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Mohamad M, Moussally K, Lakis C, El-Hajj M, Bahous S, Peruzzo C, Reid A, Edwards JK. Self-reported medication adherence among patients with diabetes or hypertension, Médecins Sans Frontières Shatila refugee camp, Beirut, Lebanon: A mixed-methods study. PLoS One 2021; 16:e0251316. [PMID: 33970972 PMCID: PMC8109801 DOI: 10.1371/journal.pone.0251316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/25/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Low adherence to medications, specifically in patients with Diabetes (DM) and Hypertension (HTN), and more so in refugee settings, remains a major challenge to achieving optimum clinical control in these patients. We aimed at determining the self-reported medication adherence prevalence and its predictors and exploring reasons for low adherence among these patients. Methods A mixed-methods study was conducted at Médecins Sans Frontières non-communicable diseases primary care center in the Shatila refugee camp in Beirut, Lebanon in October 2018. Data were collected using the validated Arabic version of the 8-items Morisky Medication Adherence Scale (MMAS-8) concurrently followed by in-depth interviews to explore barriers to adherence in patients with DM and/or HTN. Predictors of adherence were separately assessed using logistic regression with SPSS© version 20. Manual thematic content analysis was used to analyze the qualitative data. Results Of the 361 patients included completing the MMAS, 70% (n = 251) were moderately to highly adherent (MMAS-8 score = 6 to 8), while 30% (n = 110) were low-adherent (MMAS-8 score<6). Patients with DM-1 were the most likely to be moderately to highly adherent (85%; n = 29). Logistic regression analysis showed that patients with a lower HbA1C were 75% more likely to be moderately to highly adherent [(OR = 0.75 (95%CI 0.63–0.89), p-value 0.001]. Factors influencing self-reported moderate and high adherence were related to the burden of the disease and its treatment, specifically insulin, the self-perception of the disease outcomes and the level of patient’s knowledge about the disease and other factors like supportive family and healthcare team. Conclusion Adherence to DM and HTN was good, likely due to a patient-centered approach along with educational interventions. Future studies identifying additional factors and means addressing the barriers to adherence specific to the refugee population are needed to allow reaching optimal levels of adherence and design well-informed intervention programs.
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Affiliation(s)
- Mariam Mohamad
- Field mission, Médecins Sans Frontières, Operational Center Brussels, Shatila, Beirut, Lebanon
- * E-mail:
| | - Krystel Moussally
- Lebanon branch office, Médecins Sans Frontières, Beirut, Lebanon
- Middle-East Medical Unit (MEMU), Médecins Sans Frontières, Beirut, Lebanon
| | - Chantal Lakis
- Coordination, Médecins Sans Frontières, Operational Center Brussels, Beirut, Lebanon
| | - Maya El-Hajj
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Sola Bahous
- School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Carla Peruzzo
- Coordination, Médecins Sans Frontières, Operational Center Brussels, Beirut, Lebanon
| | - Anthony Reid
- Operational Research Unit, Médecins Sans Frontières, Operational Center Brussels, Luxembourg City, Luxembourg
| | - Jeffrey K. Edwards
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Abu-Ashour W, Chibrikova L, Midodzi WK, Twells LK, Gamble JM. Factors associated with early insulin initiation in Type 2 diabetes: a Canadian cross-sectional study. Diabet Med 2017; 34:229-234. [PMID: 26802577 DOI: 10.1111/dme.13082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/23/2023]
Abstract
AIM To examine the patient characteristics associated with early initiation of insulin after a diagnosis of Type 2 diabetes. METHODS We analysed cross-sectional data from the 2012 Canadian Community Health Survey conducted by Statistics Canada. Multivariable logistic regression was used to explore the association between patient sociodemographic and health status characteristics and initiating insulin within 1 year of a diagnosis of Type 2 diabetes (early insulin use). RESULTS Weighted estimates for the Canadian population showed that 32% of patients with Type 2 diabetes initiated insulin within 1 year of their diagnosis. Of the insulin initiators, 52% were female and 68% were aged ≥60 years. Factors strongly associated with early initiation of insulin were age (60-69 years: adjusted odds ratio 1.89, 95% CI 1.84-1.94; ≥ 70 years, odds ratio 2.08, 95% CI 2.01-2.15, both vs 40-49 years); smoking (smoker vs never: odds ratio 2.39, 95% CI 2.32-2.46); geography (Western Canada: odds ratio 2.75, 95% CI 2.69-2.81; Quebec: odds ratio 2.20, 95% CI 2.13-2.27, both vs Ontario); mental health (poor vs excellent: odds ratio 1.98, 95% CI 1.92-2.04); BMI (overweight vs normal/underweight: odds ratio 1.63, 95% CI 1.58-1.67); oral antidiabetic medication use (yes vs no: odds ratio 0.66, 95% CI 0.65-0.68); and alcohol use (regular vs non-drinker: odds ratio 0.66, 95% CI 0.65-0.68). CONCLUSION One-third of the study population with Type 2 diabetes initiated insulin within their first year of diagnosis. Age, smoking status, geographical location, mental health, BMI, education, oral antidiabetic medication use, employment, physical activity, language, doctor visits and alcohol consumption were associated with timing of insulin initiation.
