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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Tzogiou C, Wieser S, Eichler K, Carlander M, Djalali S, Rosemann T, Brändle M. Incidence and costs of hypoglycemia in insulin-treated diabetes in Switzerland: A health-economic analysis. J Diabetes Complications 2023; 37:108476. [PMID: 37141836 DOI: 10.1016/j.jdiacomp.2023.108476] [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] [Received: 01/02/2023] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
AIMS We assess the incidence and economic burden of severe and non-severe hypoglycemia in insulin-treated diabetes type 1 and 2 patients in Switzerland. METHODS We developed a health economic model to assess the incidence of hypoglycemia, the subsequent medical costs, and the production losses in insulin-treated diabetes patients. The model distinguishes between severity of hypoglycemia, type of diabetes, and type of medical care. We used survey data, health statistics, and health care utilization data extracted from primary studies. RESULTS The number of hypoglycemic events in 2017 was estimated at 1.3 million in type 1 diabetes patients and at 0.7 million in insulin-treated type 2 diabetes patients. The subsequent medical costs amount to 38 million Swiss Francs (CHF), 61 % of which occur in type 2 diabetes. Outpatient visits dominate costs in both types of diabetes. Total production losses due to hypoglycemia amount to CHF 11 million. Almost 80 % of medical costs and 39 % of production losses are due to non-severe hypoglycemia. CONCLUSIONS Hypoglycemia leads to substantial socio-economic burden in Switzerland. Greater attention to non-severe hypoglycemic events and to severe hypoglycemia in type 2 diabetes could have a major impact on reducing this burden.
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Affiliation(s)
- Christina Tzogiou
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland
| | - Maria Carlander
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Sima Djalali
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland.
| | - Michael Brändle
- Division of Endocrinology and Diabetes, Department of Internal Medicine, Saint Gallen Cantonal Hospital, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
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Soares AR, Coelho M, Tracey M, Carvalho D, Silva-Nunes J. Epidemiological, Social and Economic Burden of Severe Hypoglycaemia in Patients with Diabetes Mellitus in Portugal: A Structured Literature Review. Diabetes Ther 2023; 14:265-291. [PMID: 36680681 PMCID: PMC9943814 DOI: 10.1007/s13300-022-01358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/25/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The aim of this review was to identify and review studies reporting on the epidemiological, social and economic impact associated with severe hypoglycaemia (SH) in people with diabetes mellitus (DM) in Portugal. METHODS A structured literature search was carried out in PubMed and Embase using a predefined selection criterion. Studies published in either Portuguese or English, between January 2010 and February 2021 were deemed eligible for inclusion. RESULTS Twelve studies including adults (aged ≥ 18 years) with type 1 and/or type 2 diabetes mellitus (T1DM/T2DM) were eligible for inclusion. Epidemiological estimates varied according to the setting and type of data source used. The proportion of patients who experienced ≥ 1 SH episode (SHE) in the previous 6-12 months varied from 3.1% in adults with T2DM to 36.8% in adults with T1DM. In adults with T2DM the prevalence in a community-based study was highest in the insulin and secretagogue combination treated group (9.1%), while in an emergency department setting prevalence was highest in the insulin-based therapy group and the oral hypoglycaemic agent without secretagogues group (32.0% and 20.0%, respectively). The prevalence of SH in other studies in patients with DM ranged from 0.1% (emergency department) to 18.1% (hospital ward). Patients treated with secretagogues had the highest rates of hospitalisations. In patients with T1DM, the annual rate of SHE was higher in those with impaired hypoglycaemia awareness than in those with intact awareness. Mean total cost (direct and indirect) per SHE ranged from €1493.00 in patients with T2DM treated in an emergency setting to €2608.51 in patients with T1DM who were hospitalised. CONCLUSION Hypoglycaemic events, especially SHE, have a significant effect on the life of persons living with DM and their caregivers. Studies show that the prevalence of this acute complication of diabetes is not negligible. In addition to the negative impact on the quality of life, the burden of SHE in Portugal translates into a significant impact on the global health expenditure.
