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Alzahrani AM, Alshareef RJ, Balubaid MM, Alzahrani M, Alsoubhi M, Shaheen M. Perception and attitude of type 2 diabetic patients toward insulin therapy in the primary care of National Guard for Health Affairs (NGHA) in Jeddah, Saudi Arabia. J Family Med Prim Care 2023; 12:2768-2773. [PMID: 38186793 PMCID: PMC10771210 DOI: 10.4103/jfmpc.jfmpc_2484_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose/Background Our study explores and determines the perception toward insulin among patients with diabetes in the National Guard for Health Affairs (NGHA), Jeddah, the Kingdom of Saudi Arabia (KSA), and aims to gain insight into the causes of refusal. Patients with type 2 diabetes (T2D) are likely to need the use of insulin to keep blood glucose levels within normal range and delay the onset of diabetes-related problems. Individuals with diabetes may be hesitant to begin insulin therapy if they have a negative attitude toward it, which might add to the delay in beginning treatment. Materials and Methods A cross-sectional study was conducted in the primary healthcare centers of the NGHA in Jeddah, Saudi Arabia. Data were collected through a validated self-administered questionnaire that was divided into three sections, with a total of 32 questions. The first section concerned demographic data, the second part was directed toward insulin users, and the last section was directed toward non-insulin patients. Results and Conclusion Our study collected 314 responses. Males constituted 54.8% of participants and insulin users resembled 45.7%. According to our study, important deterrents to starting insulin therapy among non-insulin users included the following: the cost of insulin, the pain associated with injections, the difficulty in maintaining food control while on insulin treatment, scarring at the injection site, and the weight gain impact. Factors that were found to influence compliance to insulin therapy among insulin users included fear of weight gain and self-administration of insulin.
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Affiliation(s)
- Abdullah M. Alzahrani
- Department of Family Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Reem J. Alshareef
- Department of Family Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Marwan M. Balubaid
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Alzahrani
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Alsoubhi
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mostafa Shaheen
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Calixto AAS, Franco LJ, La Banca Barber RO, Cendejas Medina LA, Torquato MTG, Damasceno MMC, Zanetti ML, Teixeira CRDS. Glycemic outcomes of people with diabetes mellitus in Brazilian primary health care. Int J Diabetes Dev Ctries 2023:1-8. [PMID: 37360325 PMCID: PMC10208190 DOI: 10.1007/s13410-023-01203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background The capillary blood glucose monitoring program at home a challenge in primary health care. Therefore, it is fundamental to identify the glycemic control of people with diabetes mellitus through HBA1c and to analyze its associated factors. Objective To identify the glycemic profile of people with Diabetes Mellitus (DM) through HbA1c and analyze factors associated. Materials & methods Cross-sectional study developed in Ribeirão Preto, São Paulo, Brazil. Secondary data from the electronic health record of people registered in the Primary Health Care system were used. A sample of 3181 participants was obtained. People with HbA1c < 7.0% (53 mmol/mol) were considered to have adequate glycemic control. For people aged ≥ 55 years, a less stringent target, < 8.0% (64 mmol/mol), was also considered. The odds ratio was the measure of effect analyzed with their respective 95% Confidence Intervals (95% CI). Results Adequate glycemic control with HbA1c < 7.0% (53 mmol/mol) was found in 44.8% of people and, when using the less rigid target, HbA1c < 8.0% (64 mmol/mol) for people aged ≥ 55 years-old, 70.6% had adequate glycemic control. Age and drug therapy were associated with adequate glycemic control (p < 0.001), which was more frequent among older people and those who used only metformin. Conclusion The study shows that the achievement of adequate glycemic control is still a challenge, especially with regard to younger people and those who use insulin.
