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Ibrahim N. Frequency and predictors of hypoglycemia in Type 2 diabetes: A population-based study. JOURNAL OF DIABETOLOGY 2021. [DOI: 10.4103/jod.jod_48_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim YS, Cho BL, Kim WS, Kim SH, Jung IH, Sin WY, Choi DH, Lee SJ, Lim CS, Kang KP, Yu BY, Jeung W, Park CG. Frequency and Severity of Hypoglycemia in Type 2 Diabetes Mellitus Patients Treated with a Sulfonylurea-Based Regimen at University-Affiliated Hospitals in Korea: The Naturalistic Evaluation of Hypoglycemic Events in Diabetic Subjects Study. Korean J Fam Med 2019; 40:212-219. [PMID: 31344994 PMCID: PMC6669385 DOI: 10.4082/kjfm.18.0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background We assessed the frequency and severity of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylurea monotherapy or sulfonylurea+metformin. Methods We conducted a retrospective, observational, cross-sectional study in 2011 and 2012 including patients with type 2 diabetes mellitus aged ≥30 years who were treated with ≥6 months of sulfonylurea monotherapy or sulfonylurea+metformin at 20 university-affiliated hospitals in Korea. At enrollment, glycated hemoglobin (HbA1c) was assessed; participants completed self-reported questionnaires describing hypoglycemia incidents over the past 6 months. A review of medical records up to 12 months before enrollment provided data on demographics, disease history, comorbidities, laboratory results, and drug usage. Results Of 726 enrolled patients, 719 were included (55.6% male); 31.7% and 68.3% were on sulfonylurea monotherapy and sulfonylurea+metformin, respectively. Mean±standard deviation age was 65.9±10.0 years; mean HbA1c level was 7.0%±1.0%; 77.8% of patients had hypertension (89.4% used antihypertensive medication); 60.5% had lipid disorders (72.5% used lipid-lowering medication); and 52.0% had one or more micro- or macrovascular diseases. Among patients with A1c measurement (n=717), 56.4% achieved therapeutic goals (HbA1c <7.0%); 42.4% (305/719) experienced hypoglycemia within 6 months of enrollment; and 38.8%, 12.9%, 12.7%, and 3.9% of patients experienced mild, moderate, severe, and very severe hypoglycemia symptoms, respectively. Several reported hypoglycemia frequency as 1–2 times over the last 6 months. The mean number of very severe hypoglycemia episodes was 3.5±5.5. Conclusion Among type 2 diabetes mellitus patients treated with sulfonylurea-based regimens, glycemic levels were relatively well controlled but hypoglycemia remained a prevalent side effect.
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Affiliation(s)
- Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Be Long Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Sik Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee Medical Center, Kyung Hee University, Seoul, Korea
| | - Sang Hyun Kim
- Division of Cardiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Hyeon Jung
- Department of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Won Yong Sin
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Dong Hoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Cardiovascular Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Jae Lee
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University School of Medicine and Hospital, Iksan, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyung Pyo Kang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Byung Yeon Yu
- Department of Family Medicine, Konyang University Hospital, Daejeon, Korea
| | - Wonju Jeung
- MSD Korea, Global Medical Affair, Seoul, Korea
| | - Chang Gyu Park
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
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Moosa A, Bezuidenhout S, Meyer JC, Godman B. Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
Objective
The prevalence of type 2 diabetes mellitus (T2DM) is growing in Sub-Saharan countries including South Africa. This is a concern given its appreciable impact on morbidity, mortality and costs with the recent introduction of universal health care in South Africa. The purpose of the study was to assess the knowledge of patients with T2DM attending a typical community health centre (CHC) regarding the management of their disease including risk factors and prevention to guide future initiatives. Typically, patients with T2DM in South Africa are managed in ambulatory care including CHCs.
Method
A quantitative, descriptive study in a CHC. The sample included 217 adults with T2DM who have visited a physician as well as the pharmacy. Face-to-face patient exit interviews were conducted using a structured questionnaire.
Key findings
Females predominated (65%), with the majority of patients >60 years (38.2%) and more than half from the Indian racial category. Most patients did not know how their medication controls their diabetes (79.3%) or did not know any of the side effects (83.9%) from their medication. Less than half of the patients knew how to take their medication, and more than a third of patients indicated that they were not practicing any form of self-care.
Conclusion
The results indicate that these T2DM patients lacked sufficient knowledge regarding the management of their disease. Healthcare managers should consider instigating programmes to improve patients’ knowledge about the management of their disease as part of general initiatives within South Africa to improve the management of patients with chronic diseases in the public sector.
