IBM) statistical program SPSS®. We performed logistic regression analysis to predict the classification of diabetes accurately, and the total classification accuracy of the analysis was 81.7%, and the CHAID decision tree classification accuracy was 81.8%. A diabetes diagnosis decision tree was created, which included seven terminal nodes and three depth levels. This analysis showed that a blood pressure problem and hospital visits were the most decisive variables at the time of classification, and two risk levels were created for diabetes diagnosis. The suggested method is a valuable tool for predicting diabetes. Patients who visit the hospital because of blood pressure problems are more likely to develop diabetes than under-treating hyperlipidemia. The diabetes prediction model can help doctors make decisions by detecting the possibility of diabetes early; however, it is impossible to diagnose diabetes using only the model without the doctor's opinion.
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Affiliation(s)
- Hae-Young Choi
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Eun-Yeob Kim
- Research Institute for Skin Image, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Kim
- Research Institute for Skin Image, Korea University College of Medicine, Seoul, Republic of Korea
- Core Research & Development Center, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
- * Correspondence: Jaeyoung Kim, Research Institute for Skin Image, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea (e-mail: )
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Yoshimoto M, Sakuma Y, Ogino J, Iwai R, Watanabe S, Inoue T, Takahashi H, Suzuki Y, Kinoshita D, Takemura K, Takahashi H, Shimura H, Babazono T, Yoshida S, Hashimoto N. Sex differences in predictive factors for onset of type 2 diabetes in Japanese individuals: A 15-year follow-up study. J Diabetes Investig 2022; 14:37-47. [PMID: 36200977 PMCID: PMC9807159 DOI: 10.1111/jdi.13918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/25/2022] [Accepted: 09/19/2022] [Indexed: 02/07/2023] Open
Abstract
AIMS/INTRODUCTION The increase in the number of patients with type 2 diabetes mellitus is an important concern worldwide. The goal of this study was to investigate factors involved in the onset of type 2 diabetes mellitus, and sex differences in long-term follow up of people with normal glucose tolerance. MATERIALS AND METHODS Of 1,309 individuals who underwent screening at our facility in 2004, 748 individuals without diabetes were enrolled. Correlations of metabolic markers including serum adiponectin (APN) with onset of type 2 diabetes mellitus were examined over 15 years in these individuals. RESULTS The Kaplan-Meier curve for onset of type 2 diabetes mellitus for 15 years in the decreased APN group was examined. Hazard ratios for the APN concentration for onset of diabetes were 1.78 (95% confidence interval [CI] 1.20-2.63, P = 0.004) in all participants, 1.48 (95% CI 0.96-2.29, P = 0.078) for men and 3.01 (95% CI 1.37-6.59, P = 0.006) for women. During the follow-up period of 15 years, body mass index, estimated glomerular filtration rate, fatty liver, C-reactive protein and alanine aminotransferase in men were significant in univariate analysis, but only estimated glomerular filtration rate and fatty liver were significantly related to onset of type 2 diabetes mellitus in multivariate analysis. In women, body mass index, systolic blood pressure, triglyceride, fatty liver and APN were significant in univariate analysis, and APN was the only significant risk factor in multivariate analysis (P < 0.05). CONCLUSIONS There are differences between men and women with regard to targets for intervention to prevent the onset of type 2 diabetes mellitus. Individuals requiring intensive intervention should be selected with this finding to maximize the use of limited social and economic resources.
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Affiliation(s)
- Mei Yoshimoto
- Department of Diabetes, Endocrine and Metabolic Diseases, Yachiyo Medical CenterTokyo Women's Medical UniversityYachiyo, ChibaJapan
| | - Yukie Sakuma
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Jun Ogino
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Rie Iwai
- Department of Clinical LaboratoryAsahi General HospitalAsahi, ChibaJapan
| | - Saburo Watanabe
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Takeshi Inoue
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Haruo Takahashi
- Clinical Research Support CenterAsahi General HospitalAsahi, ChibaJapan
| | - Yoshifumi Suzuki
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Daisuke Kinoshita
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Koji Takemura
- Department of Diabetes and Metabolic DiseasesAsahi General HospitalAsahi, ChibaJapan
| | - Hidenori Takahashi
- Preventive Medicine Research CenterAsahi General HospitalAsahi, ChibaJapan
| | - Haruhisa Shimura
- Preventive Medicine Research CenterAsahi General HospitalAsahi, ChibaJapan,Department of Internal MedicineAsahi General HospitalAsahi, ChibaJapan
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, School of MedicineTokyo Women's Medical UniversityTokyoJapan
| | - Shouji Yoshida
- Department of Internal MedicineAsahi General HospitalAsahi, ChibaJapan
| | - Naotake Hashimoto
- Preventive Medicine Research CenterAsahi General HospitalAsahi, ChibaJapan
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Sendekie AK, Netere AK, Kasahun AE, Belachew EA. Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. PLoS One 2022; 17:e0274971. [PMID: 36130160 PMCID: PMC9491880 DOI: 10.1371/journal.pone.0274971] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background
Medication nonadherence in patients with chronic diseases, particularly in type 2 diabetes mellitus (T2DM) with comorbidity, has continued to be the cause of treatment failure. The current study assessed medication adherence and its impact on glycemic control in T2DM patients with comorbidity.
Methods
An institutional-based multicenter cross-sectional study was conducted among T2DM patients with comorbidity at the selected hospitals in Northwest Ethiopia. Medication adherence was measured using a structured questionnaire of the General Medication Adherence Scale (GMAS). A logistic regression model was used to identify predictors of the level of medication adherence and glycemic control. P < 0.05 at 95% confidence interval (CI) was statistically significant.
Results
A total of 403 samples were included in the final study. This study showed that more than three-fourths (76.9%) of the participants were under a low level of medication adherence. Source of medication cost coverage [AOR = 10.593, 95% CI (2.628–41.835; P = 0.003], monthly income (P < 0.00), self-monitoring of blood glucose (SMBG) practice [AOR = 0.266, 95% CI (0.117–0.604); P = 0.002], number of medications [AOR = 0.068, 95% CI (0.004–0.813); P = 0.014] and medical conditions [AOR = 0.307, 95% CI (0.026–0.437); P = 0.018] were found to be significant predictors of medication adherence. Significantly, majority (74.7%) of participants had poor levels of glycemic control. Patients who had a high level of medication adherence [AOR = 0.003, 95% CI (0.000–0.113); P = 0.002] were found less likely to have poor glycemic control compared with patients who were low adherent to their medications.