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Affiliation(s)
- W Abu-Ashour
- School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada
| | - L Chibrikova
- School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada
| | - W K Midodzi
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - L K Twells
- School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - J-M Gamble
- School of Pharmacy, Memorial University of Newfoundland, St. John's, NL, Canada
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Li J, Feng Z, Li Q, He Y, Zhao C, He J. Insulin glargine effectively achieves glycemic control and improves insulin resistance in patients with early type 2 diabetes that exhibit a high risk for cardiovascular disease. Exp Ther Med 2014; 8:147-152. [PMID: 24944613 PMCID: PMC4061209 DOI: 10.3892/etm.2014.1688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/13/2014] [Indexed: 01/08/2023] Open
Abstract
In the present study, the clinical efficacy and safety of administering insulin glargine to early type 2 diabetes (T2D) mellitus patients with a high risk for cardiovascular disease were assessed. A total of 42 early T2D patients at a high risk for cardiovascular disease were randomly divided into an insulin-glargine group and a standard-care group. The patients in the insulin-glargine group received oral antidiabetic agents plus glargine once a day via a subcutaneous injection. The patients in the standard-care group were administered oral antidiabetic agents according to the diabetic treatment guidelines. The median follow-up period was 6.4 years. Comparisons were made between the two groups with regard to levels of plasma glucose, glycosylated hemoglobin (HbA1c) and plasma lipids, the homeostasis model assessment-insulin secretion index (HOMA-β) and HOMA-insulin resistance index (HOMA-IR), as well as the incidence of hypoglycemia, adverse cardiovascular events and body mass index (BMI). The fasting plasma glucose level in the insulin-glargine group was significantly lower than that observed in the standard-care group. However, the levels of 2-h postprandial glucose, HbA1c and plasma lipids, as well as the BMI, were similar when comparing the two groups. Although the level of the HOMA-β did not differ between the two groups, the level of HOMA-IR in the insulin-glargine group was significantly lower than that observed in the standard-care group. During the follow-up period, the incidence of hypoglycemia in the insulin-glargine group was significantly higher when compared with the standard-care group, however, no significant difference in the incidence of adverse cardiovascular events was observed. Therefore, the results of the present study indicated that insulin glargine may effectively achieve glycemic control and improve insulin resistance without increasing the risk for cardiovascular events in early T2D patients that were considered to be at a high risk for cardiovascular disease.
