1
|
Moon JS, Kang S, Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Seo JA, Kim MK, Lim JH, Song YJ, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Bae J, Jeon E, Kim JM, Kang SM, Park JH, Yun JS, Cha BS, Moon MK, Lee BW. 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association. Diabetes Metab J 2024; 48:546-708. [PMID: 39091005 PMCID: PMC11307112 DOI: 10.4093/dmj.2024.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Jun Sung Moon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Shinae Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Yoon Ju Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Ye Seul Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Suk Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hae Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo-Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehyun Bae
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Eonju Jeon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Mee Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Hwan Park
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Ghang H, Lee J. Multilevel Analysis of the Relationship Between Prescribing Institutions and Medication Adherence Among Patients With Hypertension and Diabetes in Korea. J Prev Med Public Health 2023; 56:504-514. [PMID: 37817606 DOI: 10.3961/jpmph.23.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes. METHODS This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients' first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%. RESULTS The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intraclass correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples. CONCLUSIONS This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.
Collapse
Affiliation(s)
- Haryeom Ghang
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Korea
- Graduate School of Public Administration, Seoul National University, Seoul, Korea
| | - Juhyang Lee
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| |
Collapse
|
3
|
Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Kim NH, Seo JA, Kim MK, Lim JH, Song Y, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Choi WS, Moon MK. 2023 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association. Diabetes Metab J 2023; 47:575-594. [PMID: 37793979 PMCID: PMC10555541 DOI: 10.4093/dmj.2023.0282] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.
Collapse
Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - YoonJu Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Ye Seul Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Suk Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hae Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo-Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Committee of Clinical Practice Guidelines
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Korean Diabetes Association
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Shahabi N, Fakhri Y, Aghamolaei T, Hosseini Z, Homayuni A. Socio-personal factors affecting adherence to treatment in patients with type 2 diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2023; 17:205-220. [PMID: 37012162 DOI: 10.1016/j.pcd.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE The purpose of study was to identify the socio-personal factors affecting adherence to the treatment of patients with type 2 diabetes. METHODS Cross-sectional articles were extracted from databases such as Web of Science, PubMed, Elsevier. A meta-analysis was performed using integrated odds ratios (OR) and 95% confidence interval (CIs) for age, BMI, depression, educational level, gender, employment status, marital status, smoking status. STATA 12.0 was used to estimate pooled RR in definite subgroups. The quality of the studies included was evaluated using the STROBE checklist. RESULTS Thirty-one studies out of 7407 extracted articles were finally selected for the meta-analysis. The results showed that younger people had a 17% higher risk than older people, smokers had a 22% higher risk than non-smokers, and the employed had a 15% higher risk of non-adherence to treatment. CONCLUSION In conclusion, older age, smoking and employment can lead to non-adherence to T2D treatment. Interventions are suggested to be made besides common health care considering the socio-personal features on type 2 diabetes patients' treatment adherence.
Collapse
Affiliation(s)
- Nahid Shahabi
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Yadolah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Atefeh Homayuni
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| |
Collapse
|
5
|
Al-Waeli D, Mohammed A, Tahir I, Al-Saeedi A, Razzaq K, Abodhurais A. Barriers against the use of an optimal dose of metformin among patients with T2DM in Thi-Qar province, Iraq. J Med Life 2022; 15:557-562. [PMID: 35646179 PMCID: PMC9126465 DOI: 10.25122/jml-2021-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetes mellitus is a disease with a high burden and prevalence and serious complications. Glycemic control is vital in delaying or preventing complications. Although many people do not take optimal doses, metformin is a cornerstone in managing type 2 diabetes mellitus (T2DM) in all guidelines. This study determined the barriers interfering with optimal metformin dosage. A cross-sectional study was conducted in Thi-Qar Specialized, Diabetes, Endocrine and Metabolism Center (TDEMC) at Thi-Qar, southern Iraq, from January 2019 to January 2020. 475 patients (274 females and 201 males) were included, and examination and lab investigations were performed. Only 22 (4.6%) patients took the optimal dose with no differences between gender. Of those who took metformin, 255 (74%) took it as a regular pill, 79 (23%) as a combined form with sulfonylureas (SUs), while only 10 (0.3%) took combined pills with Dipeptidyl Peptidase-4 inhibitors (DPP4i). 188 patients (65%) took metformin with meals, 84 (29%) before meals, and 19 (6%) after meals. Ignorance caused poor adherence to optimal dose in 165 patients (38.6%), neglect in 75 (17.6%), the cost in 5 (1.2%), 11 patients (2.6%) thought they did not need metformin, 37(8.7%) and 12 (2.8%) blame side effects and shortage of supply from public health care clinics (PHCC) as a cause, respectively. The rest of the patients had more than one cause. The most common side effects were abdominal pain and bloating, 5.9% and 3.8%, respectively. Other side effects were diarrhea in 0.2%, and 7.8% of patients developed more than one side effect. Ignorance and neglect were major obstacles, so educating doctors and patients and supplying the patient with optimal doses through PHCC may overcome the problem.