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Affiliation(s)
- Afsana Moosa
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Selente Bezuidenhout
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
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Zheng S, Deng S, Huang Y, Huang M, Zhao P, Ma X, Wen Y, Wang Q, Yang X. Anti-diabetic activity of a polyphenol-rich extract from Phellinus igniarius in KK-Ay mice with spontaneous type 2 diabetes mellitus. Food Funct 2018; 9:614-623. [PMID: 29271444 DOI: 10.1039/c7fo01460k] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present study investigated the anti-diabetic activity and potential mechanisms of the polyphenol rich extract from Phellinus igniarius (PI-PRE) in vitro and in vivo. Four main phenolic compounds of PI-PRE were purified and identified as 7,8-dihydroxycoumarin, 3,4-dihydroxybenzalacetone, 7,3'-dihydroxy-5'-methoxyisoflavone and inoscavin C by the off-line semipreparative liquid chromatography-nuclear magnetic resonance protocol. In vitro, PI-PRE stimulated GLUT4 translocation by 2.34-fold and increased glucose uptake by 1.73-fold in L6 cells. However, the selective AMP-activated protein kinase (AMPK) inhibitor, compound C, completely reversed the PI-PRE-induced GLUT4 translocation. In vivo, KK-Ay mice treated with PI-PRE for four weeks had lower fasting blood glucose levels, as well as other blood-lipid indexes, compared with the vehicle control group. Mechanistic studies showed that the expressions of p-AMPKα and GLUT4 were significantly increased by treatment with PI-PRE in L6 cells. In KK-Ay mice, the expression of p-AMPKα was enhanced in the liver and skeletal muscle, and the expression of GLUT4 was increased in skeletal muscle. These findings suggest that PI-PRE possesses potential anti-diabetic effects including improving glucose tolerance, reducing hyperglycemia, and normalizing insulin levels. These effects are partly due to the activation of GLUT4 translocation via the modulation of the AMPK pathway.
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Affiliation(s)
- Sijian Zheng
- School of Pharmaceutical Sciences, South-Central University for Nationalities, 182 Min-Zu Road, Wuhan 430074, China.
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Koski RR. Practical Review of Oral Antihyperglycemic Agents for Type 2 Diabetes Mellitus. DIABETES EDUCATOR 2016; 32:869-76. [PMID: 17102154 DOI: 10.1177/0145721706294260] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article gives a practical review of the pharmacology, clinical efficacy, safety, dosing, cost, and place in therapy for oral antihyperglycemic agents used in the treatment of type 2 diabetes mellitus. There are 5 classes of oral antihyperglycemic agents available in the United States: sulfonylurea secretagogues, biguanides, α-glucosidase inhibitors, thiazolidinediones, and nonsulfonylurea secretagogues. These agents have distinct characteristics that help in their selection for the treatment of type 2 diabetes.
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Affiliation(s)
- Renee Rae Koski
- College of Pharmacy, Ferris State University, Upper Peninsula Health Education Corporation, 418 West Magnetic Street, Marquette, MI 49855, USA
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Spearson CL, Mistry A. Several Aspects of Internet and Web-Based Technology in Diabetes Management. Diabetes Spectr 2016; 29:245-248. [PMID: 27899876 PMCID: PMC5111533 DOI: 10.2337/ds15-0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Courtney L Spearson
- Eastern Michigan University College of Health and Human Services, Ypsilanti, MI
| | - Anahita Mistry
- Eastern Michigan University College of Health and Human Services, Ypsilanti, MI
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Edridge CL, Dunkley AJ, Bodicoat DH, Rose TC, Gray LJ, Davies MJ, Khunti K. Prevalence and Incidence of Hypoglycaemia in 532,542 People with Type 2 Diabetes on Oral Therapies and Insulin: A Systematic Review and Meta-Analysis of Population Based Studies. PLoS One 2015; 10:e0126427. [PMID: 26061690 PMCID: PMC4465495 DOI: 10.1371/journal.pone.0126427] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/02/2015] [Indexed: 01/27/2023] Open
Abstract
Objective To collate and evaluate the current literature reporting the prevalence and incidence of hypoglycaemia in population based studies of type 2 diabetes. Research Design and Methods Medline, Embase and Cochrane were searched up to February 2014 to identify population based studies reporting the proportion of people with type 2 diabetes experiencing hypoglycaemia or rate of events experienced. Two reviewers independently screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were carried out to calculate the prevalence and incidence of hypoglycaemia. Results 46 studies (n = 532,542) met the inclusion criteria. Prevalence of hypoglycaemia was 45% (95%CI 0.34,0.57) for mild/moderate and 6% (95%CI, 0.05,0.07) for severe. Incidence of hypoglycaemic episodes per person-year for mild/moderate and for severe was 19 (95%CI 0.00, 51.08) and 0.80 (95%CI 0.00,2.15), respectively. Hypoglycaemia was prevalent amongst those on insulin; for mild/moderate episodes the prevalence was 50% and incidence 23 events per person-year, and for severe episodes the prevalence was 21% and incidence 1 event per person-year. For treatment regimes that included a sulphonylurea, mild/moderate prevalence was 30% and incidence 2 events per person-year, and severe prevalence was 5% and incidence 0.01 events per person-year. A similar prevalence of 5% was found for treatment regimes that did not include sulphonylureas. Conclusions Current evidence shows hypoglycaemia is considerably prevalent amongst people with type 2 diabetes, particularly for those on insulin, yet still fairly common for other treatment regimens. This highlights the subsequent need for educational interventions and individualisation of therapies to reduce the risk of hypoglycaemia.