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Affiliation(s)
- Adrielen Aparecida Silva Calixto
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Rua Professor Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - Laercio Joel Franco
- Faculdade de Medicina de Ribeirão Preto da USP, Avenida Dos Bandeirantes, Ribeirão Preto, SP 3900, 14049-900 Brazil
| | | | - Luis Angel Cendejas Medina
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Rua Professor Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - Maria Tereza Gonçalves Torquato
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Rua Professor Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | | | - Maria Lúcia Zanetti
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Rua Professor Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - Carla Regina de Souza Teixeira
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Rua Professor Hélio Lourenço, 3900, Vila Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
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Alsaidan AA, Alsaidan OA, Mallhi TH, Khan YH, Alzarea AI, Alanazi AS. Assessment of Adherence to Insulin Injections among Diabetic Patients on Basal-Bolus Regimen in Primary and Secondary Healthcare Centers in Al-Jouf Region of Saudi Arabia; A Descriptive Analysis. J Clin Med 2023; 12:jcm12103474. [PMID: 37240580 DOI: 10.3390/jcm12103474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Patient adherence to insulin therapy is one of the major challenges during the treatment of diabetes mellitus. Considering the dearth of investigations, this study aimed to determine the adherence pattern and factors linked with nonadherence among diabetic patients using insulin in Al-Jouf region of Saudi Arabia. METHODS This cross-sectional study included diabetic patients using basal-bolus regimens, whether they had type 1 or type 2 diabetes. This study's objective was determined using a validated data collection form that included sections on demographics, reasons for missed insulin doses, list of barriers to therapy, difficulties during insulin administration, and factors that may improve insulin inaction adherence. RESULTS Of 415 diabetic patients, 169 (40.7%) were reported to forget doses of insulin every week. The majority of these patients (38.5%) forget one or two doses. Away from home (36,1%), inability to adhere to the diet (24.3%) and embarrassment to administer injections in public (23.7%) were frequently cited as reasons for missing insulin doses. The occurrence of hypoglycemia (31%), weight gain (26%), and needle phobia (22%) were frequently cited as obstacles to insulin injection use. Preparing injections (18.3%), using insulin at bedtime (18.3%), and storing insulin at a cold temperature (18.1%) were the most challenging aspects of insulin use for patients. Reduction in the number of injections (30.8%) and convenient timing for insulin administration (29.6%) were frequently cited as factors that may improve participant adherence. CONCLUSIONS This study revealed that the majority of diabetic patients forget to inject insulin, primarily as a result of travel. By identifying potential obstacles faced by patients, these findings direct health authorities to design and implement initiatives to increase insulin adherence among patients.
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Affiliation(s)
- Aseel Awad Alsaidan
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
| | - Omar Awad Alsaidan
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
- Health Sciences Research Unit, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
| | - Abdulaziz Ibrahim Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
| | - Abdullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
- Health Sciences Research Unit, Jouf University, Sakaka 72388, Al-Jouf Province, Saudi Arabia
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Negash Z, Mekonen T. Patient perception towards shifting oral antihyperglycemic agents to injectable insulin and associated factors in the diabetes clinic of Tikur Anbessa specialized hospital: Cross-sectional study. Metabol Open 2023; 17:100228. [PMID: 36632175 PMCID: PMC9826942 DOI: 10.1016/j.metop.2022.100228] [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: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
Background With the growing understanding of the importance of preserving adequate glycemic control for the prevention of long-term diabetes-related complications, insulin therapy has become increasingly recommended for type 2 diabetes. However, insulin use in various healthcare settings remains low due to patients' low levels of acceptability of insulin therapy, which necessitates evaluating patients' attitudes. Objective To assess patients' perception toward shifting oral antihyperglycemic agents to insulin and associated factors at the ambulatory diabetes clinics of Tikur Anbessa Specialized Hospital (TASH). Method A cross-sectional study design was applied using a pre-tested interviewer-administered questionnaire on adult type 2 diabetes patients on follow-up at the diabetes clinic of TASH, Ethiopia from July to September 2021. The questionnaire tool was adapted from Insulin Treatment Appraisal Scale with modifications to fit the purpose of the study. Data was gathered, cleaned up, entered, and analyzed using Statistical Package for the Social Sciences (SPSS) version 23 for descriptive and logistic regression. For logistic regression data, a p-value of 0.05 was used to determine the statistical significance. Result Of 293 patients, 65.9% were female. Study participants had a mean age of 53.9 ± 10.9 years. About 45% and 75% of the participants have complications and comorbidities, respectively with a mean disease duration of 19.16 ± 8.2 years. Almost 54% of patients on oral antihyperglycemic agents were unwilling to start insulin. A perception score below the median was observed in 56.3% of the respondents. Patients with primary and secondary education were 45% and 42% less likely to have a poor perception of shifting oral antihyperglycemic agents to insulin than those who couldn't read or write (P < 0.05), respectively. The study found that participants who were taking only oral antihyperglycemic agents had a 2.76 times poor perception than those who are on insulin treatment (P < 0.001). Conclusion Poor perception toward shifting oral antihyperglycemic agents to insulin was found to be high among study participants. It was substantially correlated with low educational attainment, financial constraints, exclusively using oral antihyperglycemic agents, duration of disease, and absence of disease complications.