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Affiliation(s)
- Jiling Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Zhengping Feng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Yan He
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Changhong Zhao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Jun He
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Prevención de diabetes mellitus 2. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mittendorf T, Smith-Palmer J, Timlin L, Happich M, Goodall G. Evaluation of exenatide vs. insulin glargine in type 2 diabetes: cost-effectiveness analysis in the German setting. Diabetes Obes Metab 2009; 11:1068-79. [PMID: 19732121 DOI: 10.1111/j.1463-1326.2009.01099.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this analysis was to determine the cost-effectiveness of exenatide vs. insulin glargine in patients with type 2 diabetes failing to achieve glycaemic control with oral antidiabetic agents, in the German setting, from a third-party payer perspective. METHODS Data from a published randomized controlled trial were used in combination with a published, validated computer simulation model of type 2 diabetes to project clinical and cost outcomes over a time horizon of 10 years. Cost data were obtained from published literature and expert opinion. Clinical and cost outcomes were discounted at 5% per annum. Sensitivity analyses were performed to establish key drivers and parameters. RESULTS Treatment with exenatide compared with insulin glargine was projected to be associated with improvements in life expectancy of 0.016 years and quality-adjusted life expectancy of 0.280 quality-adjusted life years (QALYs), increased lifetime direct medical costs of euro 3854 (euro 22 095 vs. euro 18 242) and an incremental cost-effectiveness ratio (ICER) of euro 13 746 per QALY. If quality of life was not taken into account, exenatide was associated with an ICER of euro 238 201 per life year gained vs. insulin glargine. Sensitivity analyses revealed that outcomes were most sensitive to changes in assumptions for (dis)utility values relating to weight change and the rate of self-monitored blood glucose testing. CONCLUSIONS Exenatide was projected to be associated with similar clinical outcomes and increased costs compared with insulin glargine. Analysis of cost-effectiveness from a third-party perspective suggests that exenatide is likely to represent good value for money in the German setting.
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Affiliation(s)
- T Mittendorf
- Center for Health Economics, Gottfried Wilhelm Leibniz University, Hannover, Germany
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Affiliation(s)
- Jean-Louis Chiasson
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Medicine, Université de Montréal, Montreal, Canada. Jean-Louis Chiasson,
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Blake EW, Sease JM. Effect of Diabetes Medications on Cardiovascular Risk and Surrogate Markers in Patients with Type 2 Diabetes. J Pharm Technol 2009. [DOI: 10.1177/875512250902500105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:To evaluate the effect of diabetes medications on the risk of cardiovascular disease and surrogate markers.Data Sources:Literature was accessed through MEDLINE (1950–July 2008) and PubMed using multiple terms for diabetes, cardiovascular risk, surrogate markers, and diabetes medications. In addition, reference citations from publications were reviewed.Study Selection and Data Extraction:English-language articles that met the above criteria, with clinical relevance, were evaluated.Data Synthesis:Evidence regarding the effect of diabetes medications on cardiovascular risk is sparse, with information on their effects on surrogate markers more widely available. Recent evidence demonstrates that glycemic control alone may not reduce the risk of macrovascular events. Multiple trials were reviewed to determine the effect of diabetes medications on this risk, as well as the effect on surrogate markers (eg, blood pressure, cholesterol, body weight). Metformin and acarbose demonstrated significant reductions in macrovascular events, including myocardial infarction. Data regarding sulfonylureas, thiazolidinediones, and insulin are conflicting. Pioglitazone may reduce cardiovascular events, except heart failure, whereas rosiglitazone may increase these events. Until direct evidence can be obtained, the full effect of diabetes medications on cardiovascular risk is unknown.Conclusions:Current literature provides little support that diabetes medications may lower the risk of cardiovascular events while some agents may increase this risk. Of the drugs available, metformin may be the least detrimental. Current literature regarding other diabetes medications provides conflicting results on their effect on cardiovascular outcomes. In the meantime, practitioners should treat all targets of cardiovascular risk in patients with diabetes.ACPE Universal Program Numbers:407-000-09-050-H01-P (Pharmacists); 407-000-09-050-H01-T (Technicians)
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Affiliation(s)
- Elizabeth W Blake
- ELIZABETH W BLAKE PharmD BCPS, Clinical Assistant Professor, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina Campus, Columbia, SC
| | - Julie M Sease
- JULIE M SEASE PharmD BCPS CDE, Clinical Assistant Professor, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina Campus
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Gerstein H, Yusuf S, Riddle MC, Ryden L, Bosch J. Rationale, design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). Am Heart J 2008; 155:26-32, 32.e1-6. [PMID: 18082485 DOI: 10.1016/j.ahj.2007.09.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 09/21/2007] [Indexed: 01/01/2023]
Abstract
AIMS Impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes arise due to insufficient insulin secretion and are risk factors for cardiovascular (CV) events. Thus, targeting normal fasting glucose levels with insulin may reduce CV events. Previous studies suggest that omega-3 fatty acid supplements may reduce CV death; however, their effect in high-risk dysglycemic individuals is not known. METHODS People aged > or = 50 years with evidence of CV disease and with IFG, IGT, newly detected or established diabetes (on 0 or 1 oral agent), and a local glycated hemoglobin < 150% of the upper limit of normal for that assay were recruited and allocated to (a) either 1 daily injection of insulin glargine with the dose titrated to achieve a fasting plasma glucose < or = 5.3 mmol/L (95 mg/dL), or standard glycemic care; and (b) either omega-3-acid ethyl esters 90 (1 g consisting of EPA 465 mg and DHA 375 mg) or identical placebo, according to a 2 x 2 factorial design. The 2 different primary outcomes for the insulin and omega-3 fatty acid arms are CV events and CV death, respectively. RESULTS A total of 12,612 (mean age 64, 35% women) people in 40 countries were randomized during a 2-year period ending December 2005. Eighty-two percent had established diabetes, 6% had new diabetes, and 12% had IGT or IFG; the mean fasting plasma glucose was 7.3 mmol/L (131 mg/dL). CONCLUSIONS The ORIGIN trial will determine whether or not either or both of these interventions can reduce CV events.