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Affiliation(s)
- Chloe L. Edridge
- University of Leicester, Department of Health Sciences, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
- * E-mail:
| | - Alison J. Dunkley
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Danielle H. Bodicoat
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Tanith C. Rose
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Laura J. Gray
- University of Leicester, Department of Health Sciences, University Road, Leicester, United Kingdom
| | - Melanie J. Davies
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
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Längst G, Seidling HM, Stützle M, Ose D, Baudendistel I, Szecsenyi J, Wensing M, Mahler C. Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals. Patient Prefer Adherence 2015; 9:1431-41. [PMID: 26508840 PMCID: PMC4612137 DOI: 10.2147/ppa.s88357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This qualitative study in patients with type 2 diabetes and health care professionals (HCPs) aimed to investigate which factors they perceive to enhance or impede medication information provision in primary care. Similarities and differences in perspectives were explored. METHODS Eight semistructured focus groups were conducted, four with type 2 diabetes patients (n=25) and four with both general practitioners (n=13) and health care assistants (n=10). Sessions were audio and video recorded, transcribed verbatim, and subjected to computer-aided qualitative content analysis. RESULTS Diabetes patients and HCPs broadly highlighted similar factors as enablers for satisfactory medication information delivery. Perceptions substantially differed regarding impeding factors. Both patients and HCPs perceived it to be essential to deliver tailored information, to have a trustful and continuous patient-provider relationship, to regularly reconcile medications, and to provide tools for medication management. However, substantial differences in perceptions related to impeding factors included the causes of inadequate information, the detail required for risk-related information, and barriers to medication reconciliation. Medication self-management was a prevalent topic among patients, whereas HCPs' focus was on fulfilling therapy and medication management responsibilities. CONCLUSION The findings suggest a noteworthy gap in perceptions between information provision and patients' needs regarding medication-related communication. Medication safety and adherence may be improved if HCPs collaborate more closely with diabetes patients in managing their medication, in particular by incorporating the patients' perspective. Health care systems need to be structured in a way that supports this process.
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Affiliation(s)
- Gerda Längst
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
- Correspondence: Gerda Längst, Department of General Practice and Health Services Research, University Hospital of Heidelberg, Vossstrasse 2, D-69115 Heidelberg, Germany, Tel +49 6221 56 35559, Fax +49 6221 56 1972, Email
| | - Hanna Marita Seidling
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Marion Stützle
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dominik Ose
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ines Baudendistel
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands
| | - Cornelia Mahler
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
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Lloyd CE, Mughal S, Roy T, Raymond NT, O'Hare JP, Barnett AH, Bellary S. What factors influence concordance with medications? Findings from the U.K. Asian Diabetes study. Diabet Med 2014; 31:1600-9. [PMID: 25073479 DOI: 10.1111/dme.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/03/2014] [Accepted: 07/28/2014] [Indexed: 01/04/2023]
Abstract
AIMS To investigate concordance with medication, as assessed at baseline and at 1- and 2-year follow-up, and to examine factors associated with non-concordance in a UK-resident South-Asian population. METHODS Data from the UK Asian Diabetes Study were analysed. Concordance with medications was assessed and recorded at three time points during the study. Multiple logistic regression was used to investigate the factors associated with non-concordance; the associations of baseline factors with year 1 concordance and baseline plus year 1 factors with year 2 concordance. RESULTS Data for 403 patients from seven practices participating in the UK Asian Diabetes Study were analysed. The numbers of patients who were non-concordant were: 63 (16%) at baseline; 101 (25%) at year 1; and 122 (30%) at year 2. The baseline-measured variables that were significantly associated with year 1 non-concordance included diabetes duration, history of cardiovascular disease, components of the EuroQol quality of life questionnaire, the EQ-5D score, and number of medications prescribed. In multivariable analyses, the most important determinant of year 1 non-concordance was baseline non-concordance: odds ratio 13.6 (95% confidence limits 4.7, 39.9). Number of medications prescribed for blood pressure control was also significant: odds ratio 1.8 (95% confidence limits 1.4, 2.4). Similar results were observed for year 2 non-concordance. CONCLUSIONS Non-concordance with medications was common and more likely in people prescribed more medications. The current target-driven management of risk factor levels may lead to increasing numbers and doses of medications. Considering the high cost of medications and the implications of poor health behaviours on morbidity and mortality, further investigation of prescribing behaviours and the factors affecting patient concordance are required.