Conclusion
The current study concluded that medication adherence was low and significantly associated with poor glycemic control. Number of medical conditions and medications were found to be associated with medication adherence. Management interventions of T2DM patients with comorbidity should focus on the improvement of medication adherence.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- * E-mail: ,
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Identification of a Multi-Messenger RNA Signature as Type 2 Diabetes Mellitus Candidate Genes Involved in Crosstalk between Inflammation and Insulin Resistance. Biomolecules 2022; 12:biom12091230. [PMID: 36139069 PMCID: PMC9496026 DOI: 10.3390/biom12091230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Type 2 Diabetes Mellitus (T2DM) is a metabolic disease associated with inflammation widening the scope of immune-metabolism, linking the inflammation to insulin resistance and beta cell dysfunction. New potential and prognostic biomarkers are urgently required to identify individuals at high risk of β-cell dysfunction and pre-DM. The DNA-sensing stimulator of interferon genes (STING) is an important component of innate immune signaling that governs inflammation-mediated T2DM. NOD-like receptor (NLR) reduces STING-dependent innate immune activation in response to cyclic di-GMP and DNA viruses by impeding STING-TBK1 interaction. We proposed exploring novel blood-based mRNA signatures that are selective for components related to inflammatory, immune, and metabolic stress which may reveal the landscape of T2DM progression for diagnosing or treating patients in the pre-DM state. In this study, we used microarray data set to identify a group of differentially expressed mRNAs related to the cGAS/STING, NODlike receptor pathways (NLR) and T2DM. Then, we comparatively analyzed six mRNAs expression levels in healthy individuals, prediabetes (pre-DM) and T2DM patients by real-time PCR. The expressions of ZBP1, DDX58, NFKB1 and CHUK were significantly higher in the pre-DM group compared to either healthy control or T2DM patients. The expression of ZBP1 and NFKB1 mRNA could discriminate between good versus poor glycemic control groups. HSPA1B mRNA showed a significant difference in its expression regarding the insulin resistance. Linear regression analysis revealed that LDLc, HSPA1B and NFKB1 were significant variables for the prediction of pre-DM from the healthy control. Our study shed light on a new finding that addresses the role of ZBP1 and HSPA1B in the early prediction and progression of T2DM.
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Ayele BA, Tiruneh SA, Ayele AA, Engidaw MT, Yitbarek GY, Gebremariam AD. Medication adherence and its associated factors among type 2 diabetic patients in Ethiopian General Hospital, 2019: Institutional based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000099. [PMID: 36962151 PMCID: PMC10021151 DOI: 10.1371/journal.pgph.0000099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/06/2022] [Indexed: 11/19/2022]
Abstract
Introduction Globally, diabetes mellitus is becoming a major public health problem in developing countries. Diabetic medication has a major role in glycemic control. However, poor adherence to diabetes medication leads to increased morbidity and morbidity. This study aimed to determine diabetes medication adherence and its associated factors among type two diabetes (T2DM) patients from December 01, 2019 to December 31, 2019, at Debre Tabor General Hospital, Northwest Ethiopia. Methods An institutional-based cross-sectional survey was conducted with a sample of 422 T2DM at Debre Tabor General Hospital diabetic clinic, Ethiopia. The study was conducted from December 01-31/2019. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale. The data were analyzed using STATA version 15.1 software. Logistic regressions were carried out to identify independent predictors for T2DM adherence. P-value less than 0.05 was used to declare statistical significance. Results A total of 408 T2DM patients were recruited for this study with a response rate of 96.7%. Overall, 58.33% (95% Confidence Interval (CI): 53.47–63.03) T2DM patients had good medication adherence.T2DM patients who were taking both oral and injectable anti-diabetic medications (Adjusted odds ratio (AOR) = 1.98, 95% CI: 1.16–3.39), got the prescribed anti-diabetic medication from the hospital (AOR = 0.51, 95% CI: 0.32–0.80), having own glucometer at home (AOR = 0.30, 95% CI: 0.16–0.54), and having good diabetes-related knowledge (AOR = 0.50, 95% CI: 0.27–0.90) were a significant determinant factors for anti-diabetic medication adherence. Conclusion Overall, more than half of T2DM patients had good medication adherence. Medication type, access to anti-diabetic medication, having own glucometer at home, diabetes-related knowledge were independent predictors of medication adherence. T2DM patients should have own glucometer at home and health promotion should provide about diabetic Mellitus for T2DM patients.
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Affiliation(s)
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health (Epidemiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- School of Health, University of New England, Armidale, Australia
| | - Melaku Tadege Engidaw
- Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbarek
- Department of Biomedical Sciences (Medical Physiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemayehu Digssie Gebremariam
- Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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QiMuge N, Fang X, Chang B, Li DM, Li Y. Predicting population: development and validation of a new predictive nomogram for evaluating medication nonadherence risk in a type 2 diabetes. PeerJ 2022; 10:e13102. [PMID: 35310157 PMCID: PMC8932313 DOI: 10.7717/peerj.13102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Diabetes mellitus is a growing global health challenge and affects patients of all ages. Treatment aims to keep blood glucose levels close to normal and to prevent or delay complications. However, adherence to antidiabetic medicines is often unsatisfactory. Purpose Here, we established and internally validated a medication nonadherence risk nomogram for use in Chinese type 2 diabetes mellitus (T2DM) patients. Methods This cross-sectional study was carried out from July-December 2020 on randomly selected T2DM patients visiting a diabetes clinic and included 753 participants. Adherence was analyzed based on an eight-item Morisky Medication Adherence Scale (MMAS-8). Other data, including patient demographics, treatment, complications, and comorbidities, were also collected on questionnaires. Optimization of feature selection to develop the medication nonadherence risk model was achieved using the least absolute shrinkage and selection operator regression model (LASSO). A prediction model comprising features selected from LASSO model was designed by applying multivariable logistic regression analysis. The decision curve analysis, calibration plot, and C-index were utilized to assess the performance of the model in terms of discrimination, calibration, and clinical usefulness. Bootstrapping validation was applied for internal validation. Results The prediction nomogram comprised several factors including sex, marital status, education level, employment, distance, self-monitoringofbloodglucose, disease duration, and dosing frequency of daily hypoglycemics (pills, insulin, or glucagon-like peptide-1). The model exhibited good calibration and good discrimination (C-index = 0.79, 95% CI [0.75-0.83]). In the validation samples, a high C-index (0.75) was achieved. Results of the decision curve analysis revealed that the nonadherence nomogram could be applied in clinical practice in cases where the intervention is decided at a nonadherence possibility threshold of 12%. Conclusion The number of patients who adhere to anti-diabetes therapy was small. Being single male, having no formal education, employed, far from hospital, long disease duration, and taking antidiabetics twice or thrice daily, had significant negative correlation with medication adherence. Thus, strategies for improving adherence are urgently needed.
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Affiliation(s)
- NaRen QiMuge
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, Tianjin, China,Department of Endocrinology and Metabolism, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia Autonomous Region, China
| | - Xu Fang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, Tianjin, China
| | - Baocheng Chang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, Tianjin, China
| | - Dong Mei Li
- Department of Endocrinology and Metabolism, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yuanyuan Li
- Department of Endocrinology and Metabolism, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia Autonomous Region, China
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11
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Taha MB, Valero-Elizondo J, Yahya T, Caraballo C, Khera R, Patel KV, Ali HJR, Sharma G, Mossialos E, Cainzos-Achirica M, Nasir K. Cost-Related Medication Nonadherence in Adults With Diabetes in the United States: The National Health Interview Survey 2013-2018. Diabetes Care 2022; 45:594-603. [PMID: 35015860 DOI: 10.2337/dc21-1757] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Health-related expenditures resulting from diabetes are rising in the U.S. Medication nonadherence is associated with worse health outcomes among adults with diabetes. We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the U.S. RESEARCH DESIGN AND METHODS We studied adults age ≥18 years with self-reported diabetes from the National Health Interview Survey (NHIS) (2013-2018), a U.S. nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (<65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN. RESULTS Of the 20,326 NHIS participants with diabetes, 17.6% (weighted 2.3 million) of those age <65 years reported CRN, compared with 6.9% (weighted 0.7 million) among those age ≥65 years. Financial hardship from medical bills, lack of insurance, low income, high comorbidity burden, and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the nonelderly but not among the elderly. Among the elderly, insulin use significantly increased the odds of reporting CRN (odds ratio 1.51; 95% CI 1.18, 1.92). CONCLUSIONS In the U.S., one in six nonelderly and one in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.