Collapse
Affiliation(s)
- Dheyaa Al-Waeli
- Department of Medicine, College of Medicine, University of Thi-Qar, Nasiriyah, Thi-Qar, Iraq,Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq,Corresponding Author: Dheyaa Al-Waeli, Department of Medicine, College of Medicine, University of Thi-Qar, Nasiriyah, Thi-Qar, Iraq. E-mail:
| | - Adel Mohammed
- Department of Medicine, College of Medicine, University of Thi-Qar, Nasiriyah, Thi-Qar, Iraq,Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq
| | - Imad Tahir
- Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq,Department of Internal Medicine, Al-Hussein Teaching Hospital, Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq
| | - Ali Al-Saeedi
- Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq,Department of Internal Medicine, Al-Hussein Teaching Hospital, Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq
| | - Khdair Razzaq
- Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq,Department of Internal Medicine, Al-Hussein Teaching Hospital, Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq
| | - Ali Abodhurais
- Thi-Qar Specialized Diabetes, Endocrine and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Nasiriyah, Thi-Qar, Iraq
| |
Collapse
|
6
|
Ye M, Vena JE, Johnson JA, Shen-Tu G, Eurich DT. Anti-Hyperglycemic Medication Adherence and Health Services Utilization in People with Diabetes: A Longitudinal Study of Alberta's Tomorrow Project. Patient Prefer Adherence 2022; 16:1457-1467. [PMID: 35722195 PMCID: PMC9199902 DOI: 10.2147/ppa.s362539] [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: 02/15/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the long-term (>2 years) relationship between the time-varying drug adherence and healthcare utilization for patients with diabetes. OBJECTIVE To characterize the relationship between time-varying anti-hyperglycemic medication adherence and healthcare utilization in patients with diabetes, using data from Alberta's Tomorrow Project, a population-based cohort study in Alberta, Canada. METHODS Incident cases of diabetes with at least 24 months of follow-up were included in the study. Anti-hyperglycemic drug adherence was measured by proportion of days covered (PDC) in the past 12 months for each year after diagnosis. The rate of healthcare utilization was assessed for the subsequent 12 months, 36 months and 60 months. A time-varying, negative binomial generalized estimating equation model was used to examine the association between medication adherence and healthcare utilization. RESULTS Among 2155 incident cases of diabetes, average age at diagnosis was 59.6±9.3, 51.0% were female and average duration of follow-up was 7.3±3.7 (range, 2.0-16.2) years. The proportion of patients taking anti-hyperglycemic medications was 47.6% during the first year of diagnosis, which increased to 77.3% by the end of follow-up. Compared to adherent patients (PDC≥0.8), non-adherent patients (PDC<0.8) had substantially higher rate of all-cause hospitalization [incident rate ratio, IRR=1.48 (1.22-1.79), ED visits [1.30 (1.15-1.47)] and GP visits [1.17 (1.08-1.27)] in the subsequent 12 months. However, these associations became weaker with longer follow-up [eg, IRR=1.18 (0.98-1.39) and 1.05 (0.94-1.18) for all-cause hospitalization in the subsequent 36 and 60 months, respectively]. CONCLUSION Poor adherence among diabetic patients was associated with substantially higher rate of healthcare utilization in the short term (eg, 12 months); however, this association weakened over a longer period (eg, 36-60 months).