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Affiliation(s)
- C E Lloyd
- Open University, Faculty of Health and Social Care, Milton Keynes, UK
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Reach G. Non-observance dans le diabète de type 2. Presse Med 2013; 42:886-92. [DOI: 10.1016/j.lpm.2013.02.314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 02/18/2013] [Indexed: 10/27/2022] Open
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Guénette L, Moisan J. Elderly People's Knowledge of the Purpose of Their Medicines. ACTA ACUST UNITED AC 2011; 9:49-57. [DOI: 10.1016/j.amjopharm.2011.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2011] [Indexed: 11/30/2022]
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Brown SHM, Hafeez U, Abdelhafiz AH. Use of multicompartment compliance aids for elderly patients: patient viewpoints and hospital length of stay. Postgrad Med 2010; 122:186-91. [PMID: 20675981 DOI: 10.3810/pgm.2010.07.2185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To explore elderly (aged > or = 75 years) patients' views regarding the use of multicompartment compliance aids (MCAs) and determine whether MCAs would prolong their length of hospital stay. METHODS A cross-sectional, prospective study in 3 acute geriatric wards in a district general hospital in the United Kingdom. Patients admitted to the hospital who were found to be users of MCAs were interviewed about their perception of MCAs, and their length of hospital stay was monitored. RESULTS A total of 1080 older patients were admitted over a 3-month period. Only 51 (4.7%) patients were users of MCAs and constituted the study group. The majority (51%) of MCAs were requested by general practitioners. Eight (16%) patients were asked whether they wished to use the MCAs and 3 (6%) had formal assessment prior to MCA start. On the patients' survey, 18 (35%) patients did not prefer the MCA if they were given the choice. This group of patients had better cognitive function assessed by the Mini-Mental State Examination (24.4 [3.6] vs 21.8 [3.6]; P = 0.02) and were less dependent on social services (39% vs 67%; P = 0.04) in comparison with patients who did prefer the MCA. They expressed a greater lack of autonomy (94% vs 52%; P = 0.002) and decision making (78% vs 49%; P = 0.04). They tended to be more informed about their medications' names (44% vs 6%; P = 0.01), indications (28% vs 9%; P = 0.02), and self-administration of medications (89% vs 39%; P = 0.01). Multicompartment compliance aids resulted in delayed discharges of 40 (78%) patients, with a mean of 1.3 days (standard deviation, 0.9 days; range, 0-3 days per patient) and a total of 65 days. CONCLUSION The use of MCAs resulted in a lack of autonomy and decision making in older patients and a significant delay of discharges, thereby increasing hospital costs.
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Hart PL, Grindel CG. Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetes. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01062.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Al-Qazaz HK, Hassali MA, Shafie AA, Syed Sulaiman SA, Sundram S. Perception and knowledge of patients with type 2 diabetes in Malaysia about their disease and medication: a qualitative study. Res Social Adm Pharm 2010; 7:180-91. [PMID: 21272545 DOI: 10.1016/j.sapharm.2010.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diabetic patients' experience and knowledge about their medication play an important role in determining the success of long-term adherence in their disease management. OBJECTIVE This study aimed to explore diabetic patients' experience and knowledge about diabetes and its medication and to understand the factors contributing to medication adherence in Malaysian population. METHODS A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by diabetic patients. Twelve patients were interviewed using a semi-structured interview guide. Saturation point of the interview was reached after the 10th interview, and no more new themes emerged from the subsequent 2 interviews. All interviews were transcribed verbatim and analyzed by means of a standard content analysis framework. RESULTS A total of 4 themes were identified from the interview analysis: knowledge about diabetes and its medication, experiences of adverse effects of medication, issues related to adherence, and the impact of medical and family relationships on well-being. Most of the patients were aware of the disease known as diabetes but unaware which type of diabetes they were suffering from. None of the participants knew the adverse effects of their medication, and most of them considered it to be safe. Financial barriers, forgetfulness, self-medication, and quality of relationships with doctor and family members seem to be the factors that challenge adherence in our sample of diabetic patients. CONCLUSION This study identified a number of key themes that might be useful in enhancing the awareness of experiences, knowledge, adherence, and attitudes of Malaysian patients with diabetes. More efforts should be taken to estimate how diabetic patients take their medication, and a well-planned educational program is also required to educate and encourage patients to practice a healthy lifestyle.