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Affiliation(s)
- Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.,Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Hyeon Ju R Ali
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine and Hospital, Baltimore, MD
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Sciences, London, U.K
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.,Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.,Center for Outcomes Research, Houston Methodist, Houston, TX
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12
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Evans M, Engberg S, Faurby M, Fernandes JDDR, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review. Diabetes Obes Metab 2022; 24:377-390. [PMID: 34779107 PMCID: PMC9299643 DOI: 10.1111/dom.14603] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
We designed a systematic literature review to identify available evidence on adherence to and persistence with antidiabetic medication in people with type 2 diabetes (T2D). Electronic screening and congress searches identified real-world noninterventional studies (published between 2010 and October 2020) reporting estimates of adherence to and persistence with antidiabetic medication in adults with T2D, and associations with glycaemic control, microvascular and/or macrovascular complications, hospitalizations and healthcare costs. Ninety-two relevant studies were identified, the majority of which were retrospective and reported US data. The proportions of patients considered adherent (median [range] 51.2% [9.4%-84.3%]) or persistent (median [range] 47.7% [16.9%-94.0%]) varied widely across studies. Multiple studies reported an association between greater adherence/persistence and greater reductions in glycated haemoglobin levels. Better adherence/persistence was associated with fewer microvascular and/or macrovascular outcomes, although there was little consistency across studies in terms of which outcomes were improved. More adherent and more persistent patients were typically less likely to be hospitalized or to have emergency department visits/admissions and spent fewer days in hospital annually than less adherent/persistent patients. Greater adherence and persistence were generally associated with lower hospitalization costs, higher pharmacy costs and lower or budget-neutral total healthcare costs compared with lower adherence/persistence. In conclusion, better adherence and persistence in people with T2D is associated with lower rates of microvascular and/or macrovascular outcomes and inpatient hospitalization, and lower or budget-neutral total healthcare expenditure. Education and treatment strategies to address suboptimal adherence and persistence are needed to improve clinical and economic outcomes.
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Affiliation(s)
- Marc Evans
- Department of Diabetes and EndocrinologyUniversity Hospital LlandoughPenarthUK
| | | | | | | | | | - William Polonsky
- Behavioral Diabetes InstituteSan DiegoCaliforniaUSA
- Department of MedicineUniversity of CaliforniaSan DiegoCaliforniaUSA
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13
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Nakanishi S, Shimoda M, Tatsumi F, Kohara K, Obata A, Sanada J, Fushimi Y, Mune T, Kaku K, Kaneto H. Association between Grit Scales and adherence to regular hospital visits among Japanese patients with type 2 diabetes: Prospective observational study. J Diabetes Investig 2021; 12:2259-2262. [PMID: 34018334 PMCID: PMC8668056 DOI: 10.1111/jdi.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/01/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
This study examined the association between Grit Scales and adherence to a schedule of regular hospital visits among Japanese type 2 diabetes patients. Patients with type 2 diabetes who visited the outpatient clinic as new patients comprised the study's participants. Self-administered Short Grit Scale data were obtained from 122 patients at the first consultation and were then observed for 1 year. As the results, 21 participants failed to attend the hospital. In a logistic regression analysis, the Grit Scale as a continuous variable was positively associated with adherence to regular clinical visits. Its odds ratio and 95% confidential interval was 9.68 and 2.87-32.65 (P = 0.0003). In conclusion, it is likely that the Grit Scale is closely associated with adherence to regular hospital visits among Japanese type 2 diabetes patients.
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Affiliation(s)
- Shuhei Nakanishi
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Fuminori Tatsumi
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Kenji Kohara
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Atsushi Obata
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Junpei Sanada
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Yoshiro Fushimi
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Tomoatsu Mune
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
| | - Kohei Kaku
- Department of MedicineKawasaki Medical SchoolKawasaki HospitalOkayamaJapan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolOkayamaJapan
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14
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Campbell PJ, Axon DR, Taylor AM, Smith K, Pickering M, Black H, Warholak T, Chinthammit C. Hypertension, cholesterol and diabetes medication adherence, health care utilization and expenditure in a Medicare Supplemental sample. Medicine (Baltimore) 2021; 100:e27143. [PMID: 34477169 PMCID: PMC8416010 DOI: 10.1097/md.0000000000027143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
Limited evidence exists regarding the relationships between adherence, as defined in Pharmacy Quality Alliance (PQA) medication adherence measures, health care utilization, and economic outcomes. PQA adherence measures for hypertension, cholesterol, and diabetes are of particular interest given their use in Medicare Star Ratings to evaluate health plan performance.The objective of this study was to assess the relationship between adherence and utilization and cost among Medicare Supplemental beneficiaries included in the aforementioned PQA measures over a 1-year period.Retrospective cohort study.Three cohorts (hypertension, cholesterol, and diabetes) of eligible individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009-2015) were used to assess associations between adherence and health care expenditure and utilization for Medicare Supplemental beneficiaries.Generalized linear models with log link and negative binomial (utilization) or gamma (expenditure) distributions assessed relationships between adherence (≥80% proportion of days covered) and health care utilization and expenditure (in 2015 US dollars) while adjusting for confounding variables. Beta coefficients were used to compute cost ratios and rate ratios.Adherence for all 3 disease cohorts was associated with lower outpatient and inpatient visits. During the 1-year study period, adherence was associated with lower outpatient, inpatient, and total expenditures across the cohorts, ranging from 9% lower outpatient costs (diabetes cohort) to 41.9% lower inpatient costs (hypertension cohort). Savings of up to $324.53 per member per month in total expenditure were observed for the hypertension cohort.Our findings indicate adherence is associated with lower health care utilization and expenditures within 1 year.