Collapse
Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta’s Tomorrow Project, CancerCare Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Shen-Tu
- Alberta’s Tomorrow Project, CancerCare Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Correspondence: Dean T Eurich, School of Public Health, University of Alberta, Canada, Email
| |
Collapse
|
7
|
Islam SMS, Mishra V, Siddiqui MU, Moses JC, Adibi S, Nguyen L, Wickramasinghe N. Smartphone Apps for Diabetes Medication Adherence: A Systematic Review (Preprint). JMIR Diabetes 2021; 7:e33264. [PMID: 35727613 PMCID: PMC9257622 DOI: 10.2196/33264] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/24/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Vinaytosh Mishra
- College of Healthcare Management and Economics, Gulf Medical University, Ajman, United Arab Emirates
| | - Muhammad Umer Siddiqui
- Department of Internal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Sasan Adibi
- School of Information Technology, Deakin University, Burwood, Australia
| | - Lemai Nguyen
- School of Information Technology, Deakin University, Burwood, Australia
| | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
8
|
Lin CS, Khan H, Chang RY, Liao WC, Chen YH, Siao SY, Hsieh TF. A study on the impact of poor medication adherence on health status and medical expense for diabetes mellitus patients in Taiwan: A longitudinal panel data analysis. Medicine (Baltimore) 2020; 99:e20800. [PMID: 32590763 PMCID: PMC7328918 DOI: 10.1097/md.0000000000020800] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Medication adherence plays an important role in disease management, especially for diabetes. The aim of this study was to examine the impacts of demographic characteristics on medication nonadherence and the impacts of nonadherence on both health status and medical expenses for diabetic patients in Taiwan.A total of 1 million diabetes mellitus patients were randomly selected from the National Health Insurance Research Database between January 1, 2000 and December 31, 2004. All records with missing values and those for participants under 18 years of age were then deleted. Because many patients had multiple clinical visit records, all records within the same calendar year were summarized into 1 single record for each person. This pre-processing resulted in 14,602 total patients with a combined 73,010 records over the course of 5 years. Generalized estimating equation models were then constructed to investigate the effects of demographic characteristics on medication nonadherence and the effects of nonadherence on patient health status and medical expenses. The demographic characteristics examined for each patient include gender, age, residential area, and socioeconomic status.Our analysis of how demographic variables impacted nonadherence revealed that elderly patients exhibited better overall medication adherence, but that male patients exhibited poorer medication adherence than female patients. Next, our analysis of how nonadherence impacted health status revealed that patients who exhibited medication nonadherence had poorer health status than patients with proper medication adherence. Finally, our analysis of how nonadherence impacted medical expenses revealed that patients who exhibited medication nonadherence incurred more medical expenses than those who exhibited proper medication adherence.This study's empirical results corroborate the general relationships expressed in the current literature regarding medication nonadherence. However, this study's results were statistically more reliable and revealed the precise impact on health status in terms of the Charlson comorbidity index and increased annual medical expenses. This indicates the need to improve patient attitudes toward medication adherence, which can have substantial effects both medically and economically.
Collapse
Affiliation(s)
- Chin-Shien Lin
- Department of Business Administration, National Chung Hsing University, Taichung, Taiwan
| | - Haider Khan
- Josef Korbel School of International Studies, University of Denver, Denver, CO
| | - Ruei-Yuan Chang
- Department of Finance, Providence University
- Department of Hospitality Management, Hungkuang University
| | - Wei-Chih Liao
- Department of Business Administration, National Chung Hsing University, Taichung, Taiwan
- Department of Infectious Disease, Tungs’ Taichung MetroHarbor Hospital
| | - Yi-Hsin Chen
- Department of Nephrology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei
- School of Medicine, Tzu Chi University, Hualian
| | - Sih-Yin Siao
- Department of Business Administration, National Chung Hsing University, Taichung, Taiwan
| | - Teng-Fu Hsieh
- School of Medicine, Tzu Chi University, Hualian
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| |
Collapse
|
9
|
Initial Therapy, Regimen Change, and Persistence in a Spanish Cohort of Newly Treated Type 2 Diabetes Patients: A Retrospective, Observational Study Using Real-World Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103742. [PMID: 32466267 PMCID: PMC7277774 DOI: 10.3390/ijerph17103742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
The World Health Organization considers the non-adherence to medication a significant issue with global impact, especially in chronic conditions such as type 2 diabetes. We aim to study antidiabetic treatment initiation, add-on, treatment switching, and medication persistence. We conducted an observational study on 4247 individuals initiating antidiabetic treatment between 2013 and 2014 in the EpiChron Cohort (Spain). We used Cox regression models to estimate the likelihood of non-persistence after a one-year follow-up, expressed as hazard ratios (HRs). Metformin was the most frequently used first-line antidiabetic (80% of cases); combination treatment was the second most common treatment in adults aged 40–79 years, while dipeptidyl peptidase-4 inhibitors were the second most common in individuals in their 80s and over, and in patients with renal disease. Individuals initiated on metformin were less likely to present addition and switching events compared with any other antidiabetic. Almost 70% of individuals initiated on monotherapy were persistent. Subjects aged 40 and over (HR 0.53–0.63), living in rural (HR 0.79) or more deprived areas (HR 0.77–0.82), or receiving polypharmacy (HR 0.84), were less likely to show discontinuation. Our findings could help identify the population at risk of discontinuation, and offer them closer monitoring for proper integrated management to improve prognosis and health outcomes.