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Affiliation(s)
- Harith Khalid Al-Qazaz
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia.
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Affiliation(s)
- Stefano Del Prato
- Department of Endocrinology and Metabolism, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy.
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Banning M. A review of interventions used to improve adherence to medication in older people. Int J Nurs Stud 2009; 46:1505-15. [DOI: 10.1016/j.ijnurstu.2009.03.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 02/04/2009] [Accepted: 03/27/2009] [Indexed: 12/31/2022]
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Abstract
The primary cause of hypoglycaemia in Type 2 diabetes is diabetes medication-in particular, those which raise insulin levels independently of blood glucose, such as sulphonylureas (SUs) and exogenous insulin. The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser insulin reserve and perhaps in the drive for strict glycaemic control. Differing definitions, data collection methods, drug type/regimen and patient populations make comparing rates of hypoglycaemia difficult. It is clear that patients taking insulin have the highest rates of self-reported severe hypoglycaemia (25% in patients who have been taking insulin for > 5 years). SUs are associated with significantly lower rates of severe hypoglycaemia. However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention. Hypoglycaemia has substantial clinical impact, in terms of mortality, morbidity and quality of life. The cost implications of severe episodes-both direct hospital costs and indirect costs-are considerable: it is estimated that each hospital admission for severe hypoglycaemia costs around pound1000. Hypoglycaemia and fear of hypoglycaemia limit the ability of current diabetes medications to achieve and maintain optimal levels of glycaemic control. Newer therapies, which focus on the incretin axis, may carry a lower risk of hypoglycaemia. Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications.
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Affiliation(s)
- S A Amiel
- King's College London School of Medicine, London, UK
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Chao J, Nau DP, Aikens JE. Patient-reported perceptions of side effects of antihyperglycemic medication and adherence to medication regimens in persons with diabetes mellitus. Clin Ther 2007; 29:177-80. [PMID: 17379058 DOI: 10.1016/j.clinthera.2007.01.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND With recent media attention to drug safety, patients may have heightened concerns about the side effects of medications that may affect their compliance with treatment. OBJECTIVES The purpose of this study was to determine the proportion of patients with type 2 diabetes mellitus who perceived having experienced side effects of antihyperglycemic medications, the proportion of these patients who communicated their concerns to physicians, and the potential association between the perception of experiencing side effects and adherence to medication regimens. METHODS Patients with diabetes were identified through the claims of a Midwest US managed care organization, using Health Plan Employer Data and Information Set criteria. Questionnaires were mailed to randomly selected patients. Patients receiving oral antihyperglycemic medications were selected as prospective subjects. Patients were excluded if they were receiving insulin. RESULTS The responses of 445 patients meeting the study criteria were collected and analyzed. The subjects were pre-dominantly white, with a mean (SD) age of 56 (11) years and a mean duration of diabetes of 7.3 (8.8) years. One hundred forty-eight (33%) subjects reported a perception of having experienced side effects of antihyperglycemic medication; 126 (85%) subjects reported that they had communicated these concerns to their physicians. Analysis of the subjects' responses indicated an association between the perception of having experienced side effects and nonadherence to antihyperglycemic medication regimens (beta=-0.15; P < 0.010). CONCLUSIONS Nearly one third of subjects with diabetes receiving oral noninsulin antihyperglycemic medications reported a perception of having experienced medication-related side effects. Despite the large portion of subjects who reported that they had communicated these concerns to their physicians, the perception of experiencing medication-related side effects was significantly associated with nonadherence to antihyperglycemic drug regimens.
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Mehuys E, De Bolle L, Van Bortel L, Annemans L, Van Tongelen I, Remon JP, Giri M. Medication use and disease management of type 2 diabetic flemish patients. ACTA ACUST UNITED AC 2007; 30:51-6. [PMID: 17588213 DOI: 10.1007/s11096-007-9140-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 05/29/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was (International Diabetes Federation. Diabetes Atlas Second Edition Executive Summary. Brussels: International Diabetes Federation; 2003) to describe the current status of medication use and disease management of type 2 diabetic patients in Flanders (Belgium), (World Health Organization. Prevention of diabetes mellitus. Technical report series no. 844. Geneva: World Health Organization; 1994) to identify the aspects of type 2 diabetes care a community pharmacist could provide additional educational services for, and (American Diabetes Association. Diabetes Care 2006;29:S4-42) to propose these services as a pharmacist intervention. METHOD We recruited 338 patients in 77 community pharmacies in Flanders (Belgium). Each patient completed a questionnaire collecting personal data, information on duration of diabetes, medication, diabetes symptoms and self-management. At inclusion, patients measured their fasting plasma glucose (FPG) on three consecutive days. Prescription drugs (antidiabetic and other) purchased by each patient during the 12 months prior to inclusion in the study were reviewed from anonymized computerized pharmacy records. MAIN OUTCOME MEASURES Degree of self-management, glycaemic control and medication use. RESULTS The mean FPG of the sample was 150.7+/-43.0 mg/dl. Controlled glycaemia (FPG between 90 and 130 mg/dl (5.0-7.2 mmol/l)) was achieved in only 34.9% of the patients. Mainstay of hypoglycemic treatment consisted of metformin monotherapy (29.6%) and metformin combined with sulfonylurea (29.0%). Regarding co-medication, 76.9% of the patients used antihypertensive drugs whereas only 33.1% and 39.9% were on aspirin and statin therapy, respectively. ADA recommendations for annual eye and foot examination were not followed in 38.8% (eye) and 39.2% (feet) of the patients. CONCLUSION The current management of type 2 diabetic Flemish patients falls short of recommended treatment goals. Community pharmacists may play a role in enhancing the awareness of glycaemic control and in stimulating self-management in diabetic patients by motivating patients towards correct medication use, better medication adherence, healthy lifestyle and smoking cessation.