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Affiliation(s)
| | - David R. Axon
- University of Arizona College of Pharmacy, 1295N Martin Avenue, Tucson, AZ
| | - Ann M. Taylor
- University of Arizona College of Pharmacy, 1295N Martin Avenue, Tucson, AZ
| | - Karen Smith
- Regis University School of Pharmacy, 3333 Regis Boulevard, Denver, CO
| | - Matthew Pickering
- Pharmacy Quality Alliance, Inc., 5911 Kingstowne Village Parkway, Suite 130, Alexandria, VA
| | - Heather Black
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ
| | - Terri Warholak
- University of Arizona College of Pharmacy, 1295N Martin Avenue, Tucson, AZ
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15
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Work-related factors related to forgetting to take oral diabetes medication during the working day among Japanese male employees with diabetes. Diabetol Int 2021; 13:253-261. [DOI: 10.1007/s13340-021-00532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
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16
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Marchini F, Caputo A, Convertino A, Napoli A. Psychodynamics in Diabetes: The Relevance of Deepening the Symbolic in Treatment Adherence. Front Psychol 2021; 12:661211. [PMID: 34017293 PMCID: PMC8130673 DOI: 10.3389/fpsyg.2021.661211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesco Marchini
- Italian Centre of Analytical Psychology (CIPA), "Sapienza" University of Rome, Rome, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza" University of Rome, Rome, Italy
| | - Alessio Convertino
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
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17
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Li Y, Guo L, Li L, Yang C, Guang P, Huang F, Chen Z, Wang L, Hu J. Early Diagnosis of Type 2 Diabetes Based on Near-Infrared Spectroscopy Combined With Machine Learning and Aquaphotomics. Front Chem 2021; 8:580489. [PMID: 33425846 PMCID: PMC7794015 DOI: 10.3389/fchem.2020.580489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Early diagnosis is important to reduce the incidence and mortality rate of diabetes. The feasibility of early diagnosis of diabetes was studied via near-infrared spectra (NIRS) combined with a support vector machine (SVM) and aquaphotomics. Firstly, the NIRS of entire blood samples from the population of healthy, pre-diabetic, and diabetic patients were obtained. The spectral data of the entire spectra in the visible and near-infrared region (400–2,500 nm) were used as the research object of the qualitative analysis. Secondly, several preprocessing steps including multiple scattering correction, variable standardization, and first derivative and second derivative steps were performed and the best pretreatment method was selected. Finally, for the early diagnosis of diabetes, models were established using SVM. The first overtone of water (1,300–1,600 nm) was used as the research object for an aquaphotomics model, and the aquagram of the healthy group, pre-diabetes, and diabetes groups were drawn using 12 water absorption patterns for the early diagnosis of diabetes. The results of SVM showed that the highest accuracy was 97.22% and the specificity and sensitivity were 95.65 and 100%, respectively when the pretreatment method of the first derivative was used, and the best model parameters were c = 18.76 and g = 0.008583.The results of the aquaphotomics model showed clear differences in the 1,400–1,500 nm region, and the number of hydrogen bonds in water species (1,408, 1,416, 1,462, and 1,522 nm) was evidently correlated with the occurrence and development of diabetes. The number of hydrogen bonds was the smallest in the healthy group and the largest in the diabetes group. The suggested reason is that the water matrix of blood changes with the worsening of blood glucose metabolic dysfunction. The number of hydrogen bonds could be used as biomarkers for the early diagnosis of diabetes. The result show that it is effective and feasible to establish an accurate and rapid early diagnosis model of diabetes via NIRS combined with SVM and aquaphotomics.
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Affiliation(s)
- Yuanpeng Li
- College of Physical Science and Technology, Guangxi Normal University, Guilin, China.,Guangxi Key Laboratory Nuclear Physics and Technology, Guangxi Normal University, Guilin, China
| | - Liu Guo
- Guangdong Hongke Agricultural Machinery Research & Development Co., Ltd., Guangzhou, China
| | - Li Li
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chuanmei Yang
- College of Physical Science and Technology, Guangxi Normal University, Guilin, China
| | - Peiwen Guang
- Guangdong Provincial Key Laboratory of Optical Sensing and Communications, Department of Optoelectronic Engineering, Jinan University, Guangzhou, China
| | - Furong Huang
- Guangdong Provincial Key Laboratory of Optical Sensing and Communications, Department of Optoelectronic Engineering, Jinan University, Guangzhou, China
| | - Zhenqiang Chen
- Guangdong Provincial Key Laboratory of Optical Sensing and Communications, Department of Optoelectronic Engineering, Jinan University, Guangzhou, China
| | - Lihu Wang
- College of Physical Science and Technology, Guangxi Normal University, Guilin, China
| | - Junhui Hu
- College of Physical Science and Technology, Guangxi Normal University, Guilin, China
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18
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Van Alsten SC, Harris JK. Cost-Related Nonadherence and Mortality in Patients With Chronic Disease: A Multiyear Investigation, National Health Interview Survey, 2000-2014. Prev Chronic Dis 2020; 17:E151. [PMID: 33274701 PMCID: PMC7735485 DOI: 10.5888/pcd17.200244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Prescription costs are rising, and many patients with chronic illnesses have difficulty paying for prescriptions. Missing or delaying medication because of financial concerns is common; however, the effects of cost-related nonadherence (CRN) on patient outcomes have not been described. Our objective was to determine if CRN is associated with higher all-cause and disease-specific mortality among patients living with diabetes and cardiovascular disease in a representative sample of US adults. Methods We ascertained CRN, vital status, and cause of death for 39,571 patients with diabetes, 61,968 patients with cardiovascular disease, and 124,899 patients with hypertension in the 2000 through 2014 releases of the National Health Interview Survey. We used adjusted Cox proportional hazards models to estimate associations between CRN and all-cause mortality and CRN and disease-specific mortality. Results On average, 15% of the sample reported CRN in the year before interview. After adjusting for confounders, CRN was associated with 15% to 22% higher all-cause mortality rates for all conditions (diabetes hazard ratio [HR] = 1.18; 95% CI, 1.1–1.3; cardiovascular disease [CVD] HR = 1.15; 95% CI, 1.1–1.2; hypertension HR = 1.22; 95% CI, 1.2–1.3). Relative to no CRN, CRN was associated with 8% to 18% higher disease-specific mortality rates (diabetes HR = 1.18; 95% CI, 1.0–1.4; CVD HR = 1.09; 95% CI, 1.0–1.2; hypertension HR = 1.08; 95% CI, 0.9–1.3). Conclusion Relative to full adherence, CRN is associated with higher mortality rates for patients with diabetes, cardiovascular disease, and hypertension, although associations may have weakened since 2011. Policies that increase prescription affordability may decrease mortality for patients experiencing CRN.
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Affiliation(s)
- Sarah C Van Alsten
- Washington University in Saint Louis, George Warren Brown School of Social Work, Public Health, Saint Louis, Missouri.,University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina.,129.5 Purefoy Rd, Chapel Hill, NC 27514.
| | - Jenine K Harris
- Washington University in Saint Louis, George Warren Brown School of Social Work, Public Health, Saint Louis, Missouri
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19
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Márquez-Palacios JH, Yanez-Peñúñuri LY, Salazar-Estrada JG. Relación entre sentido de coherencia y diabetes mellitus: una revisión sistemática. CIENCIA & SAUDE COLETIVA 2020; 25:3955-3967. [DOI: 10.1590/1413-812320202510.34312018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 01/08/2019] [Indexed: 11/22/2022] Open
Abstract
Resumen El objetivo fue sintetizar las mejores evidencias científicas sobre el efecto del sentido de coherencia en el desarrollo de la enfermedad, tratamiento e indicadores biomédicos de control metabólico y desarrollo de complicaciones de personas en riesgo de desarrollar diabetes y en diabéticos. El método utilizado fue la revisión sistemática. Búsqueda y selección por dos revisores independientes en las bases de datos Scopus, Web of Science, PubMed, Ebsco, Science Direct y manuales, disponibles hasta 2017, en español e inglés, en población con edad superior a 18 años. De un total de 154 estudios, 20 artículos fueron incluidos en la revisión sistemática. Más de la mitad de los estudios utilizaron la versión SOC-13 para la verificación del sentido de coherencia y el indicador de control metabólico más frecuente fue la hemoglobina glucosilada. Además, 14, de los 20 estudios, encontraron una relación estadísticamente significativa entre el sentido de coherencia y la diabetes. Se concluye que el sentido de coherencia tiene una fuerte correlación con la diabetes en las diferentes fases de la enfermedad y está relacionado con la reducción del riesgo para el desarrollo de la enfermedad, la reducción de los valores de hemoglobina glucosilada y la aparición de complicaciones de la diabetes mellitus.
