Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

The impact of neuropsychological functions on self-care/self-management of type 2 diabetes in middle-aged people: a scoping review and meta-analysis

INTRODUCTION

This study aimed to investigate the impact of neuropsychological functions on self-care/self-management in middle-aged individuals with type 2 diabetes (T2DM).

AREAS COVERED

A comprehensive literature search was conducted from January 2012 to April 2023 across multiple databases. Ten articles were included in the scoping review, and 3 articles were included in the meta-analysis. The findings consistently indicated an association between reduced neuropsychological functions and poor self-care/self-management in this population. Memory functions, executive functions, and other domains were found to be significantly related to self-care/self-management, including diet management, exercise, blood glucose monitoring, and foot care.

EXPERT OPINION

This study highlights the importance of considering neuropsychological factors in understanding and improving diabetes management outcomes. The findings underscore the need for comprehensive neuropsychological assessments and the development of targeted interventions to address specific vulnerable domains. Future research should focus on elucidating underlying mechanisms, addressing methodological inconsistencies, and exploring the effectiveness of interventions targeting neuropsychological impairments. Incorporating technology and personalized approaches into diabetes management can enhance self-care/self-management and clinical outcomes in individuals with T2DM.

[Indicators of diabetes mellitus after liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin]

Background

The control of diabetes mellitus is multifactorial, the different therapeutic options make it necessary to compare the effectiveness with previous therapeutic schemes.

Objective

Analize the indicators of control of diabetes mellitus after incorporating liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin.

Methods

Observational, analytical, longitudinal study. Glucose, glycosylated hemoglobin, and blood pressure were compared after the inclusion of new cues in patients with diabetes mellitus; in addition to the control indicators reported in the unit in october, november, and december 2000, with those of 2021 in the same months. A descriptive analysis was performed, T for related samples and McNemar, a value of < .05 was considered significant, a confidence level of 95%, with the IBM-SPSS 24 software.

Results

352 files were analyzed, 59% women, aged 26 to 88 years, and the percentage of control decreased after the change of scheme (38.4% vs 35.8%) without a statistical difference (p .503). There was no statistical difference between the levels of glucose, glycated hemoglobin, weight, and blood pressure before and six months after the change. In the unit, the regimen glycemic control indicator improved in October, November, and December 2020 compared to the same months in 2021, it increased (from 17.2, 18.7, and 16.3, to 41.6, 47.2, and 46.5%). Blood pressure control went from 64.5, 66.7, and 67 to 82.4, 85.1, and 83.1%.

Conclusions

The control indicators in the unit improved, however, the patients who used the new keys did not show any difference.

Great diversity in the utilization and reporting of latent growth modeling approaches in type 2 diabetes: A literature review

Introduction

The progression of complications of type 2 diabetes (T2D) is unique to each patient and can be depicted through individual temporal trajectories. Latent growth modeling approaches (latent growth mixture models [LGMM] or latent class growth analysis [LCGA]) can be used to classify similar individual trajectories in a priori non-observed groups (latent groups), sharing common characteristics. Although increasingly used in the field of T2D, many questions remain regarding the utilization of these methods.

Objective

To review the literature of longitudinal studies using latent growth modeling approaches to study T2D.

Methods

MEDLINE (Ovid), EMBASE, CINAHL and Wb of Science were searched through August 25^th, 2021. Data was collected on the type of latent growth modeling approaches (LGMM or LCGA), characteristics of studies and quality of reporting using the GRoLTS-Checklist and presented as frequencies.

Results

From the 4,694 citations screened, a total of 38 studies were included. The studies were published beetween 2011 and 2021 and the length of follow-up ranged from 8 weeks to 14 years. Six studies used LGMM, while 32 studies used LCGA. The fields of research varied from clinical research, psychological science, healthcare utilization research and drug usage/pharmaco-epidemiology. Data sources included primary data (clinical trials, prospective/retrospective cohorts, surveys), or secondary data (health records/registries, medico-administrative). Fifty percent of studies evaluated trajectory groups as exposures for a subsequent clinical outcome, while 24% used predictive models of group membership and 5% used both. Regarding the quality of reporting, trajectory groups were adequately presented, however many studies failed to report important decisions made for the trajectory group identification.