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Affiliation(s)
- Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Harelbekestraat 72, Gent 9000, Belgium.
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Villanyi D, Wong RYM. Self-reported understanding of diabetes and its treatment among elderly ambulatory subjects in British Columbia. ACTA ACUST UNITED AC 2007; 5:18-30. [PMID: 17608244 DOI: 10.1016/j.amjopharm.2007.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is little published information on the level of self-reported understanding of diabetes mellitus (DM) and its treatment among elderly subjects with DM or on the association between such understanding and the likelihood of errors in the recall of medication regimens. OBJECTIVES The primary objectives of the present study were to describe self-reported understanding of DM and its treatment among elderly subjects with DM, and to determine whether poorer understanding of the disease and its treatment was predictive of medication-recall errors. Secondary objectives were to assess the potential association of certain demographic and disease-specific variables with subjects' understanding of DM and its treatment. METHODS This was a cross-sectional survey of elderly subjects (age > or =65 years) with DM who were taking oral hypoglycemic medications and/or insulin and were seen at an outpatient DM clinic in British Columbia. The study questionnaire, which was administered at the clinic, included questions on self-reported understanding of DM and its treatment, sources of disease and drug information, and subjects' specific medication regimens. Subjects' reports of their medication regimens (medication, dose, directions for administration) were reconciled against information in the provincial prescription drug database. A medication-recall error was defined as a discrepancy between the self-reported medication name (including failure to mention a medication), dose, or frequency of administration and the record in the database. Medication-recall errors were used as a proxy for the likelihood of making an error that could lead to actual medication-related harm. RESULTS Forty-nine subjects (25 men, 24 women; mean [SD] age, 76.1 [6.3] years) were enrolled in the study. The majority (59.2%) of subjects reported having an above average understanding of DM, and 36.7% reported having an above average understanding of DM treatment. When subjects' reported diabetic medication regimens were checked against the provincial prescription database, 12 subjects had not accurately recalled at least 1 aspect of their regimen: 6 cases involved incorrect recall of the dose, 4 involved inability to state the medication name, and 2 involved omitting to mention a medication. Among the 12 subjects with medication-recall errors, 10 (83.3%) reported having an above average understanding of DM, and 7 (58.3%) reported having an above average understanding of DM treatment. CONCLUSION In this cohort, despite a high self-reported understanding of DM and its treatment, 24.5% of subjects made at least 1 error in accurately recalling their medication regimen.
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Affiliation(s)
- Diane Villanyi
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Chao J, Nau DP, Aikens JE, Taylor SD. The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes. Res Social Adm Pharm 2007; 1:508-25. [PMID: 17138493 DOI: 10.1016/j.sapharm.2005.09.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although bivariate relationships between depressive symptoms, health beliefs, and medication adherence have been identified, the complex relationship among these 3 constructs has not been explicated. OBJECTIVE This study examines the mediating role of patients' beliefs about diabetes and diabetes medications in relation to depressive symptoms and diabetes medication adherence. METHODS A survey was sent to 1700 persons with type 2 diabetes who were enrolled in a managed care organization in the United States. The bivariate relationships between depressive symptoms, diabetes-related health beliefs, and diabetes medication adherence were assessed. A structural equation model was developed to determine if health beliefs mediated the relationship between depressive symptoms and medication adherence. RESULTS Usable responses were received from 445 subjects. Greater depressive symptoms were associated with lower adherence to diabetes medications. The structural equation model indicated that the effect of depressive symptoms on medication adherence was mediated through perceived side effect barriers, perceived general barriers, and self-efficacy. Patients with severe depressive symptoms perceived more barriers to treatment adherence and were less confident in their ability to adhere to medication. In turn, reduced self-efficacy and heightened perceived barriers had a negative association with patients' adherence to diabetes medication regimens. CONCLUSIONS Decreased adherence to diabetes medications in patients with both diabetes and depressive symptoms may be partly explained by the association of depression with patients' beliefs about diabetes medications and their self-efficacy for medication use.