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Kruger DF. Tying it all together: matching insulin regimens to individual patient needs. DIABETES EDUCATOR 2007; 33 Suppl 4:91S-95S. [PMID: 17485417 DOI: 10.1177/0145721707302s060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scheen AJ. Antidiabetic agents in subjects with mild dysglycaemia: prevention or early treatment of type 2 diabetes? DIABETES & METABOLISM 2007; 33:3-12. [PMID: 17258489 DOI: 10.1016/j.diabet.2006.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 11/01/2006] [Indexed: 10/23/2022]
Abstract
Besides lifestyle, various pharmacological treatments have proven their efficacy to reduce the incidence of type 2 diabetes in high-risk individuals, especially in those with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG). Major placebo-controlled clinical trials demonstrated favourable effects of various glucose-lowering drugs generally used for the treatment of type 2 diabetes, i.e. metformin, acarbose and thiazolidinediones (glitazones). These trials showed a lower rate of progression to overt diabetes and a higher regression rate to a normal glucose status with active treatment as compared to placebo after a follow up of several years. Ongoing trials should confirm such a favourable effect with those drugs and may demonstrate a similar protective effect with other pharmacological approaches such as glinides or even basal insulin regimen. However, the reported favourable effects were generally observed while the subjects were still on treatment, and partially vanished after a rather short period of wash-out of several weeks. Therefore, the distinction between a true preventing effect and simply a masking effect is difficult with glucose-lowering drugs. In addition, as type 2 diabetes is a progressive disease, it is still questionable whether the effect corresponds to a prevention effect or only to a postponing of the development of the disease. Owing to the pathophysiology of the disease, the only way to block the progression of type 2 diabetes is probably to avoid the progressive loss of beta-cell function and/or mass. Whatsoever, these data obtained in large clinical trials bring further argument to support early treatment of diabetes, even at a prediabetic state, in order to stop the vicious circle leading to an inevitable deterioration of glycaemia in predisposed subjects.
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Affiliation(s)
- A J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU de Sart-Tilman (B35), 4000 Liege-I, Belgium.
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Bartnik M, Malmberg K, Rydén L. Management of patients with type 2 diabetes after acute coronary syndromes. Diab Vasc Dis Res 2005; 2:144-54. [PMID: 16334596 DOI: 10.3132/dvdr.2005.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Acute coronary syndromes are associated with a high risk for subsequent major cardiovascular events and with a risk for mortality that remains substantially increased for many months following the acute phase. Patients with type 2 diabetes mellitus are especially vulnerable and encounter excessive long-term mortality. Effective management of patients with type 2 diabetes following acute coronary syndromes requires aggressive multidisciplinary efforts for reduction of several risk factors, including meticulous control of blood glucose. The evidence for different medication and treatment strategies capable of improving the outcomes is reviewed and the currently available recommendations are summarised.
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Affiliation(s)
- Małgorzata Bartnik
- Department of Cardiology, Karolinska University Hospital, 117 71 Stockholm, Sweden
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