Collapse
|
10
|
Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, Rossing P, Tsapas A, Wexler DJ, Buse JB. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2018; 61:2461-2498. [PMID: 30288571 DOI: 10.1007/s00125-018-4729-5] [Citation(s) in RCA: 748] [Impact Index Per Article: 124.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.
Collapse
Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK.
- Leicester Diabetes Centre, Leicester General Hospital, Leicester,, LE5 4PW, UK.
| | - David A D'Alessio
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Judith Fradkin
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Walter N Kernan
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Geltrude Mingrone
- Department of Internal Medicine, Catholic University, Rome, Italy
- Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Apostolos Tsapas
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Deborah J Wexler
- Department of Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
11
|
Kadowaki T, Sarai N, Hirakawa T, Taki K, Iwasaki K, Urushihara H. Persistence of oral antidiabetic treatment for type 2 diabetes characterized by drug class, patient characteristics and severity of renal impairment: A Japanese database analysis. Diabetes Obes Metab 2018; 20:2830-2839. [PMID: 29974673 PMCID: PMC6282986 DOI: 10.1111/dom.13463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the persistence with oral antidiabetic drug (OAD) treatment characterized by drug class, patient characteristics and severity of renal impairment (RI) in patients with type 2 diabetes (T2DM) in Japan. MATERIALS AND METHODS This retrospective, observational study extracted data from a large-scale hospital database (April 2008 to September 2016). Patients with T2DM aged ≥40 years on the day of their first prescription (index date) of any OAD (biguanides [BGs], thiazolidinediones [TZDs], sulphonylureas [SUs], glinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, or α-glucosidase inhibitors [α-GIs]) available between January 1, 2014 and September 30, 2016 were identified. Sodium-glucose co-transporter-2 inhibitors were not available at study initiation. Treatment persistence was assessed by Kaplan-Meier survival curves. Patients were also categorized by RI status using estimated glomerular filtration rate: ≥90 mL/min/1.73 m2 (G1); 60 to <90 mL/min/1.73 m2 (G2); 30 to <60 mL/min/1.73 m2 (G3); and <30 mL/min/1.73 m2 (G4+). RESULTS We identified 206 406 index dates from 162 116 eligible patients. The largest number of index dates (91634) was observed for DPP-4 inhibitors, followed by BGs, SUs, α-GIs, glinides and TZDs. Treatment persistence was longest for DPP-4 inhibitors (median 17.0 months, 95% confidence interval [CI] 16.4-17.5) and BGs (median 17.3 months, 95% CI 16.6-18.2), and shortest for α-GIs (median 5.6 months, 95% CI 5.4-5.9) and SUs (median 4.3 months, 95% CI 4.2-4.6). Persistence was longest with DPP-4 inhibitors at all RI stages (G1-G4+), followed by BGs at stages G1/G2. CONCLUSIONS The longest OAD persistence was observed for BGs and DPP-4 inhibitors at RI stages G1/G2, and for DPP-4 inhibitors at RI stages G3/G4+.