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20
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Diagnosis of complications of type 2 diabetes based on weighted multi-label small sphere and large margin machine. APPL INTELL 2020. [DOI: 10.1007/s10489-020-01824-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Oh A, Kisanuki K, Nishigaki N, Shimasaki Y, Sakaguchi K, Morimoto T. Comparison of persistence and adherence between DPP-4 inhibitor administration frequencies in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study. Curr Med Res Opin 2020; 36:387-395. [PMID: 31778076 DOI: 10.1080/03007995.2019.1699519] [Citation(s) in RCA: 4] [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] [Indexed: 02/01/2023]
Abstract
Objective: To explore persistence and adherence with once-daily, twice-daily, or once-weekly DPP-4 inhibitors (DPP-4i) in Japanese patients with type 2 diabetes.Methods: This retrospective, longitudinal, observational cohort study used data from the Japanese nationwide hospital-based Medical Data Vision (MDV) administrative claims database. Data were collected for patients given a new DPP-4i prescription between May 2015 and June 2017 with 1-year follow-up until May 2018. Treatment persistence was defined as the total duration of continuous prescription. Adherence to treatment was measured as the proportion of days covered (PDC).Results: A total of 598,419 patients with a prescription for DPP-4i treatment were identified in the MDV database. Of the 39,826 patients who met the inclusion criteria, 82.4% were receiving once-daily DPP-4i, 15.6% twice-daily DPP-4i, and 2.0% once-weekly DPP-4i. Twelve-month persistence rates with once-daily regimens were 66.3% versus 64.7% with twice-daily (p = .1187), and versus 38.8% with once-weekly, regimens (p < .0001) in the overall population (including untreated [UT] and previously treated [PT] patients); 62.8% with once-daily versus 58.3% with twice-daily (p = .0309), and versus 12.3% with once-weekly regimens (p < .0001) in the UT cohort; and 68.6% with once-daily versus 67.9% with twice-daily (p = .5471), and versus 49.1% with once-weekly regimens (p < .0001) in the PT cohort. In the overall population, 97.8% of patients had a mean PDC of 0.97 with once- and twice-daily, and 65.8% of patients had a mean PDC of 0.74 with once-weekly, DPP-4i regimens.Conclusions: Overall, persistence at 12 months was highest in patients receiving once-daily DPP-4i regimens.
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Affiliation(s)
- Akinori Oh
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koichi Kisanuki
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Nobuhiro Nishigaki
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Yukio Shimasaki
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Kazuhiko Sakaguchi
- Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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22
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Noda M, Hayashino Y, Yamazaki K, Suzuki H, Goto A, Kato M, Izumi K, Kobayashi M. A cluster-randomized trial of the effectiveness of a triple-faceted intervention promoting adherence to primary care physician visits by diabetes patients. Sci Rep 2020; 10:2842. [PMID: 32071329 PMCID: PMC7028948 DOI: 10.1038/s41598-020-59588-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/20/2020] [Indexed: 11/09/2022] Open
Abstract
We aimed to assess whether a triple-faceted intervention program administered in the primary care setting could decrease the risk of insufficient adherence to primary care physician (PCP) appointments among this patient population. We conducted a cluster-randomized controlled study to assess the effects of a 1-year intervention. The primary outcome was insufficient adherence to regular PCP attendance for diabetes treatment, defined as failure to visit a PCP within 2 months of an original appointment date. The intervention consisted of mailing patient reminders of their PCP appointments, providing patients with health education aimed at lifestyle modification and benchmarking PCP procedures. Eleven municipal level district medical associations employing 192 PCPs were divided into two subregions for assignment to intervention and control clusters, with 971 and 1,265 patients assigned to the intervention and control groups, respectively. Primary outcome data were available for 2,200 patients. The intervention reduced insufficient adherence to regular PCP appointments by 63% (hazard ratio, 0.37; 95% confidence interval [CI], 0.23-0.58). In conclusion, a triple-faceted intervention program consisting of health education, appointment reminders, and physician benchmarking may decrease the risk of incomplete adherence to regular PCP appointments by diabetes patients.
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Affiliation(s)
- Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, 6-1-14 Kounodai, Ichikawa, Chiba, Japan. .,Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan.
| | - Yasuaki Hayashino
- Department of Endocrinology, Tenri Hospital, 200 Mishimacho, Tenri, Nara, Japan.,Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine, Yoshida-konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Katsuya Yamazaki
- First Department of Internal Medicine, Faculty of Medicine, Toyama University, 2630 Sugitani, Toyama, Toyama, Japan.,Kawai Clinic, 715-1 Higashihiratsuka, Tsukuba, Ibaraki, Japan
| | - Hikari Suzuki
- First Department of Internal Medicine, Faculty of Medicine, Toyama University, 2630 Sugitani, Toyama, Toyama, Japan.,Japan Community Health care Organization Takaoka Fushiki Hospital, 8-5 Fushiki Kofumotomachi, Takaoka, Toyama, Japan
| | - Atsushi Goto
- Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan.,Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Masayuki Kato
- Toranomon Hospital Health Management Center and Diagnostic Imaging Center, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Kazuo Izumi
- Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Masashi Kobayashi
- First Department of Internal Medicine, Faculty of Medicine, Toyama University, 2630 Sugitani, Toyama, Toyama, Japan.,Japan Community Health care Organization Takaoka Fushiki Hospital, 8-5 Fushiki Kofumotomachi, Takaoka, Toyama, Japan
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24
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Beltrán S, Lett E, Cronholm PF. Nonadherence Labeling in Primary Care: Bias by Race and Insurance Type for Adults With Type 2 Diabetes. Am J Prev Med 2019; 57:652-658. [PMID: 31564598 DOI: 10.1016/j.amepre.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little is known about how provider bias can influence nonadherence labeling. Therefore, a retrospective cohort analysis was conducted to assess the risk of patients with Type 2 diabetes being labeled nonadherent by sociodemographic factors. METHODS Patients with Type 2 diabetes were identified from 4 primary care sites of the University of Pennsylvania Health System. Demographics, HbA1c, and ICD-10 codes for Type 2 diabetes and nonadherence were extracted from the electronic health record and analyzed in October 2017. Log-binomial regression models were used to estimate patients' risk of nonadherence labeling by race, age, sex, BMI, and insurance payer while controlling for HbA1c as a proxy for medication use. RESULTS This study included 3,768 adults aged 18-70 years with Type 2 diabetes who received care from 1 of 4 primary care sites at University of Pennsylvania from 2014 to 2017. An increased risk was found for black patients relative to white patients (RR=2.86, 95% CI=1.91, 4.27) and Medicaid (RR=1.8, 95% CI=1.45, 2.22) or Medicare (RR=1.69, 95% CI=1.36, 2.1) relative to private insurance to be labeled as nonadherent while adjusting for HbA1c. Though statistically insignificant, Hispanic patients also showed increased risk of nonadherence labeling. BMI, age, and sex showed no association. CONCLUSIONS Black race and nonprivate insurance status were shown to be associated with increased risk of nonadherence labeling. The findings may indicate a concerning bias among providers in their perception of patient behavior by race and insurance.