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Hsu SH, Tang KP, Lin CH, Chen PC, Wang LH. Applying the theory of planned behavior to investigate type 2 diabetes patients' intention to receive injection therapy. Front Public Health 2023; 11:1066633. [PMID: 36875423 PMCID: PMC9978190 DOI: 10.3389/fpubh.2023.1066633] [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: 10/12/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Objectives This study applied the theory of planned behavior (TPB) in shared decision making (SDM) to understand behavioral intention in patients with type 2 diabetes with regard to injection therapy for blood sugar control. Methods A cross sectional study was conducted. Two hundred and fifty-four patients with type 2 diabetes participated this study and were interviewed by pharmacists in different clinics. A patient decision aid (PDA) entitled "Should I receive injection therapy regarding my type 2 diabetes condition?" was developed for this study and served as interview agenda which comprised 18 items to inquire their willingness to use injection therapy and related considerations during the SDM process. Results The questionnaires were revised using item analysis, exploratory factor analysis, and a criteria of Cronbach's α > 0.7. This resulted in three constructs for all questionnaires that fit the TPB model. Attitude (β = 0.432; P < 0.001) and PBC (β = 0.258; P < 0.001) were directly correlated with intention. TPB explained 35.2% of the variance in intention toward the use of injection therapy. Conclusions Attitude and PBC toward injection therapy positively and significantly influence the patients' intention to use injection therapy. Practical implications These findings identify a key association for understanding behavioral intention in patients with type 2 diabetes with regard to blood sugar control during SDM.
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Affiliation(s)
- Su-Han Hsu
- Department of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, Taiwan.,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy and Master Program, Tajen University, Pingtung City, Taiwan
| | - Kung-Pei Tang
- Department of Education and Humanities in Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Early Childhood and Family Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Chia-Hui Lin
- Department of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, Taiwan.,Department of Pharmacy and Master Program, Tajen University, Pingtung City, Taiwan
| | - Pei-Chun Chen
- Department of Pharmacy, Taipei City Hospital Yangming Branch, Taipei, Taiwan
| | - Li-Hsuan Wang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
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Alhagawy AJ, Yafei S, Hummadi A, Abutaleb R, Hakamy M, Alzughbi T, Gharawi N, Moafa M, Mokali A, Alhiqwy I, Altherwi M. Barriers and Attitudes of Primary Healthcare Physicians to Insulin Initiation and Intensification in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16794. [PMID: 36554673 PMCID: PMC9779059 DOI: 10.3390/ijerph192416794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Saudi Arabia is a country with high prevalence of diabetes, uncontrolled diabetes, and diabetes-related complications. Poor glycemic control is multifactorial and could be explained in part by physician and patient reluctance toward insulin or insulin inertia. This study aimed to address physician barriers toward insulin therapy in primary care settings. It included 288 physicians from 168 primary healthcare centers (PHC) in the Jazan region of Saudi Arabia. Participants responded to questionnaire investigating physicians' attitude and barriers to insulin initiation and intensification in PHCs. In physician opinion, the most common barriers among their patients were fear of injection, lack of patient education, fear of hypoglycemia, and difficult administration. Physicians were reluctant to initiate insulin for T2D patients mostly due to patient non-adherence to blood sugar measurement, non-adherence to appointment or treatment, elderly patients, or due to patient refusal. Physicians' fear of hypoglycemia, lack of staff for patient education, and lack of updated knowledge were the primary clinician-related barriers. Exaggerated fears of insulin side effects, patient non-adherence, limited staff for patient's education, patient refusal, and inadequate consultation time were the main barriers to insulin acceptance and prescription.
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Affiliation(s)
- Ali Jaber Alhagawy
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Saeed Yafei
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
- Faculty of Medicine and Health Sciences, Taiz University, Taiz P.O. Box 6803, Yemen
| | - Abdulrahman Hummadi
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Raed Abutaleb
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Hakamy
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Turki Alzughbi
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Nabeel Gharawi
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Manal Moafa
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Asma Mokali
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ibrahim Alhiqwy
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mousa Altherwi
- Nursing Department, Ministry of Health, Jazan 45142, Saudi Arabia
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Alyami M, Serlachius A, Law M, Murphy R, Almigbal TH, Lyndon M, Batais MA, Algaw RK, Broadbent E. Utility and acceptability of a brief type 2 diabetes visual animation: A mixed-methods feasibility study (Preprint). JMIR Form Res 2021; 6:e35079. [PMID: 35943787 PMCID: PMC9399876 DOI: 10.2196/35079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/08/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Visualizations of illness and treatment processes are promising interventions for changing unhelpful perceptions and improving health outcomes. However, these are yet to be tested in patients with type 2 diabetes mellitus (T2DM). Objective This study assesses the cross-cultural acceptability and potential effectiveness of a brief visual animation of T2DM at changing unhelpful illness and treatment perceptions and self-efficacy among patients and family members in 2 countries, New Zealand and Saudi Arabia. Health care professionals’ views on visualization are also explored. Methods A total of 52 participants (n=39, 75% patients and family members and n=13, 25% health care professionals) were shown a 7-minute T2DM visual animation. Patients and family members completed a questionnaire on illness and treatment perceptions and self-efficacy before and immediately after the intervention and completed semistructured interviews. Health care professionals completed written open-ended questions. Means and 95% CIs are reported to estimate potential effectiveness. Inductive thematic analysis was conducted on qualitative data. Results All participants rated the visual animation as acceptable and engaging. Four main themes were identified: animation-related factors, impact of the animation, animation as an effective format for delivering information, and management-related factors. Effect sizes (ranged from 0.10 to 0.56) suggested potential effectiveness for changing illness and treatment perceptions and self-efficacy among patients and family members. Conclusions Visualizations are acceptable and may improve the perceptions of patients’ with diabetes in a short time frame. This brief visual animation has the potential to improve current T2DM education. A subsequent randomized controlled trial to investigate the effects on illness and treatment perceptions, adherence, glycemic control, and unplanned hospital admission is being prepared.