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Affiliation(s)
| | | | - Marsha Tracey
- Eli Lilly and Company, Global Scientific Communications, Little Island, Cork, Ireland.
| | - Davide Carvalho
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - José Silva-Nunes
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciências Médicas, New University of Lisbon, Lisbon, Portugal
- Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal
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de Souza ML, de Albuquerque Wanderley Sales V, Alves L, Santos WM, Ferraz LR, Lima G, Mendes L, Rolim LA, Neto PJR. A systematic review of functionalized polymeric nanoparticles to improve intestinal permeability of drugs and biological products. Curr Pharm Des 2021; 28:410-426. [PMID: 34348618 DOI: 10.2174/1381612827666210804104205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The oral route is the most frequently used and the most convenient route of drug administration, since it has several advantages, such as ease of use, patient compliance and better cost-effectiveness. However, physicochemical and biopharmaceutical limitations of various active pharmaceutical ingredients (API) hinder suitability for this route, including degradation in the gastrointestinal tract, low intestinal permeability and low bioavailability. To overcome these problems, while maintaining therapeutic efficacy, polymeric nanoparticles have attracted considerable attention for their ability to increase drug solubility, promote controlled release, and improve stability. In addition, the functionalization of nanocarriers can increase uptake and accumulation at the target site of action, and intestinal absorption, making it possible to obtain more viable, safe and efficient treatments for oral administration. <P> Objective: This systematic review aimed to seek recent advances in the literature on the use of polymeric nanoparticles functionalization to increase intestinal permeability of APIs that are intended for oral administration. <P> Method: Two bibliographic databases were consulted (PubMed and ScienceDirect). The selected publications and the writing of this systematic review were based on the guidelines mentioned in the PRISMA statement. <P> Results: Out of a total of 3036 studies, 22 studies were included in this article based on our eligibility criteria. The results were consistent for the application of nanoparticle functionalization to increase intestinal permeability. <P> Conclusion: The functionalized polymeric nanoparticles can be considered as carrier systems that improve the intestinal permeability and bioavailability of APIs, with the potential to result, in the future, in the development of oral medicines.
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Affiliation(s)
- Myla Lôbo de Souza
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco. Brazil
| | | | - Larissa Alves
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco. Brazil
| | - Widson Michael Santos
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco. Brazil
| | - Leslie Raphael Ferraz
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco. Brazil
| | - Gustavo Lima
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco. Brazil
| | - Larissa Mendes
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco. Brazil
| | - Larissa Araújo Rolim
- Central de Análise de Fármacos, Medicamentos e Alimentos. Federal University of Vale do São Francisco (UNIVASF), Petrolina-PE. Brazil
| | - Pedro José Rolim Neto
- Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife, Pernambuco. Brazil
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Alão S, Conceição J, Dores J, Santos L, Araújo F, Pape E, Reis M, Chipepo Á, Nascimento E, Baptista A, Pires V, Marques C, Lages ADS, Pelicano-Romano J, de Jesus PM. Hypoglycemic episodes in hospitalized people with diabetes in Portugal: the HIPOS-WARD study. Clin Diabetes Endocrinol 2021; 7:2. [PMID: 33402217 PMCID: PMC7786902 DOI: 10.1186/s40842-020-00114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications. METHODS In this cross-sectional, multicentered study, the observational data was collected by physicians from patient's hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level. RESULTS There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DM patients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001). CONCLUSIONS Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.