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Affiliation(s)
- Sourik Beltrán
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter F Cronholm
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Horii T, Momo K, Yasu T, Kabeya Y, Atsuda K. Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan. PLoS One 2019; 14:e0223431. [PMID: 31593574 PMCID: PMC6782087 DOI: 10.1371/journal.pone.0223431] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan. Methods This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient’s possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications. Results Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50–<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period. Conclusions We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50–<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.
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Affiliation(s)
- Takeshi Horii
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Kanagawa, Japan
- * E-mail:
| | - Kenji Momo
- Department of Pharmacy, The Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Hospital Pharmaceutics, School of pharmacy, Showa University, Tokyo, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Tokyo, Japan
| | - Yusuke Kabeya
- Department of Home Care Medicine, Sowa Hospital, Kanagawa, Japan
| | - Koichiro Atsuda
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Kanagawa, Japan
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Saraswati K, Sichanh C, Newton PN, Caillet C. Quality of medical products for diabetes management: a systematic review. BMJ Glob Health 2019; 4:e001636. [PMID: 31637025 PMCID: PMC6768360 DOI: 10.1136/bmjgh-2019-001636] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 11/04/2022] Open
Abstract
Background The global prevalence of diabetes mellitus is increasing alarmingly. However, the quality of vital medicines and medical products used to treat and monitor diabetes remains uncertain but of potential great public health significance. Here, we review the available evidence on the quality of antidiabetic medicines and supplies for self-monitoring of blood glucose (SMBG) and discuss their potential impact for the patients and society. Methods Searches were conducted in PubMed, Embase, Google Scholar, Google and relevant websites in English and French. The Medicine Quality Assessment Reporting Guideline (MEDQUARG) was used to assess the quality of medicine quality surveys. Results 52 publications on the quality of antidiabetic medicines, including 5 medicine quality prevalence surveys and 20 equivalence studies, were analysed. The prevalence surveys and equivalence studies included 674 samples of which 73 (10.8%) were of poor quality. The median (Q1-Q3) concordance with MEDQUARG items was 30.8% (19.2%-42.3%). No prevalence surveys on SMBG supplies' quality were found, but 29 publications, including falsified products and incorrect results due to strip degradation or contamination, were identified. Conclusion There is little accessible evidence on the quality of antidiabetic medicines and SMBG supplies. Surveys were poorly designed and reported, making data aggregation and interpretation problematic. Despite these caveats, these results suggest that there are important issues with the quality of medical products for diabetes that need focused monitoring. There is an urgent need to achieve consensus protocols for designing, conducting and reporting medical product quality surveys. PROSPERO registration number CRD42016039841.
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Affiliation(s)
- Kartika Saraswati
- Lao-Oxford-Mahosot-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory/WorldWide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Chanvilay Sichanh
- Lao-Oxford-Mahosot-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Paul N Newton
- Lao-Oxford-Mahosot-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory/WorldWide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Céline Caillet
- Lao-Oxford-Mahosot-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory/WorldWide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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27
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Horii T, Iwasawa M, Kabeya Y, Atuda K. Polypharmacy and oral antidiabetic treatment for type 2 diabetes characterised by drug class and patient characteristics: A Japanese database analysis. Sci Rep 2019; 9:12992. [PMID: 31506542 PMCID: PMC6736933 DOI: 10.1038/s41598-019-49424-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/23/2019] [Indexed: 11/09/2022] Open
Abstract
Polypharmacy (PP) occurs in patients with type 2 diabetes (T2DM) owing to multimorbidity. We evaluated concomitant PP and medication adherence in T2DM 3 years after initiation of administration of a hypoglycaemic agent using a nationwide claim-based database in Japan. Factors associated with medication PP and imperfect adherence were identified using multivariable logistic regression. PP was defined as using ≥6 medications. Patients with proportion of days covered (PDC) of <80% were defined as having poor medication adherence. A total of 884 patients were analysed. Multivariate analysis revealed that age, total number of consultations and body mass index (BMI) are factors that influence PP. Factors associated with PDC < 80% were 2–3, 4–5 and ≥ 6 medications compared with 1 medication, male sex, <17 consultations and age 50–59 and ≥ 60 years compared with <40 years. In conclusion, older age, high total number of consultations and BMI ≥ 25 kg/m2 are risk factors for PP. PP influenced good medication adherence at the end of the observation period.
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Affiliation(s)
- Takeshi Horii
- Division of Clinical Pharmacy (Laboratory of Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan.
| | - Makiko Iwasawa
- Division of Clinical Pharmacy (Laboratory of Drug Information) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan
| | - Yusuke Kabeya
- Sowa Hospital, Department of Home Care Medicine, Sagamihara, Kanagawa, Japan
| | - Koichiro Atuda
- Division of Clinical Pharmacy (Laboratory of Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan
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Nishi T, Babazono A, Maeda T. Association between income levels and irregular physician visits after a health checkup, and its consequent effect on glycemic control among employees: A retrospective propensity score-matched cohort study. J Diabetes Investig 2019; 10:1372-1381. [PMID: 30758145 PMCID: PMC6717811 DOI: 10.1111/jdi.13025] [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: 12/04/2018] [Revised: 01/23/2019] [Accepted: 02/11/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS/INTRODUCTION The present study aimed to evaluate the effects of income levels on physician visit patterns and to quantify the consequent impact of irregular physician visits on glycemic control among employees' health insurance beneficiaries in Japan. MATERIALS AND METHODS We obtained specific health checkup data of untreated diabetes patients from the Fukuoka branch of the Japanese Health Insurance Association. We selected 2,981 insurance beneficiaries and classified 650 and 2,331 patients into, respectively, the regular visit and irregular visit group. We implemented propensity score matching to select an adequate control group. RESULTS Compared with those with a standard monthly income <$2,000 (US$1 = ¥100), those with a higher monthly income were less likely to have irregular visits; $2,000-2,999: odds ratio 0.74 (95% confidence interval 0.56-0.98), $3,000-3,999: odds ratio 0.63 (95% confidence interval 0.46-0.87) and ≥$5,000: odds ratio 0.58 (95% confidence interval 0.39-0.86). After propensity score matching and adjusting for covariates, the irregular visit group tended to have poor glycemic control; increased glycated hemoglobin ≥0.5: odds ratio 1.90 (95% confidence interval 1.30-2.77), ≥1.0: odds ratio 2.75 (95% confidence interval 1.56-4.82) and ≥20% relatively: odds ratio 3.18 (95% confidence interval 1.46-6.92). CONCLUSIONS We clarified that there was a significant relationship between income and irregular visits, and this consequently resulted in poor glycemic control. These findings would be useful for more effective disease management.