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Affiliation(s)
- Mohsen Alyami
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mikaela Law
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mataroria Lyndon
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Rawabi K Algaw
- Vision College of Medicine, Vision Colleges, Riyadh, Saudi Arabia
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Alidrisi HA, Bohan A, Mansour AA. Barriers of Doctors and Patients in Starting Insulin for Type 2 Diabetes Mellitus. Cureus 2021; 13:e18263. [PMID: 34712538 PMCID: PMC8543092 DOI: 10.7759/cureus.18263] [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] [Accepted: 09/25/2021] [Indexed: 11/05/2022] Open
Abstract
Background Management of patients with type 2 diabetes mellitus (T2DM) may involve insulin therapy. However, this treatment may be avoided or delayed by physicians or patients due to the presence of certain barriers. This study aimed to evaluate the barriers to initiating insulin therapy for both physicians and patients with T2DM. Method This was a cross-sectional, questionnaire-based study. Data related to the physicians' personal and professional experience were collected, and 15 barriers to initiating insulin therapy were scored by each physician on a four-point Likert scale. Also, the patients' general data were collected, including previous insulin experience, discontinuation reason, and willingness to start insulin therapy if indicated. Twenty-one other barriers were examined with yes/no questions as well. Results For physicians, the patient's treatment compliance, motive, dependence on others for insulin therapy, hypoglycemia, socioeconomic status, occupation, and lack of follow-up were the most highly ranked barriers to initiating insulin therapy. A history of insulin use was reported in 42 (20.7%) patients, 31 of whom had decided to discontinue insulin therapy themselves (73.8%). The three most common reasons for discontinuing insulin therapy among patients were deterioration of T2DM and causing complications, hypoglycemia, and needle injections. Based on the findings, 99 (48.8%) patients were willing to start insulin therapy, if indicated. The family history of insulin therapy was positively correlated with the patient's willingness to start insulin. On the other hand, it was negatively correlated with a low educational level and some barriers to insulin therapy, such as fear of death, dependence on others, the difficulty of carrying insulin while traveling, follow-up challenges, the difficulty of dosing accuracy, the difficulty of keeping insulin, inconveniences in daily life, considering insulin as the last resort, the deterioration of T2DM with insulin, and social stigma. Conclusion The physicians believed that the barriers to initiating insulin therapy were mainly related to the patient's attitudes and thoughts about this therapy. While hypoglycemia and weight gain are well-known side effects of insulin therapy, the most important patient-related barriers to insulin therapy were related to its impact on the patient's social life and misperceptions about the side effects of insulin.
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Affiliation(s)
- Haider A Alidrisi
- Diabetes and Endocrinology, College of Medicine, University of Basrah, Basrah, IRQ
| | - Ali Bohan
- Diabetes and Endocrinology, College of Medicine, University of Basrah, Basrah, IRQ
| | - Abbas A Mansour
- Diabetes and Endocrinology, College of Medicine, University of Basrah, Basrah, IRQ
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Zakaria N, Baskaran N, Lim WL. Perception towards Insulin Therapy and Factors Related to Insulin Refusal among Insulin Naive Type 2 Diabetes Mellitus Patients in Primary Care Clinics PKD Lipis. JOURNAL OF PHARMACY 2021. [DOI: 10.31436/jop.v1i2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Insulin is one of the suggested treatments to prevent and reduce long-term diabetes complications. However, due to many factors such as socio-demographic factors, many Type 2 diabetes mellitus patients refuse this treatment. This study aimed to determine perception towards insulin among naive Type 2 diabetes mellitus patients, to calculate the prevalence of rejecting insulin therapy, and to find out factors related to the refusal.