Collapse
Affiliation(s)
- Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Nobuaki Sarai
- Clinical Development and Medical AffairsNippon Boehringer Ingelheim Co., LtdTokyoJapan
| | - Takeshi Hirakawa
- Clinical Development and Medical AffairsNippon Boehringer Ingelheim Co., LtdTokyoJapan
| | - Kentaro Taki
- Medicine Development Unit JapanEli Lilly Japan K.K.KobeJapan
| | | | - Hisashi Urushihara
- Division of Drug Development and Regulatory Science, Faculty of PharmacyKeio UniversityTokyoJapan
| |
Collapse
|
12
|
Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, Rossing P, Tsapas A, Wexler DJ, Buse JB. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 41:2669-2701. [PMID: 30291106 PMCID: PMC6245208 DOI: 10.2337/dci18-0033] [Citation(s) in RCA: 1691] [Impact Index Per Article: 281.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication, and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.
Collapse
Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,Leicester Diabetes Centre, Leicester General Hospital, Leicester, U.K
| | - David A D'Alessio
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Judith Fradkin
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Walter N Kernan
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Geltrude Mingrone
- Department of Internal Medicine, Catholic University, Rome, Italy.,Diabetes and Nutritional Sciences, King's College London, London, U.K
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Apostolos Tsapas
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Deborah J Wexler
- Department of Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
13
|
A preliminary study of the potential role of Malaysian community pharmacists in type 2 diabetes medicines management clinics. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
14
|
Wang X, Li X, Qie S, Zheng Y, Liu Y, Liu G. The efficacy and safety of once-weekly DPP-4 inhibitor omarigliptin in patients with type 2 diabetes mellitus: A systemic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11946. [PMID: 30142816 PMCID: PMC6112932 DOI: 10.1097/md.0000000000011946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The efficacy and safety of once-weekly dipeptidyl peptidase-4 inhibitor (DPP-4i) omarigliptin as monotherapy or add on to other antihyperglycemic agents (AHAs) in patients with type 2 diabetes mellitus (T2DM) is unclear. METHODS PubMed, EMBASE, Cochrane library, and ClinicalTrials.gov were searched from the inception to January 24, 2018. Randomized controlled trials comparing omarigliptin with placebo or other AHAs in T2DM patients were included in our meta-analysis. Risk ratio (RR) and mean difference (MD) were used to evaluate the outcomes. RESULTS Totally, 11 trials involving 8276 patients were satisfied with our inclusion criteria. Compared with control group, omarigliptin was associated with a significantly stronger reduction in hemoglobin A1c (HbA1c) (MD 0.38%, 95% confidence interval [CI] [0.18, 0.58], P = .0002) and fasting plasma glucose (MD 0.48 mmol/L, 95% CI [0.14 mmol/L, 0.82 mmol/L], P = .006). Omarigliptin increased the number of participants who achieved HbA1c < 7.0% compared with control group (RR 2.03, 95% CI [1.38, 2.98], P = .0003). No significant difference was found in the aspect of adverse events (RR 1.00, 95% CI [0.97, 1.03], P = .99), serious adverse events (RR 1.02, 95% CI [0.91, 1.13], P = .75), hypoglycemic events (RR 0.86, 95% CI [0.48, 1.54], P = .61) between omarigliptin and control group. Omarigliptin has a homologous efficacy and safety background to other AHAs according to the results of subgroup analysis. CONCLUSIONS This review revealed that omarigliptin had a favorable efficacy and safety as monotherapy or add on to other AHAs in treating T2DM patients. It is a superior choice for T2DM patients who have a poor adherence to daily AHAs.