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Affiliation(s)
- Sílvia Alão
- MSD Portugal, R. Qta da Fonte 19, 2770-192, Paço de Arcos, Portugal.
| | - João Conceição
- MSD International GmbH (Singapore Branch), Medical Affairs, Singapore, Singapore
| | - Jorge Dores
- Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Lèlita Santos
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | | | | | - Mónica Reis
- Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | | | | | - Ana Baptista
- Centro Hospitalar Universitário do Algarve - Faro, Faro, Portugal
| | - Vanessa Pires
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Carlos Marques
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
| | | | | | - Paula M de Jesus
- MSD Portugal, R. Qta da Fonte 19, 2770-192, Paço de Arcos, Portugal
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Ferreira JP, Araújo F, Dores J, Santos L, Pape E, Reis M, Chipepo Á, Nascimento E, Baptista A, Pires V, Marques C, Lages AS, Conceição J, Laires PA, Pelicano-Romano J, Alão S. Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting Approach. Diabetes Ther 2020; 11:2237-2255. [PMID: 32654070 PMCID: PMC7509029 DOI: 10.1007/s13300-020-00868-0] [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: 05/11/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Hypoglycemia leading to hospitalization is associated with adverse economic outcomes, although the real burden is unknown. The HIPOS-WARD (Hypoglycemia In Portugal Observational Study-Ward) aimed to characterize ward admissions due to hypoglycemia episodes in treated patients with diabetes and assess their economic impact to the National Health System. METHODS Observational, cross-sectional study, conducted in 16 Portuguese centers for 22 months. The applied microcosting approach was based on healthcare resource data, collected from patients' charts upon ward admission until discharge, and unitary costs from official/public data sources. Absenteeism was also estimated for active workers on the basis of the human capital approach. RESULTS Of the 176 patients with diabetes mellitus enrolled, 86% had type 2 diabetes. Half of the patients (50.0%) were on insulin-based therapy, followed by 30.1% on a secretagogue-based regimen, 9.7% on non-secretagogue therapy, and 10.2% on a combination of insulin and secretagogue. Overall mean costs per patient were medication, 45.45 €; laboratory analysis, 218.14 €; examinations, 64.91 €; physician and nurse time, 268.55 € and 673.39 €, respectively. Bed occupancy was the main cost driver (772.09 €) and indirect cost averaged 140.44 €. Overall, the cost per hypoglycemia episode leading to hospitalization averaged 2042.52 € (range 194.76-16,762.87 €). Patients treated with insulin-based regimens (2267.76 €) and type 2 diabetes (2051.29 €) had the highest mean costs. The mean cost increased with repeated hypoglycemic events (2191.67 €), correlated complications (2109.26 €), and death (5253.38 €). CONCLUSION HIPOS-WARD's findings confirm and support both the substantial clinical and economic impact of hospitalization due to hypoglycemia in Portugal.
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Affiliation(s)
| | | | - Jorge Dores
- Centro Hospitalar e Universitário Do Porto, Porto, Portugal
| | - Lèlita Santos
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | | | - Mónica Reis
- Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | | | | | - Ana Baptista
- Centro Hospitalar Universitário do Algarve-Faro, Faro, Portugal
| | - Vanessa Pires
- Centro Hospitalar de Trás-Os-Montes E Alto Douro, Vila Real, Portugal
| | - Carlos Marques
- Unidade Local de Saúde Do Baixo Alentejo, Beja, Portugal
| | - Adriana S Lages
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Conceição
- Medical Affairs, MSD International GmbH (Singapore Branch), Singapore, Singapore
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Adverse drug reactions to anti-diabetic drugs are commonest in patients whose treatment do not adhere to diabetes management clinical guidelines: cross-sectional study in a tertiary care service in sub-Saharan Africa. Eur J Clin Pharmacol 2020; 76:1601-1605. [PMID: 32607780 DOI: 10.1007/s00228-020-02949-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/26/2020] [Indexed: 01/19/2023]
Abstract