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Affiliation(s)
- Jingdong Chao
- Department of Health Outcomes, Aventis Pharmaceuticals, Bridgewater, NJ, USA
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Del Prato S, Felton AM, Munro N, Nesto R, Zimmet P, Zinman B. Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract 2005; 59:1345-55. [PMID: 16236091 DOI: 10.1111/j.1742-1241.2005.00674.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite increasingly stringent clinical practice guidelines for glycaemic control, the implementation of recommendations has been disappointing, with over 60% of patients not reaching recommended glycaemic goals. As a result, current management of glycaemia falls significantly short of accepted treatment goals. The Global Partnership for Effective Diabetes Management has identified a number of major barriers that can prevent individuals from achieving their glycaemic targets. This article proposes 10 key practical recommendations to aid healthcare providers in overcoming these barriers and to enable a greater proportion of patients to achieve glycaemic goals. These include advice on targeting the underlying pathophysiology of type 2 diabetes, treating early and effectively with combination therapies, adopting a holistic, multidisciplinary approach and improving patient understanding of type 2 diabetes. Implementation of these recommendations should reduce the risk of diabetes-related complications, improve patient quality of life and impact more effectively on the increasing healthcare cost related to diabetes.
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Shane-McWhorter L, Oderda GM. Providing Diabetes Education and Care to Underserved Patients in a Collaborative Practice at a Utah Community Health Center. Pharmacotherapy 2005; 25:96-109. [PMID: 15767225 DOI: 10.1592/phco.25.1.96.55623] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Many underserved patients in Utah lack insurance coverage for health care and prescription drugs but are provided medical care in community health centers (CHCs). Before June 2000, comprehensive pharmacy services were not provided to these patients at a Utah CHC. As part of a Health Resources and Services Administration grant, a collaborative agreement between the University of Utah College of Pharmacy and Utah CHCs was established so that a faculty clinician who is a certified diabetes educator (CDE) could provide diabetes education and care to underserved patients. The College of Pharmacy faculty clinician (pharmacist CDE) collaborated with physicians and midlevel practitioners to provide diabetes education and care for 176 patients. In addition to initial diabetes education, the pharmacist CDE provided continuing disease management by providing information and feedback to patients and recommendations to providers. The pharmacist CDE conducted continuing chart reviews to track certain parameters, such as laboratory test results for hemoglobin A 1c (A1C) and lipid levels, and blood pressure. Patients were followed for 1-3 years. The same outcome data were also collected for 176 patients with diabetes mellitus in another CHC clinic to provide a comparison group. Total cholesterol, low-density lipoprotein cholesterol, A1C, and triglyceride levels declined significantly from baseline at both sites. However, more patients who were provided care by the pharmacist CDE reached the American Diabetes Association A1C target goal of below 7%.
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Affiliation(s)
- Laura Shane-McWhorter
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah 84112, USA
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Bartels D. Adherence to Oral Therapy for Type 2 Diabetes: Opportunities for Enhancing Glycemic Control. ACTA ACUST UNITED AC 2004; 16:8-16. [PMID: 15008033 DOI: 10.1111/j.1745-7599.2004.tb00366.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Although diet and exercise are important parts of type 2 diabetes treatment, most patients require pharmacological intervention with multiple agents to maintain adequate glycemic control. This article addresses the numerous patient-related, disease-related, and demographic variables affecting medication adherence in this patient population. DATA SOURCES Extensive review of scientific literature, clinical practice guidelines, and Internet sources. CONCLUSIONS Studies have demonstrated that treatments including multiple medications or frequent dosing had a negative impact on adherence. Practitioners have used several approaches in an effort to improve adherence to oral antidiabetic medical therapy, including increased communication between health care providers and patients, implementation of multidisciplinary programs, and use of treatment regimens with easier dosing (i.e., reduced number of drugs or doses taken per day). IMPLICATIONS FOR PRACTICE Options for type 2 diabetes treatments that combine effective medications into a simpler oral-dosage form may motivate and improve patient adherence. Ultimately, simplifying dosing may lead to better glycemic control, thereby reducing the risks associated with long-term consequences of the disease.
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Affiliation(s)
- David Bartels
- University of Illinois, Chicago College of Pharmacy and College of Medicine at Rockford, Illinois, USA.