Collapse
|
15
|
McGovern A, Tippu Z, Hinton W, Munro N, Whyte M, de Lusignan S. Comparison of medication adherence and persistence in type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2018; 20:1040-1043. [PMID: 29135080 DOI: 10.1111/dom.13160] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
Abstract
Limited medication adherence and persistence with treatment are barriers to successful management of type 2 diabetes (T2D). We searched MEDLINE, EMBASE, the Cochrane Library, the Register of Controlled Trials, PsychINFO and CINAHL for observational and interventional studies that compared the adherence or persistence associated with 2 or more glucose-lowering medications in people with T2D. Where 5 or more studies provided the same comparison, a random-effects meta-analysis was performed, reporting mean difference (MD) or odds ratio (OR) for adherence or persistence, depending on the pooled study outcomes. We included a total of 48 studies. Compared with metformin, adherence (%) was better for sulphonylureas (5 studies; MD 10.6%, 95% confidence interval [CI] 6.5-14.7) and thiazolidinediones (TZDs; 6 studies; MD 11.3%, 95% CI 2.7%-20.0%). Adherence to TZDs was marginally better than adherence to sulphonylureas (5 studies; MD 1.5%, 95% CI 0.1-2.9). Dipeptidyl peptidase-4 inhibitors had better adherence than sulphonylureas and TZDs. Glucagon-like peptide-1 receptor agonists had higher rates of discontinuation than long-acting analogue insulins (6 studies; OR 1.95; 95% CI 1.17-3.27). Long-acting insulin analogues had better persistence than human insulins (5 studies; MD 43.1 days; 95% CI 22.0-64.2). The methods used to define adherence and persistence were highly variable.
Collapse
Affiliation(s)
- Andrew McGovern
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Zayd Tippu
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - William Hinton
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Neil Munro
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Martin Whyte
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| |
Collapse
|
16
|
Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ Open 2017; 7:e016317. [PMID: 28912194 PMCID: PMC5640112 DOI: 10.1136/bmjopen-2017-016317] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The disease burden of type 2 diabetes mellitus (T2DM) is rising due to suboptimal glycaemic control leading to vascular complications. Medication adherence (MA) directly influences glycaemic control and clinical consequences. This study aimed to assess the MA of patients with T2DM and identify associated factors. DESIGN Analysis of data from a cross-sectional survey and electronic medical records. SETTING Primary care outpatient clinic in Singapore. PARTICIPANTS Adult patients with T2DM. MAIN OUTCOME MEASURES MA to each prescribed oral hypoglycaemic agent (OHA) was measured using the five-question Medication Adherence Report Scale (MARS-5). Low MA is defined as a MARS-R score of <25. Demographic data, clinical characteristics and investigation results were collected to identify factors that are associated with low MA. RESULTS The study population comprised 382 patients with a slight female predominance (53.4%) and a mean±SD age of 62.0±10.4 years. 57.1% of the patients had low MA to at least one OHA. Univariate analysis showed that patients who were younger, of Chinese ethnicity, married or widowed, self-administering their medications or taking fewer (four or less) daily medications tended to have low MA to OHA. Logistic regression revealed that younger age (OR 0.97; 95% CI 0.95 to0.99), Chinese ethnicity (OR 2.80; 95% CI 1.53 to5.15) and poorer glycaemic control (HbA1c level) (OR 1.27; 95% CI 1.06 to1.51) were associated with low MA to OHA. CONCLUSIONS Younger patients with T2DM and of Chinese ethnicity were susceptible to low MA to OHA, which was associated with poorer glycaemic control. Polytherapy was not associated with low MA.