AIMS The study aimed to identify and describe adverse drug reactions and adherence to clinical guidelines in patients receiving treatment for type 2 diabetes mellitus (T2DM) in Cameroon. METHODS The method used was a cross-sectional study at a tertiary diabetes care service in Yaoundé, Cameroon. Adult T2DM patients attending the diabetes clinic were interviewed using a pre-structured data collection form. Adverse drug reactions (ADRs) were self-reported by the patients. Naranjo's algorithm and Hartwig and Siegel's scale were used for assessment of causality and severity of ADRs, respectively. A blinded senior endocrinologist assessed whether treatment pattern of patients was "adherent" or not to local clinical guidelines for the management of diabetes. RESULTS Of a total of 350 patients enrolled into the study 61.1% were on oral hypoglycaemic agents only, 24.9% were on both oral hypoglycaemic agents and insulin, while 13.4% were on insulin alone. Metformin was used by 96.3% of the patients. Ninety patients reported 101 suspected ADRs. The proportion of ADRs among patients with poor adherence to clinical guidelines was higher than ADRs reported among adherent patients (Chi-square test = 7.3273; p = 0.007). Hypoglycaemia was more frequent ADR among non-adherent (25.7% of the suspected ADR) than adherent participants (11.6%). In the participants whose treatment pattern did not adhere to local clinical guidelines, ADRs were definite in 63.9%, probable in 16.6%, doubtful in 13.9% and possible in 5.6% of the cases. ADRs were moderate in 61.1% and severe in 19.4% of cases whose treatment pattern was non-adherent to clinical guidelines. INTERPRETATION Adverse drug reactions may be frequent in type 2 diabetes patients whose treatment pattern does not adhere to local clinical guidelines in Cameroon. Therefore, the promotion of active pharmacovigilance and the design of training activities to promote the appropriate use of medicines at hospital level in Cameroon could help to improve the management of diabetes and reduce the incidence of avoidable ADRs in the future.
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Torre C, Guerreiro J, Longo P, Raposo JF, Leufkens H, Martins AP. Intensive monitoring of adverse drug events associated with the use of new glucose-lowering drugs: results from an inception cohort study in Portugal. Diabet Med 2020; 37:648-656. [PMID: 31692117 DOI: 10.1111/dme.14168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/11/2022]
Abstract
AIMS To determine the frequency and the time-course profile of adverse drug events associated with new glucose-lowering drugs in daily practice and to explore factors potentially associated to these events. METHODS An inception cohort study was implemented. Adults with type 2 diabetes mellitus initiating a dipeptidyl peptidase-4 inhibitor, a glucagon-like peptide-1 receptor agonist or a sodium-glucose co-transporter-2 inhibitor were eligible for inclusion. Data were collected through baseline and follow-up telephone questionnaires, administered at 2 weeks, 3 months and 6 months. Kaplan-Meier curves and log-rank were computed to compare the time to adverse drug event onset. Cox models were used to explore potential factors associated with adverse drug events. RESULTS A total of 1328 participants were recruited to the study. In all, 1118 adverse drug events were reported (of which 36% were not listed in the summary of product characteristics) by 41% of participants. The median latency time of adverse drug events reported in ≥1% of participants ranged from 0 to 2 days. Glucagon-like peptide-1 receptor agonist and sodium-glucose co-transporter-2 inhibitor subgroups were associated with an increased likelihood of adverse drug event reporting when compared with the dipeptidyl peptidase-4 inhibitor subgroup. A total of 328 glucose-lowering drugs were withdrawn, more than half as a result of an adverse drug event. CONCLUSIONS More than two-fifths of participants reported an adverse drug event; dipeptidyl peptidase-4 inhibitors led to the highest proportion of unlabelled adverse drug events. Adverse drug event latency time data show that counselling and adverse drug event management should be proactively addressed from treatment initiation. There should be greater focus on prevalent new users of glucose-lowering drugs, who were more complex participants in this study in terms of type 2 diabetes disease, as they were more likely to report an adverse drug event than the incident new users.
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Affiliation(s)
- C Torre
- Centre for Health Evaluation and Research, National Association of Pharmacies, Lisbon, Portugal
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - J Guerreiro
- Centre for Health Evaluation and Research, National Association of Pharmacies, Lisbon, Portugal
| | - P Longo
- Centre for Health Evaluation and Research, National Association of Pharmacies, Lisbon, Portugal
| | - J F Raposo
- Nova Medical School, New University of Lisbon, Lisbon, Portugal
- Portuguese Diabetes Association, Lisbon, Portugal
| | - H Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - A P Martins
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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