Conclusion

Although LCGA were preferred, the contexts of utilization were diverse and unrelated to the type of methods. We recommend future authors to clearly report the decisions made regarding trajectory groups identification.

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There is a growing body of literature on trajectory modeling in type 2 diabetes.

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Latent class growth analysis can be used in many different contexts.

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The current reporting of methods used should be improved.

Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review

Background

Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients.

Methods

The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed.

Results

Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients’ race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies.

Conclusions

Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01209-w.

Social capital and cost-related medication nonadherence (CRN): A retrospective longitudinal cohort study using the Health and Retirement Study data, 2006-2016

Prescription drug spending and other financial factors (e.g., out-of-pocket costs) partially explain variation in cost-related medication nonadherence (CRN). Indicators of social capital such as neighborhood factors and social support may influence the health and well-being of older adults as they may rely on community resources and support from family and peers to manage conditions. Previous research on the relationship of social capital and CRN has limited evidence and contradictory findings. Hence, our objective is to assess the relationship of social capital indicators (neighborhood social cohesion, neighborhood physical disorder, positive social support, and negative social support) and CRN using a longitudinal design, 2006 to 2016, in a nationally representative sample of older adults in the United States (US). The Health and Retirement Study is a prospective panel study of US adults aged ≥ 50 years evaluated every two years. Data was pooled to create three waves and fitted using Generalized Estimating Equation modelling adjusting for both baseline and timevarying covariates (age, sex, education, race, total household income, and perceived health status). The three waves consisted of 11,791, 12,336, and 9,491 participants. Higher levels of neighborhood social cohesion and positive social support were related with lower CRN (OR 0.92, 95% CI 0.88-0.95 and OR 0.77, 95% CI 0.70-0.84, p<0.01). In contrast, higher levels of neighborhood physical disorder and negative social support were related to higher CRN (OR 1.07, 95% CI 1.03-1.11 and OR 1.46, 95% CI 1.32-1.62, p<0.01). Interventions targeting social capital are needed, reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support for older adults.

Racial and Regional Disparities in Outcomes Among Veterans Initially Adherent to Oral Antidiabetic Therapies: an Observational Cohort Study

BACKGROUND

Adherence to prescribed medications is connected with, but is not a guarantee of, improved disease management and health outcomes. It remains unclear whether underlying health disparities exist among patients adherent to therapy and whether differences in outcomes vary by race and residential areas of the country.

OBJECTIVE

To determine the extent of racial and regional variation in outcomes within 5 years of oral antidiabetic drug initiation among veterans adherent to therapy.

DESIGN

Retrospective cohort study of 83,265 US Veterans Health Administration data, 2002-2014 PATIENTS: US veterans with uncomplicated diabetes and taking oral antidiabetic agents MAIN MEASURES: Veterans initially adherent to oral antidiabetic therapy were followed for up to 5 years, and comparisons focused on differences between non-Hispanic White and non-Hispanic Black veterans across geographic region and residential type (urban or rural). Outcomes included composite cardiovascular events, composite cerebrovascular events, or all-cause mortality using Poisson and adjusted Cox proportional hazards models.

KEY RESULTS

Cardiovascular event and all-cause mortality rates differed by race and region, while urban/rural differences were evident for cerebrovascular events and all-cause mortality. For non-Hispanic Blacks, the mortality rate was half that compared to non-Hispanic Whites (6.5 [95% CI 5.8-7.2] versus 13.3 [95% CI 12.9-13.8], p < 0.0001). Compared to the Northeast, all other regions had higher adjusted hazards for cardiovascular or cerebrovascular events (with a single exception), but no regional differences in all-cause mortality were observed. Models with interactions demonstrated that racial differences in cardiovascular events and all-cause mortality were isolated to the Midwest (HR 1.99 [95% CI 1.301-3.06; HR 1.64 [95% CI 1.210-2.215]) and South (HR 1.69 [85% CI 1.347-2.131]; HR 1.27 [95% CI 1.095-1.470]).