Materials and methods: This cross-sectional study involved 188 insulin naive Type 2 diabetes mellitus patients attending five primary health clinics in Lipis district, Pahang from October to November 2017. A five-point Likert Scale was used to determine perception towards insulin therapy and the Chi-square test was used to assess the proportion of acceptance of the therapy. Simple and multiple logistic regressions were utilised to study the associated factor(s).
Results: Mean score of 60.5 ± 8.2 pointed towards a negative appraisal of insulin therapy. Embarrassment to inject in public (69.1%) and concern of frequent hypoglycaemia (52.7%) were the most common perception. Nearly half of the respondents (46.3%) refused insulin therapy upon suggestion. After adjusting the variables using multiple logistic regressions, only gender (Adjusted OR=0.20, 95% CI=0.10-0.40, p<0.001), educational level (Adjusted OR=0.17, 95% CI=0.06-0.50, p=0.001), age (Adjusted OR=1.04, 95% CI=1.01-1.08, p=0.012) and glycated haemoglobin level (Adjusted OR=1.33, 95% CI=1.07-1.67, p=0.013) remained significant.
Conclusion: In conclusion, insulin refusal among insulin naive patients was common in Lipis with an overall negative perception towards therapy. By tailoring strategies according to the patient’s factors such as gender, educational level, age, and glycated haemoglobin level, the insulin refusal rate might decrease in the future.
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Al-Sofiani ME, Batais MA, Aldhafiri E, Alzaid A. Pharmacological treatment of type 2 diabetes in Saudi Arabia: A consensus statement from the Saudi Society of Endocrinology and Metabolism (SSEM). Diabetes Metab Syndr 2021; 15:891-899. [PMID: 33895710 DOI: 10.1016/j.dsx.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/14/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS The list of available treatment options for managing blood glucose in patients with type 2 diabetes (T2D) has grown over recent years making the task of choosing between traditional and newer glucose-lowering agents a difficult one for healthcare providers. METHODS We summarize treatment algorithms developed by popular professional societies and propose a patient-centered and culture-driven recommendations for selecting diabetes medications for people with T2D in Saudi Arabia. RESULTS Though most professional societies recognize patient's adherence to medications as an important factor in achieving glycemic targets, published algorithms schemes do not formally enlist adherence to medication as a deciding factor in the choice of glucose-lowering agents. Medication appeal to patients, an important determinant of medication adherence, is influenced by several factors including lifestyle, common beliefs, customs and traditions, health literacy, perception of health and disease, socioeconomic and cultural backgrounds, and religious commitments and obligations. In Saudi Arabia, poor adherence to therapy is a major obstacle to effective management of local people with T2D. CONCLUSIONS The Saudi population has a unique socioeconomic and cultural background that widely respect adherence to religion and culture; and the applicability of international guidelines for the management of T2D to the Saudi population has been called into question. In this consensus statement, we propose patient-centered and culture-driven recommendations that integrate medication-adherence and medication-cost into overall selection of diabetes medications for people with T2D in Saudi Arabia.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Endocrinology, Diabetes & Metabolism, the Johns Hopkins University, Baltimore, MD, USA; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Aus Alzaid
- Diabetes Consultant, Riyadh, Saudi Arabia
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Ngassa Piotie P, Wood P, Webb EM, Marcus TS, Rheeder P. Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP). Diabetes Res Clin Pract 2020; 168:108366. [PMID: 32791159 DOI: 10.1016/j.diabres.2020.108366] [Citation(s) in RCA: 6] [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: 03/03/2020] [Revised: 06/22/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
AIMS To determine factors associated with 'hypothetical willingness' to start insulin among people with Type 2 diabetes (T2DM). METHODS A quantitative cross-sectional study with insulin-naïve T2DM patients at 23 primary care facilities in the Tshwane Metropolitan Municipality. Data collected included demographic and clinical data, willingness to start insulin, attitudes and barriers to insulin therapy. Factors associated with unwillingness to start insulin therapy were explored using a multivariable logistic regression model. RESULTS Of 468 T2DM study patients (mean age 57.2, SD = 11.3 years), more than half (51.9%) expressed unwillingness to starting insulin therapy. Unwillingness was associated with negative attitudes (OR = 1.32, 95% CI = 1.12-1.55, p = 0.001) and reluctance (OR = 1.41, 95% CI = 1.27-1.57, p < 0.001) rather than age, sex, education or diabetes duration. The strongest reasons for patient unwillingness were injection anxieties, fear of needles, insufficient knowledge of insulin, feeling unable to cope with insulin and concerns about out-of-pocket costs. CONCLUSIONS The prospect of insulin therapy disturbs patients' sense of self and their psychological wellbeing. The high prevalence of psychological insulin resistance among these T2DM patients needs to be addressed for effective diabetes management.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paola Wood
- Division of Biokinetics, Department of Physiology, Faculty of Health Sciences, University of Pretoria, P/Bag 14760, Hatfield 0001, City of Tshwane, South Africa.