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Grant RW, Devita NG, Singer DE, Meigs JB. Improving adherence and reducing medication discrepancies in patients with diabetes. Ann Pharmacother 2003; 37:962-9. [PMID: 12841801 DOI: 10.1345/aph.1c452] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To improve medication adherence by reducing self-reported adherence barriers, and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimens. DESIGN Prospective, randomized, controlled trial. SETTING AND PARTICIPANTS A single academically affiliated community health center. Eligible patients had type 2 diabetes, had undergone laboratory testing in the year preceding the study, and had visited the clinic in the 6 months preceding the study. INTERVENTION A pharmacist administered detailed questionnaires, provided tailored education regarding medication use and help with appointment referrals, and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care provider. MEASUREMENTS Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview. Intervention patients with medication discrepancies at baseline were assessed for resolution of discrepancies at 3 months. RESULTS Rates of self-reported medication adherence were very high and did not improve further at 3 months (6.9 of 7 d, with all medicines taken as prescribed; p = 0.3). Medical regimen discrepancies were identified in 44% of intervention patients, involving 45 doses of medicines. At 3-month follow-up, 60% of discrepancies were resolved by corrections in the medical record, while only 7% reflected corrections by patients. CONCLUSIONS In this community cohort, patients reported few adherence barriers and very high medication adherence rates. Our patient-tailored intervention did not further reduce these barriers or improve self-reported adherence. The high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors.
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Affiliation(s)
- Richard W Grant
- General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114-2517, USA.
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Shane-McWhorter L, Fermo JD, Bultemeier NC, Oderda GM. National survey of pharmacist certified diabetes educators. Pharmacotherapy 2002; 22:1579-93. [PMID: 12495168 DOI: 10.1592/phco.22.17.1579.34131] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We sought to determine the demographics of pharmacists who were certified diabetes educators (CDEs) and information about their training, professional affiliations, and types of diabetes education services that they provide. We also queried these pharmacists about clinical activities, reimbursement, impact of certification, and intent to pursue CDE recertification. A list of pharmacists who were CDEs as of August 31, 2000, was obtained from the National Certification Board for Diabetes Educators. We then sent a six-page anonymous survey to 415 pharmacist CDEs; 233 surveys (56.1%) were returned. Of these respondents, 140 are women and 93 are men, with a mean age of 41.5 years. Most reside in Southern or Western states. Average time since pharmacist licensure was 17 years, and average time as a CDE was 5 years. Most had completed postgraduate training, including residencies and/or fellowships; 52.8% had faculty appointments; 46.7% stated they were billing for their services; and 45.9% were obtaining reimbursement. Most pharmacists (84.4%) stated that they intended to pursue CDE recertification. Providing details about pharmacist CDEs and their clinical activities may motivate other pharmacists to pursue this credential. Pharmacists are often the most accessible of all health care providers, and earning the CDE credential may be an important contribution to diabetes care and education.
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Affiliation(s)
- Laura Shane-McWhorter
- Department of Pharmacy Practice, University of Utah, College of Pharmacy, 30 South 2000 E #260, Salt Lake City, UT 84112, USA
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Donnan PT, MacDonald TM, Morris AD. Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study. Diabet Med 2002; 19:279-84. [PMID: 11942998 DOI: 10.1046/j.1464-5491.2002.00689.x] [Citation(s) in RCA: 319] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the patterns and predictors of adherence in all patients with Type 2 diabetes in the community receiving treatment with a single oral hypoglycaemic drug. In particular, to test the hypothesis that one tablet per day is associated with better adherence than more than one. METHODS The study design was a retrospective cohort study set in the Tayside region of Scotland (population approx. 400 000). Participants were residents of Tayside from 1 January 1993 until 31 December 1995 with at least 12 months of prescriptions of oral hypoglycaemic drugs (OHDs). The main outcome measures were adherence indices for sulphonylureas and metformin separately, adjusting for prescribing while hospitalized. RESULTS Of the total 2920 subjects identified, adequate adherence (> or = 90%) was found in 31% of those prescribed sulphonylureas alone (n = 1329, median adherence = 300 days per year), and in 34% of those prescribed metformin alone (n = 528, median = 302 days per year). There were significant linear trends of poorer adherence with each increase in the daily number of tablets taken (p = 0.001) and increase in co-medication (p = 0.0001) for sulphonylureas alone after adjustment for other factors. CONCLUSIONS In the community only one in three with Type 2 diabetes had adequate adherence to OHDs. One tablet per day administration was associated with greater adherence than multiple tablets. Poor adherence is a major obstacle to the benefit of complex drug regimens in the treatment of Type 2 diabetes.
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Affiliation(s)
- P T Donnan
- Tayside Centre for General Practice, Department of Clinical Pharmacology, University of Dundee, Dundee, UK.
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