CONCLUSIONS

Despite adherence to therapy, differences in outcomes are likely among veterans with diabetes based on race and geography. Localized analyses may uncover specific social determinants contributing to differences in outcomes.

Trajectories of adherence to mood stabilizers in patients with bipolar disorder

Background

Nonadherence with mood stabilizers is a major problem that negatively impacts the course of bipolar disorder. Medication adherence is a complex individual behavior, and adherence rates often change over time. This study asked if distinct classes of adherence trajectories with mood stabilizers over time could be found, and if so, which patient characteristics were associated with the classes.

Methods

This analysis was based on 12 weeks of daily self-reported data from 273 patients with bipolar 1 or II disorder using ChronoRecord computer software. All patients were taking at least one mood stabilizer. The latent class mixed model was used to detect trajectories of adherence based on 12 weekly calculated adherence datapoints per patient.

Results

Two distinct trajectory classes were found: an adherent class (210 patients; 77%) and a less adherent class (63 patients; 23%). The characteristics associated with the less adherent class were: more time not euthymic (p < 0.001) and female gender (p = 0.016). No other demographic associations were found.

Conclusion

In a sample of motivated patients who complete daily mood charting, about one quarter were in the less adherent class. Even patients who actively participate in their care, such as by daily mood charting, may be nonadherent. Demographic characteristics may not be useful in assessing individual adherence. Future research on longitudinal adherence patterns in bipolar disorder is needed.

Beliefs about medicines as mediators in medication adherence in type 2 diabetes

AIMS

This study analysed whether beliefs about medicines mediated the relationship between illness representations and medication adherence.

BACKGROUND

Adherence to medication is required in diabetes treatment, contributing to decreased blood glycaemic levels. The knowledge and perception of patients about diabetes as well as the beliefs about medicines are considered to be key factors for medication adherence.

DESIGN

The study used a cross-sectional design that included 387 patients recently diagnosed with type 2 diabetes.

METHODS

Participants were assessed, between 2010 and 2013, and answered the Medication Adherence Scale, the Beliefs about Medicines Questionnaire, and the Brief Illness Perception Questionnaire.

RESULTS

The results of the path analysis showed that beliefs about medicines had a mediating role on self-report medication adherence with the exception of beliefs about specific concerns with medicines. Therefore, both general beliefs and specific needs about medicines mediated the relationship between diabetes consequences and self-report medication adherence as well as between treatment control and self-report medication adherence. Needs about medicines mediated the relationship between personal control and self-report medication adherence.

CONCLUSION

Health professionals should target beliefs about medicines besides illness representations regarding medication adherence. The current study may help optimize adherence to medication in early-diagnosed type 2 diabetes patients.

Coping with diabetes: Provider attributes that influence type 2 diabetes adherence

Diabetes, a chronic disease affecting over 29 million people in the United States, requires the integration of complex medical tasks into a person's daily life. Patient-centered care and compassion are recognized as essential dimensions of the quality care experience. This research examined provider attributes that influence adherence to type 2 diabetes mellitus (T2DM) regimens and sought to understand the phenomena of provider attributes, treatment adherence, and their relationship to coping ability and treatment outcomes. This quantitative study sampled 474 people with T2DM using a 62-item online survey administered to three different groups. The sample population included people over age 18 diagnosed with T2DM. The first group included 91 persons with T2DM identified through a Facebook group and personal social media connections, the second group included 120 Amazon Mechanical Turk participants with T2DM, and the third group included 263 respondents from a Qualtrics panel who had T2DM. Results indicated that perceived provider compassion (β = .41, ρ < .001) and optimism (β = .48, ρ < .001) positively affected coping ability. Additionally, full mediation effects for self-management were revealed, with coping ability positively mediating the effect of compassion on self-management and the effects of optimism on self-management. Furthermore, full mediation effects were found for treatment satisfaction, with coping ability positively mediating the effect of compassion on treatment satisfaction and the effects of optimism on treatment satisfaction. This research has implications for patients, healthcare professionals, and leaders suggesting that providers who communicate with optimism and compassion positively affect coping ability. As a result, healthcare providers and professionals have an opportunity to enhance self-management adherence by helping their patients cope with the burdens of diabetes. In addition, this study has implications for developing provider communication tools aimed at assessing patients' coping capacity and increasing compassionate communication.

Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study

BACKGROUND

In the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD).

AIM

We examined risk factors for medication adherence and the relationship between adherence and levels of CVD risk factors among older participants with hypertension, dyslipidaemia and diabetes in the Framingham Heart Study.

METHODS

The four-item Morisky Medication Adherence Scale was administered to 1559 participants, median age 70 years, 53% women. We created an adherence score, ranging from 0 to 4, with low adherence defined as a score ≥2. CVD risk factors were assessed using standard protocols. Cognition was measured using the Mini-Mental State Examination (MMSE) and depressive symptoms were measured using the Center for Epidemiologic Studies of Depression (CES-D) scale.

RESULTS

Among participants who self-reported taking antihypertensive, lipid-lowering and/or hyperglycaemic medication(s), 12% (n = 191) had low medication adherence. The risk of low adherence increased by 45% (95% confidence interval (CI): 25-68%, P < 0.001) per five-unit increase in CES-D score. In participants taking antihypertensive medication (n = 1017), low adherence was associated with higher mean diastolic blood pressure (73 mmHg, 95% CI: 71-75 vs 71 mmHg, 95% CI: 70-71; P = 0.04) after adjusting for covariates. Among participants taking lipid-lowering medication (n = 937), low adherence was associated with higher mean low-density lipoprotein cholesterol (92 mg/dL, 95% CI: 87-96 vs 86 mg/dL, 95% CI: 84-88; P = 0.03). Low adherence was not associated with fasting plasma glucose (P = 0.10) or haemoglobin A1c (P = 0.68) in the subgroup of participants (n = 192) taking hypoglycaemic medication.

CONCLUSIONS

Depressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older-aged adults.

Neighborhood Social Environment and Patterns of Depressive Symptoms Among Patients with Type 2 Diabetes Mellitus

This study sought to examine whether neighborhood social environment was related to patterns of depressive symptoms among primary care patients with type 2 diabetes mellitus (DM). Neighborhood social environment was assessed in 179 patients with type 2 DM. Individual patient residential data at baseline was geo-coded at the tract level and was merged with measures of neighborhood social environment. Depressive symptoms at baseline and at 12-week follow up were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Patients in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage were much less likely to have a persistent pattern of depressive symptoms compared to a pattern of few or no depressive symptoms (adjusted odds ratio (OR) = 0.06, 95 % confidence interval (CI) [0.01, 0.36]). Detrimental neighborhood influences may amplify risk for persistent depressive symptoms.

Neighborhood social environment and patterns of adherence to oral hypoglycemic agents among patients with type 2 diabetes mellitus

This study examined whether neighborhood social environment was related to patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus. Residents in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage, compared to residents in neighborhoods with one or no high features present, were significantly more likely to have an adherent pattern compared to a nonadherent pattern. Neighborhood social environment may influence patterns of adherence. Reliance on a multilevel contextual framework, extending beyond the individual, to promote diabetic self-management activities may be essential for notable public health improvements.

A brief adherence intervention that improved glycemic control: mediation by patterns of adherence

This study examined whether longitudinal adherence profiles mediated the relationship between a brief adherence intervention and glycemic control among patients with type 2 diabetes. Adherence was assessed using the Medication Event Monitoring System. Longitudinal analysis via growth curve mixture modeling was carried out to classify patients according to patterns of adherence to oral hypoglycemic agents. Hemoglobin A1c assays were used to measure glycemic control as the clinical outcome. Across the whole sample, longitudinal adherence profiles mediated 35.2% (13.2, 81.0%) of the effect of a brief adherence intervention on glycemic control [from odds ratio (OR) = 8.48, 95% confidence interval (CI) (3.24, 22.2) to 4.00, 95% CI (1.34, 11.93)]. Our results suggest that patients in the intervention had better glycemic control largely due to their greater likelihood of adherence to oral hypoglycemic agents.