| | - Elizabeth M Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Tessa S Marcus
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
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12
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Alomran AM, Almubarak DA, Alrashed BA, Khan AS. Psychological insulin resistance among type 2 diabetic patients attending primary healthcare centers, Al-Ahsa, Saudi Arabia. J Family Community Med 2020; 27:192-199. [PMID: 33354150 PMCID: PMC7745782 DOI: 10.4103/jfcm.jfcm_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/25/2020] [Accepted: 08/15/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients' adherence to insulin therapy is crucial to achieve good glycemic control. The present study was conducted to determine psychological insulin resistance (PIR) and the effect of doctor-patient relationship on PIR among type 2 diabetes patients attending primary health-care centers of Al-Ahsa region in Saudi Arabia. MATERIALS AND METHODS This was a cross-sectional survey of all type 2 diabetic patients attending the primary healthcare centers of Al-Ahsa. A multistage sampling technique was used. The calculated sample size was 396. Two validated structured questionnaires were used to collect information. The degree of agreement to insulin therapy was done on the Likert 5° scale. SPSS was used for data entry and analysis. Chi-square test was used to test for stistical significane at P=0.05. RESULTS Out of 396 patients who were given the questionnaires, 366 filled the questionnaires yielding 92% response rate. Fifty-one percent were male and about 85% were older than 35 years. Willingness to use insulin was significantly associated with age (P = 0.013) and duration of diabetes (P=0.0001). The strongest negative attitudes toward insulin therapy arose from participants having heard about a bad experience with insulin (59.34%, P < 0.05) and the fear of possible dependence (54.20%, P < 0.05). Participants who responded of "mostly appropriate" and "very appropriate" to questions on patient-doctor relationship were significantly more willing to take insulin (64.9% vs 24.5%, and 70.3% vs 22.9%, P = 0.0001). CONCLUSION The study showed that one-third of the patients with type 2 diabetes had PIR. Since the behavior of doctor plays an important role in reducing PIR, there is a need for greater emphasis on the importance of good doctor-patient relationship and the establishment of a therapeutic education program.
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Affiliation(s)
- Asmaa M. Alomran
- Postgraduate Center for Studies of Family and Community Medicine, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Duaa A. Almubarak
- Postgraduate Center for Studies of Family and Community Medicine, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Batool A. Alrashed
- Postgraduate Center for Studies of Family and Community Medicine, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Abdul S. Khan
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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13
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Klenner JB, Van Noorden BA, Knopp JL, Holder Pearson LR, Hardy AR, Vergeer SL, Shaw GM, Chase J. Determining the effects of insulin Detemir on endogenous secretion of insulin. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2943-2946. [PMID: 31946507 DOI: 10.1109/embc.2019.8857643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Type 2 diabetes (T2D) is a long-term metabolic disorder. A pilot trial was designed to investigate the effects of the long acting insulin Detemir on endogenous insulin secretion, to assess use in early T2D care. Provesn metabolic system models are used to identify patient-specific insulin sensitivity and endogenous insulin secretion from clinical data. Post-cardiac surgery patients with early T2D or pre-diabetes based on HbA1c were given a bolus of insulin Detemir on one day, and none on the second day in hospital. Blood glucose, insulin, C-Peptide, and all nutrition given are recorded. Early results from N=3 patients show 0.8-1.0U/hour insulin Detemir doses have no apparent suppression of endogenous insulin secretion, but does help lower glucose levels. The results show the model captures glucose-insulin dynamics in pre-diabetic post-surgical patients, and insulin Detemir may be useful to support individuals with pre-diabetes in reducing blood glucose levels. Tests with higher doses, need to be carried out to verify these results over a greater range of patients.