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Affiliation(s)
- Takumi Nishi
- Department of Research Planning and Information ManagementFukuoka Institute of Health and Environmental SciencesFukuokaJapan
| | - Akira Babazono
- Department of Health Care Administration and ManagementGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshiki Maeda
- Department of Public Health and Preventive MedicineFukuoka UniversityFukuokaJapan
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Balkhi B, Alwhaibi M, Alqahtani N, Alhawassi T, Alshammari TM, Mahmoud M, Almetwazi M, Ata S, Kamal KM. Oral antidiabetic medication adherence and glycaemic control among patients with type 2 diabetes mellitus: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open 2019; 9:e029280. [PMID: 31340969 PMCID: PMC6661664 DOI: 10.1136/bmjopen-2019-029280] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The purpose of this study is to measure the adherence rates of oral antidiabetic drugs (OADs) in patients with type 2 diabetes mellitus (T2DM) and assess the relationship of glycaemic control and adherence to OADs after controlling for other associated factors. DESIGN Cross-sectional retrospective study. SETTING Large tertiary hospital in the central region of Saudi Arabia. PARTICIPANTS 5457patients aged 18 years and older diagnosed with T2DM during the period from 1 January 2016 to 31 December 2016. PRIMARY AND SECONDARY OUTCOME MEASURES The modified medication possession ratio (mMPR) was calculated as a proxy measure for adherence of OADs. The factors associated with OADs non-adherence and medication oversupply were assessed using multinomial logistic regression models. The secondary outcomes were to measure the association between OADs adherence and glycaemic control. RESULTS Majority of patients with T2DM were females (n=3400, 62.3%). The average glycated haemoglobin was 8.2±1.67. Among the study population, 48.6% had good adherence (mMPR >0.8) and 8.6% had a medication oversupply (mMPR >1.2). Good adherence was highest among those using repaglinide (71.0%) followed by pioglitazone (65.0%) and sitagliptin (59.0%). In the multivariate analysis, women with T2DM were more likely to have poor adherence (adjusted OR (AOR)=0.76, 95% CI=0.67, 0.86) compared with men. Also, medication oversupply was more likely among patients with hyperpolypharmacy (AOR=1.88, 95% CI=1.36, 2.63), comorbid osteoarthritis (AOR=1.72, 95% CI=1.20, 02.45) and non-Saudi patients (AOR=1.53, 95% CI=1.16, 2.01). However, no association was found between glycaemic control and adherence to OADs. CONCLUSION The study findings support the growing concern of non-adherence to OADs among patients with T2DM in Saudi Arabia. Decision makers have to invest in behavioural interventions that will boost medication adherence rates. This is particularly important in patients with polypharmacy and high burden of comorbid conditions.
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Affiliation(s)
- Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nasser Alqahtani
- Drug Sector, Saudi Food and Drug Authority, Riyadh, Riyadh, Saudi Arabia
| | - Tariq Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Thamir M Alshammari
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Mansour Mahmoud
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Mansour Almetwazi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sondus Ata
- Investigational Drugs and Research Unit, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Khalid M Kamal
- Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, USA
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Pereira MDG, Ferreira G, Machado JC, Pedras S. Beliefs about medicines as mediators in medication adherence in type 2 diabetes. Int J Nurs Pract 2019; 25:e12768. [PMID: 31328394 DOI: 10.1111/ijn.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 02/01/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
AIMS This study analysed whether beliefs about medicines mediated the relationship between illness representations and medication adherence. BACKGROUND Adherence to medication is required in diabetes treatment, contributing to decreased blood glycaemic levels. The knowledge and perception of patients about diabetes as well as the beliefs about medicines are considered to be key factors for medication adherence. DESIGN The study used a cross-sectional design that included 387 patients recently diagnosed with type 2 diabetes. METHODS Participants were assessed, between 2010 and 2013, and answered the Medication Adherence Scale, the Beliefs about Medicines Questionnaire, and the Brief Illness Perception Questionnaire. RESULTS The results of the path analysis showed that beliefs about medicines had a mediating role on self-report medication adherence with the exception of beliefs about specific concerns with medicines. Therefore, both general beliefs and specific needs about medicines mediated the relationship between diabetes consequences and self-report medication adherence as well as between treatment control and self-report medication adherence. Needs about medicines mediated the relationship between personal control and self-report medication adherence. CONCLUSION Health professionals should target beliefs about medicines besides illness representations regarding medication adherence. The current study may help optimize adherence to medication in early-diagnosed type 2 diabetes patients.
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Affiliation(s)
| | - Gabriela Ferreira
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - José C Machado
- Institute of Social Sciences, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Susana Pedras
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
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Nishimura R, Kato H, Kisanuki K, Oh A, Hiroi S, Onishi Y, Guelfucci F, Shimasaki Y. Treatment patterns, persistence and adherence rates in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study. BMJ Open 2019; 9:e025806. [PMID: 30826768 PMCID: PMC6429930 DOI: 10.1136/bmjopen-2018-025806] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine real-world trends in antidiabetic drug use, and persistence and adherence, in Japanese patients with type 2 diabetes mellitus (T2DM). DESIGN Retrospective evaluation of administrative claims data (2011-2015) using the Japan Medical Data Center (JMDC) and Medical Data Vision (MDV) databases. SETTING Analysis of two administrative claims databases for Japanese patients with T2DM. PARTICIPANTS Adults (aged ≥18 years) with an International Classification of Diseases, 10th Revision code of T2DM and at least one antidiabetic drug prescription. MAIN OUTCOME MEASURES Treatment patterns in untreated (UT) or previously treated (PT) patients receiving antidiabetic therapy; persistence with treatment at 12 months; adherence to treatment at 12 months. RESULTS 40 908 and 90 421 patients were included from the JMDC and MDV databases, respectively. The most frequently prescribed therapy at the index (first prescription) date was dipeptidyl peptidase-4 inhibitor (DPP-4i) in UT patients (JMDC: 44.0%, MDV: 54.8%) and combination therapy in PT patients (74.6%, 81.1%). Most common combinations were DPP-4i plus: biguanide (BG; 11.4%, 10.9%), sulfonylurea (SU; 8.4%, 11.0%) or BG+SU (7.8%, 9.1%). In UT or PT patients from either database whose index prescription was for any antidiabetic drug class(es) other than DPP-4i, the most frequent add-on or switch was to DPP-4i. 12-month persistence with index monotherapy was highest with DPP-4i and BG. Adherence was high (≥80%) for all monotherapy schedules, except insulin and glucagon-like peptide-1 agonist, and for the five most frequent two-drug and three-drug combinations. Persistence was greater in elderly UT patients and in those receiving ≤5 medications, but comparatively worse in UT patients with ≥3 index antidiabetic drug classes. CONCLUSIONS The findings indicate that DPP-4i is the most commonly used antidiabetic drug class in Japanese patients with T2DM, and persistence and adherence to this antidiabetic drug class are high.
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Affiliation(s)
| | - Haruka Kato
- Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Koichi Kisanuki
- Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Akinori Oh
- Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Shinzo Hiroi
- Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | | | | | - Yukio Shimasaki
- Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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32
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MUTO G, ISHII-NAKAMURA R, YOKOYAMA K, KITAMURA F, OMORI Y, SAITO M, ENDO M. Information exchange using a prescribed form and involvement of occupational health nurses promotes occupational physicians to collaborate with attending physicians for supporting workers with illness in Japan. INDUSTRIAL HEALTH 2019; 57:10-21. [PMID: 29269602 PMCID: PMC6363580 DOI: 10.2486/indhealth.2017-0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Abstract
The maintenance of a balance between work and disease treatment is an important issue in Japan. This study explored factors that affect collaboration between occupational physicians (OPs) and attending physicians (APs). A questionnaire was mailed to 1,102 OPs. The questionnaire assessed the demographic characteristics of OPs; their opinions and behaviors related to collaboration, including the exchange of medical information with APs; and the occupational health service system at their establishments. In total, 275 OPs completed the questionnaire (25.0% response rate). Over 80% of respondents believed OPs should collaborate with APs. After adjusting for company size, collaboration ≥10 times/yr (with regard to both returning to work following sick leave and annual health check-ups for employees) was significantly associated with environmental factors, such as the presence of occupational health nurses (odds ratio (OR): 5.56 and 5.01, respectively, p<0.05) and the use of prescribed forms for information exchange (OR: 4.21 and 3.63, respectively, p<0.05) but not with the demographic characteristics of the OPs (p>0.05). The majority of OPs believed that collaboration with APs is important for supporting workers with illnesses. Support systems including prescribed forms of information exchange and occupational health nurses, play pivotal roles in promoting this collaboration.