Collapse
Affiliation(s)
- Cia Sin Lee
- SingHealth Polyclinics, Singapore, Singapore
| | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
17
|
Cai J, Divino V, Burudpakdee C. Adherence and persistence in patients with type 2 diabetes mellitus newly initiating canagliflozin, dapagliflozin, dpp-4s, or glp-1s in the United States. Curr Med Res Opin 2017; 33:1317-1328. [PMID: 28418262 DOI: 10.1080/03007995.2017.1320277] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Sodium-glucose co-transporter 2 inhibitors were first approved in the US in 2013; therefore, real-world (RW) studies describing outcomes are limited. This retrospective study evaluated adherence and persistence among patients initiating canagliflozin (CANA), dapagliflozin (DAPA), GLP-1 agonists (GLP-1s), and DPP-4 inhibitors (DPP-4s) over a 12-month follow-up from a US managed care perspective. METHODS Patients newly initiating CANA, DAPA, GLP-1s, or DPP-4s from February 1, 2014-June 30, 2014 were identified from the QuintilesIMS PharMetrics Plus Database. The first fill defined the index date/drug. Patients were required to have a T2DM diagnosis (ICD-9-CM 250.x[0,2]) and ≥12 months of continuous enrollment pre- and post-index (follow-up). Main outcome measures were adherence (proportion of days covered, PDC; medication possession ratio, MPR) and persistence on index therapy. PDC or MPR ≥0.80 was considered adherent. Patients were considered persistent until evidence of discontinuation (gap ≥90 days between two subsequent index therapy prescriptions). Kaplan-Meier (KM) analysis assessed time to discontinuation, while a Cox proportional hazards model (PHM) evaluated risk of discontinuation. Logistic regression models evaluated the likelihood of non-adherence. RESULTS The final sample consisted of 23,702 patients (6,546 CANA, 3,087 DAPA, 6,273 GLP-1s, and 7,796 DPP-4s; 56% male, and mean [SD] age = 55 [9.1] years). Mean PDC ranged from 0.56 (GLP-1), to 0.71 (CANA), with 33-56% adherent, respectively; MPR results were similar. Fifty-two per cent (GLP-1) to 68% (CANA) were persistent over the follow-up. CANA patients had the longest time to discontinuation. In regression analyses, compared to CANA 100 mg, DAPA, DPP-4, and GLP-1 patients had a significantly higher likelihood of non-adherence and a significantly higher risk of discontinuation. CANA 300 mg patients had a significantly lower likelihood of non-adherence and a significantly lower risk of discontinuation compared to CANA 100 mg. CONCLUSIONS Adherence and persistence were significantly better with CANA (100 mg and 300 mg) compared to DAPA, GLP-1s, and DPP-4s in the RW setting.
Collapse
Affiliation(s)
- Jennifer Cai
- a Janssen Scientific Affairs, LLC , Titusville , NJ , USA
| | | | - Chakkarin Burudpakdee
- b QuintilesIMS , Fairfax , VA , USA
- c University of North Carolina in Charlotte , Charlotte , NC , USA
| |
Collapse
|
18
|
Ofori-Asenso R, Zomer E, Curtis A, Tonkin A, Nelson M, Gambhir M, Liew D, Zoungas S. Patterns and Predictors of Adherence to Statin Therapy Among Older Patients: Protocol for a Systematic Review. JMIR Res Protoc 2017; 6:e39. [PMID: 28270383 PMCID: PMC5360893 DOI: 10.2196/resprot.7195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 12/14/2022] Open
Abstract
Background The benefits of statin therapy are significantly compromised by noncompliance. Although elderly patients may have particular challenges with medication adherence and persistence, previous reviews on statin adherence have not focused on this population. Additionally, comparisons of adherence and persistence specific to statin indication (primary or secondary prevention) have not been thoroughly explored. Objective We aim to assess the extent of, and factors associated with, adherence and persistence to statin therapy among older populations (aged ≥65 years). Methods A systematic review will be undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Searches will be performed using multiple electronic databases (Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and the National Health Service Economic Evaluation Database) to identify relevant randomized trials and observational studies that evaluated statin adherence and/or persistence as an outcome. Eligible studies will include those involving community-living or outpatient elderly individuals. The methodological quality of randomized controlled trials (RCTs) will be assessed via the Joanna Briggs Institute’s critical appraisal checklist for RCTs, and the quality assessment of observational studies will be undertaken using a set of questions formulated with resort to the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. When possible, meta-analyses will be conducted using random-effect modeling and generic inverse variance analyses for adjusted-effect estimates. Heterogeneity across studies will be quantified using the I2 statistic. The presence of publication bias will be assessed using funnel plots and Egger’s regression tests. A leave-one-out sensitivity analysis will also be conducted to assess the impact of individual study results on pooled estimates. To explore possible sources of heterogeneity across studies, subgroup analyses will be performed based on covariates such as study design, statin indication, country of study, and length of patient follow-up. Results The electronic database searches were completed in December 2016. Retrieved articles are currently being screened and the entire study is expected to be completed by June 2017. Conclusions This systematic review will provide further understanding of the patterns of, and barriers to, statin adherence and persistence among older patients. The findings will inform clinical practice and the design of appropriate interventions. Trial Registration PROSPERO CRD42016053191
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrea Curtis
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Nelson
- Discipline of General Practice, University of Tasmania, Hobart, Australia
| | - Manoj Gambhir
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia Zoungas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|