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14
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Gelhorn HL, Boye KS, Shalhoub H, Matza LS, Jordan JB, Alhammad A, Anand SB, Ekhzaimy AA, Strizek A. Patient-Reported Outcomes and Impact of Type 2 Diabetes: A Cross-Sectional Study in the Kingdom of Saudi Arabia. Patient Prefer Adherence 2020; 14:2231-2242. [PMID: 33204074 PMCID: PMC7667182 DOI: 10.2147/ppa.s265126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Kingdom of Saudi Arabia (KSA) has the second highest prevalence of type 2 diabetes mellitus (T2DM) in the Middle East. There is a paucity of research on the experiences and treatment preferences of patients with T2DM in KSA. This study explored Saudi patients' health-related quality of life, eating habits, experiences during Ramadan, and preference between two glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment devices. METHODS A cross-sectional, observational study was conducted in three cities in KSA. Participants completed sociodemographic and clinical forms, EQ-5D-5L, Impact of Weight on Self-Perceptions, and a diabetes treatment survey. Participants also viewed instructional videos on GLP-1 RA injection devices and indicated their device preference. RESULTS Of the 310 participants, 53% were male. The mean age was 43 years (range: 30.0-75.0), duration since diabetes diagnosis was 6.3 years (range: 0.2-27.1), the most commonly reported last HbA1c level was between ≥7.1% and 8% (45%). The mean EQ-5D-5L index score was 0.90, with some participants reporting problems with pain/discomfort (34.5%) and usual activities (33.2%). Patients reported a low-to-moderate impact of weight on self-perception. In preparation for Ramadan, participants sought physician advice on diabetes management (37%) and/or increased checks of their blood glucose (37%). After watching the videos, 89% (n=277) of participants indicated a device preference, with significantly more preferring the dulaglutide device (n=186, 67%) over the semaglutide device (n=91, 33%) (p<0.0001). CONCLUSION This study indicates that T2DM has a significant social, emotional, and behavioral impact on the lives of patients in KSA.
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Affiliation(s)
- Heather L Gelhorn
- Evidera, Bethesda, MD, USA
- Correspondence: Heather L Gelhorn Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD20814, USATel +1 970-363-7333 Email
| | | | | | | | | | - Ali Alhammad
- Eli Lilly and Company, Riyadh, Kingdom of Saudi Arabia
| | | | - Aishah A Ekhzaimy
- King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
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15
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van Noorden B, Knopp JL, Chase JG. A subcutaneous insulin pharmacokinetic model for insulin Detemir. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 178:1-9. [PMID: 31416537 DOI: 10.1016/j.cmpb.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/16/2019] [Accepted: 06/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Type 2 diabetes (T2D) is rapidly increasing in incidence and has significant social and economic costs. Given the increasing cost of complications, even relatively short delays in the onset of T2D can significantly reduce long-term complications and costs. Equally, recent studies have shown the onset of T2D can be delayed by use of long-acting insulin, despite the risk and concomitant low adherence. Thus, there is a strong potential motivation to develop models of long-acting insulin analogues to enable safe, effective use in model-based dosing systems. In particular, there are no current models of long-acting insulin Detemir and its unique action for model-based control. The objective of this work is to develop a first model of insulin Detemir and its unique action, and validate it against existing data in the literature. METHODS This study develops a detailed compartment model for insulin Detemir. Model specific parameters are identified using data from a range of published clinical studies on the pharmacokinetic of insulin Detemir. Model validity and robustness are assessed by identifying the model for each study and using average identified parameters over several dose sizes and study cohorts. Comparisons to peak concentration, time of peak concentration and overall error versus measured plasma concentrations are used to assess model accuracy and validity. RESULTS Almost all studies and cohorts fit literature data to within one standard deviation of error, even when using averaged identified model parameters. However, there appears to be a noticeable dose dependent dynamic not included in this first model, nor reported in the literature studies. CONCLUSIONS A first model of insulin Detemir including its unique albumin binding kinetics is derived and provisionally validated against clinical pharmacokinetic data. The pharmacokinetic curves are suitable for model-based control and general enough for use. While there are limitations in the studies used for validation that prevent a more complete understanding, the results provide an effective first model and justify the design and implementation of further, more precise human trials.
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Affiliation(s)
- Ben van Noorden
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
| | - Jennifer L Knopp
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
| | - J Geoffrey Chase
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand.
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16
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Hussein A, Mostafa A, Areej A, Mona AM, Shimaa A, Najd AG, Futoon A. The perceived barriers to insulin therapy among type 2 diabetic patients. Afr Health Sci 2019; 19:1638-1646. [PMID: 31148993 PMCID: PMC6531943 DOI: 10.4314/ahs.v19i1.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Problems may arise with insulin treatment, due to patients' perspective towards it leading to refusal. OBJECTIVES To evaluate diabetic patients' refusal towards insulin therapy, and to assess patients' perception and perceived barriers towards insulin. METHODS A cross-sectionalstudy, where type 2 diabetics participated in the study during a period, February through March 2017. They were interviewed in person by a questionnaire including three sections; socio-demography, medical history and a health belief model, comprising barriers to use insulin. Five points Likert scale was used to measure patients' perception and barriers towards insulin therapy. RESULTS One fourth (24.4%) of the diabetic patients refused insulin. Among the controlled group, 34.4% refused insulin, while 21% refused insulin among the uncontrolled group. The study showed different barriers towards insulin therapy, including fear of injection, pain, insulin injection needs help from others, fear of hypoglycaemia and embarrassment. CONCLUSION Diabetics showed a negative attitude towards insulin therapy due to social and psychological factors. The results necessitate the development of a strategy to address problems related with a reluctance to initiate insulin and put a strategy to implement education and better interaction with diabetic team to the stigma from phobia from insulin use.