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Affiliation(s)
- Go MUTO
- Department of Epidemiology and Environmental Health, Juntendo
University Faculty of Medicine, Japan
- Department of Global Health and Population, Harvard T.H. Chan
School of Public Health, USA
| | - Rina ISHII-NAKAMURA
- Department of Epidemiology and Environmental Health, Juntendo
University Faculty of Medicine, Japan
| | - Kazuhito YOKOYAMA
- Department of Epidemiology and Environmental Health, Juntendo
University Faculty of Medicine, Japan
| | - Fumihiko KITAMURA
- Department of Epidemiology and Environmental Health, Juntendo
University Faculty of Medicine, Japan
| | - Yuki OMORI
- Department of Hygiene, Kitasato University School of
Medicine, Japan
| | | | - Motoki ENDO
- Department of Public Health, Tokyo Women’s Medical
University, Japan
- Department of Public Health, Juntendo University Faculty of
Medicine, Japan
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Meng X, Gao W, Wang K, Han C, Zhang W, Sun C. Adherence to medical regimen after pediatric liver transplantation: a systematic review and meta-analysis. Patient Prefer Adherence 2019; 13:1-8. [PMID: 30587939 PMCID: PMC6301298 DOI: 10.2147/ppa.s181195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Adherence to the medical regimen after pediatric liver transplantation is crucial for good clinical outcomes. However, the existing literature provides inconsistent evidence regarding the prevalence of and risk factors for nonadherence to the medical regimen after pediatric liver transplantation. This study aimed to investigate such nonadherence after pediatric liver transplantation and risk factors associated with this nonadherence using findings of reported studies. METHODS The electronic databases of Excerpta Medica, Ovid Technologies, PubMed and WanFang Data were searched using the keywords "adherence", "liver transplant" and "paediatric". Additionally, relevant references cited in related studies were used to obtain original articles. Using 22 original articles, data regarding nonadherence to the medical regimen after pediatric liver transplantation were quantitatively combined, and risk factors associated with nonadherence were qualitatively identified. Average rates of nonadherence in four areas of medical regimens were calculated. The heterogeneity of the included original articles was also analyzed. When I 2>50 and P<0.05, a random effects model was used; otherwise, a fixed effects model was used. Moreover, Egger's and Begg's tests were used to evaluate publication bias, if any, and original articles with P>0.05 were considered to have no publication bias. RESULTS The clinical attendance nonadherence rate was 45% (95% confidence interval [CI]: 39-51), global nonadherence rate was 17% (95% CI: 13-21) and immunosuppression non-adherence rates were 39% (95% CI: 26-52) and 34% (95% CI: 30-39) for cyclosporine and tacrolimus, respectively. Risk factors included older age of the pediatric patient, low family cohesion, poor social functioning, poor mental health and single-parent family. CONCLUSIONS The nonadherence rate in pediatric liver transplantation is high. Therefore, intervention on the basis of risk factors, such as mental health and family function, may be necessary. Moreover, a standard technique for assessing nonadherence to the medical regimen after pediatric liver transplantation, comprising as many dimensions as possible, is required in order to be more objective and comprehensive when assessing nonadherence.
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Affiliation(s)
- Xingchu Meng
- Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin, China,
| | - Wei Gao
- Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin, China,
| | - Kai Wang
- Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin, China,
| | - Chao Han
- Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin, China,
| | - Wei Zhang
- Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin, China,
| | - Chao Sun
- Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin, China,
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Patel S, Abreu M, Tumyan A, Adams-Huet B, Li X, Lingvay I. Effect of medication adherence on clinical outcomes in type 2 diabetes: analysis of the SIMPLE study. BMJ Open Diabetes Res Care 2019; 7:e000761. [PMID: 31803482 PMCID: PMC6887507 DOI: 10.1136/bmjdrc-2019-000761] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/28/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Medication adherence is impacted by regimen complexity. The SIMPLE (Simple basal Insulin titration, Metformin Plus Liraglutide for type 2 diabetes with very Elevated HbA1c) study compared GLP1RA plus basal insulin (GLP1RA+BI) to basal-bolus insulin (BBI) regimen in participants with very uncontrolled type 2 diabetes mellitus (T2DM). This analysis aimed to evaluate medication adherence to GLP1RA+BI compared with BBI, the effect of adherence on clinical and patient-reported outcomes, and baseline predictors of adherence. RESEARCH DESIGN AND METHODS This was an analysis of the SIMPLE study based on prespecified outcome. The study took place in pragmatic, real-world setting. A total of 120 adults with T2DM and HgbA1c≥10% were randomized to detemir plus liraglutide, or detemir plus aspart before each meal; 6-month follow-up. The main outcomes evaluated were: adherence, HgbA1c, weight, quality of life, and hypoglycemia. Adherence rate was calculated for each study medication at each follow-up visit; participants were classified as ≥80% or <80% adherent. RESULT A higher percentage of participants in the GLP1RA+BI compared with the BBI group had ≥80% adherence to detemir (59.3% vs 35.7%, p=0.02) as well as liraglutide versus aspart (57.4% vs 30.4%, p=0.007). Higher age was predictive of ≥80% adherence (OR per 5-year increment=1.48, 95% CI 1.09 to 2.0, p=0.01). Higher adherence led to greater improvement in HbA1c and weight in both groups. Treatment with GLP1RA+BI compared with BBI led to greater improvement in HbA1c, weight, and quality of life and lower risk of hypoglycemia even after adjusting for the difference in adherence between groups. CONCLUSIONS Adherence was higher with the simplified regimen of GLP1RA+BI compared with BBI. Greater adherence to the simpler regimen amplified the treatment effect on HbA1c, weight, quality of life, and risk of hypoglycemia, yet statistically significant greater benefits were noted even when adjusted for adherence. TRIAL REGISTRATION NUMBER NCT01966978.
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Affiliation(s)
- Sapna Patel
- Endocrinology, Diabetes and Metabolism, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Marconi Abreu
- Endocrinology, Diabetes and Metabolism, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Anna Tumyan
- Endocrinology, Diabetes and Metabolism, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Beverley Adams-Huet
- Population and Data Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Xilong Li
- Population and Data Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Ildiko Lingvay
- Endocrinology, Diabetes and Metabolism, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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Abstract
Early-onset dementia (EOD) affects the employment of patients and family members. To demonstrate how likely employees are to leave their jobs after an EOD diagnosis for themselves or a family member, we conducted a matched cohort study of 143 employees and 77 family members diagnosed with EOD using a claims database. We matched these participants to 5 controls each, and followed them for approximately 600 days. In the employee cohort, patients with EOD were more likely to leave their jobs than were controls (hazard ratio: 2.26). This suggests that healthcare providers should offer employment support to patients just after diagnosis.
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Affiliation(s)
- Nobuo Sakata
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Yasuyuki Okumura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
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