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Affiliation(s)
- Amin Hussein
- King Saud University, Family and Community Medicine
| | | | - Alnomi Areej
- King Saud University, Family and Community Medicine
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17
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Manarvi IA, Matta NM. Investigating Information Needs of Saudi Diabetic Patients. Curr Diabetes Rev 2019; 15:149-157. [PMID: 29895254 DOI: 10.2174/1573399814666180612080718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/18/2018] [Accepted: 06/10/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies have shown that newly diagnosed diabetic patients need a lot of information about medical examinations, checkups, tests and precautions for its control besides its disastrous effects on heart, kidneys, eyes, foot and nerves. Patients in Saudi Arabia are generally not aware of most of the information they may need which is one the major reasons for its increasing number of patients. Past studies conducted are based on clinical data of hospitals and healthcare centers only discussed its effects. METHODS Present research was conducted through a survey questionnaire in the Arabic language from Type 1 and Type 2 patients to establish if they knew about this disease and its criticality in the day to day activities and were they being provided sufficient information about its requirements. Data for checkups, tests, management by food and nutrition and physical activity education were collected for this purpose. Approximately 25% female and 33% male patients reported that diabetes affected their day to day activities. RESULTS Analysis of results showed that awareness of importance of tests including blood glucose level test HbA1c was only among 50% patients, 51% Type 1 did not have cholesterol test, 31% Type 1 and 16% Type 2 % never had eye test, 97% Type 1 and 60% Type 2 were unaware of barefoot examination, 34% Type 1 and 70% Type 2 never went to a dietician to ascertain their nutrition needs, 24% Type 2 did not know importance of exercise for diabetes control. CONCLUSION It was concluded that Saudi patients suffering from diabetes seriously lacked information about its monitoring, control and treatment in form of tests to be conducted and requirements of diet control and physical activities. Therefore, a national level awareness campaign for providing this information could be considered as a key requirement.
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Affiliation(s)
- Irfan A Manarvi
- Department of Engineering Management, College of Engineering, Prince Sultan University, Riyadh, Saudi Arabia
| | - Nader M Matta
- Department of Endocrinology, Dallah Hospital, Riyadh, Saudi Arabia
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18
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Jeon HJ, Ku EJ, Oh TK. Dapagliflozin improves blood glucose in diabetes on triple oral hypoglycemic agents having inadequate glucose control. Diabetes Res Clin Pract 2018; 142:188-194. [PMID: 29807104 DOI: 10.1016/j.diabres.2018.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022]
Abstract
AIMS The aim of this study was to evaluate whether a combination drug therapy that consists of dapagliflozin with three other oral hypoglycemic agents (OHAs) would have a beneficial safety and efficacy profile in T2DM patients who have uncontrolled glucose levels compared to a treatment regimen that contains of basal insulin with two different OHAs. METHODS A total of 162 type 2 diabetic patients who are unable to control glucose on their current therapy consisting of 3 OHAs were enrolled in dapagliflozin group and 148 patients in insulin glargine group for the 24-week study period. RESULTS The mean changes in HbA1c level were comparable as -0.97 ± 1.29% in dapagliflozin group and -0.95 ± 1.41% in insulin glargine group (p = 0.911). Also, the fasting plasma glucose or post-prandial 2 h glucose were comparably decreased in dapagliflozin or insulin glargine. In terms of the body-weight, there was a significant decrease of -2.36 ± 0.51 kg following treatment of dapagliflozin, whereas the increment of 1.93 ± 0.49 kg was in insulin glargine (p < 0.001). In terms of adverse events, hypoglycemic events were higher in insulin glargine rather than dapagliflozin (15.1% vs. 1.6%, p < 0.05). CONCLUSIONS Our findings demonstrated that the addition of dapagliflozin to an existing drug regimen consisting of three different OHAs in patients exhibiting inadequate blood glucose control could be alternate treatment modality in T2D who hesitate to initiate insulin therapy.
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Affiliation(s)
- Hyun Jeong Jeon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju Si, Republic of Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju Si, Republic of Korea
| | - Tae Keun Oh
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju Si, Republic of Korea.
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