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Shabnam S, Abner S, Gillies CL, Davies MJ, Dex T, Khunti K, Webb DR, Zaccardi F, Seidu S. Effect of delay in treatment intensification in people with type 2 diabetes and suboptimal glycaemia after basal insulin initiation: A real-world observational study. Diabetes Obes Metab 2024; 26:512-523. [PMID: 37857573 DOI: 10.1111/dom.15337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
AIM Despite global recommendations for type 2 diabetes mellitus treatment to maintain optimal glycaemic targets, a significant proportion of people remain in suboptimal glycaemic control. Our objective was to investigate the impact of intensification delay after basal insulin (BI) initiation on long-term complications in people with suboptimal glycaemia. MATERIALS AND METHODS We conducted a retrospective cohort study in individuals with type 2 diabetes mellitus initiated on BI. Those with suboptimal glycaemia (glycated haemoglobin ≥7% or ≥53 mmol/mol) within 12 months of BI initiation were divided into early (treatment intensified within 5 years), or late (≥5 years) intensification groups. We estimated the age-stratified risks of micro- and macrovascular complications among these groups compared with those with optimal glycaemia (glycated haemoglobin <7%). RESULTS Of the 13 916 people with suboptimal glycaemia, 52.5% (n = 7304) did not receive any treatment intensification. In those aged <65 years, compared with the optimal glycaemia group late intensification was associated with a 56% higher risk of macrovascular complications (adjusted hazard ratio 1.56; 95% confidence intervals 1.08, 2.26). In elderly people (≥65 years), late intensification was associated with a higher risk of cardiovascular-related death (1.62; 1.03, 2.54) and a lower risk of microvascular complications (0.26; 0.08, 0.83). CONCLUSIONS Those who had late intensification were at an increased risk of cardiovascular death if they were ≥65 years and an increased risk of macrovascular complications if they were <65 years. These findings highlight the critical need for earlier intensification of treatment and adopting personalized treatment strategies to improve patient outcomes.
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Affiliation(s)
- Sharmin Shabnam
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Sophia Abner
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- IQVIA, London, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Terry Dex
- Department of Medical Affairs, Sanofi, Bridgewater, New Jersey, USA
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - David R Webb
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
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Niño-de-Guzmán E, Bracchiglione J, Vásquez-Mejía A, de Graaf G, Rocha Calderón C, Alonso-Coello P. How Do Patients With Type 2 Diabetes Mellitus Value the Importance of Outcomes? An Overview of Reviews. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1782-1794. [PMID: 37516195 DOI: 10.1016/j.jval.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/16/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES We aimed to assess how patients value the importance of type 2 diabetes mellitus (T2DM) related outcomes. METHODS Overview of systematic reviews (SRs) reporting patients' utilities or disutilities for T2DM outcomes. We searched 3 databases from inception until June 2021. Study selection and data extraction were conducted in pairs. We evaluated the quality of SRs with the Joanna Briggs Institute Checklist, and the overlap with the corrected covered area. We estimated descriptive statistics, and, when possible, conducted metanalysis. RESULTS We identified 11 SRs, including 119 studies and 70 outcomes. Most reviews were high-quality SRs. The outcomes with the lowest utilities were hypoglycemia with very severe symptoms (acute complications), stroke (macrovascular complications), diabetic peripheral neuropathy with severe pain (microvascular complications), extreme obesity (comorbidities), and insulin only or combined (management of diabetes). Good/excellent glucose control and noninsulin injectable showed higher values than T2DM without complications. The outcomes with the highest disutilities were amputation, depression, major hypoglycemia, stroke, and management using only insulin. CONCLUSIONS We provide standardized, reliable utility values (or associated disutilities) for T2DM, acute, microvascular and macrovascular complications, related comorbidities and treatments that may support judgments when making clinical recommendations, designing decision support tools, and developing interventions and economic analysis.
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Affiliation(s)
- Ena Niño-de-Guzmán
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Cancer Prevention and Control Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Javier Bracchiglione
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, Chile; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Adrián Vásquez-Mejía
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Gimon de Graaf
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Claudio Rocha Calderón
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Nayak A, Vakili S, Nayak K, Nikolov M, Chiu M, Sosseinheimer P, Talamantes S, Testa S, Palanisamy S, Giri V, Schulman K. Use of Voice-Based Conversational Artificial Intelligence for Basal Insulin Prescription Management Among Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2340232. [PMID: 38039007 PMCID: PMC10692866 DOI: 10.1001/jamanetworkopen.2023.40232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/17/2023] [Indexed: 12/02/2023] Open
Abstract
Importance Optimizing insulin therapy for patients with type 2 diabetes can be challenging given the need for frequent dose adjustments. Most patients receive suboptimal doses and do not achieve glycemic control. Objective To examine whether a voice-based conversational artificial intelligence (AI) application can help patients with type 2 diabetes titrate basal insulin at home to achieve rapid glycemic control. Design, Setting, and Participants In this randomized clinical trial conducted at 4 primary care clinics at an academic medical center from March 1, 2021, to December 31, 2022, 32 adults with type 2 diabetes requiring initiation or adjustment of once-daily basal insulin were followed up for 8 weeks. Statistical analysis was performed from January to February 2023. Interventions Participants were randomized in a 1:1 ratio to receive basal insulin management with a voice-based conversational AI application or standard of care. Main Outcomes and Measures Primary outcomes were time to optimal insulin dose (number of days needed to achieve glycemic control), insulin adherence, and change in composite survey scores measuring diabetes-related emotional distress and attitudes toward health technology and medication adherence. Secondary outcomes were glycemic control and glycemic improvement. Analysis was performed on an intent-to-treat basis. Results The study population included 32 patients (mean [SD] age, 55.1 [12.7] years; 19 women [59.4%]). Participants in the voice-based conversational AI group more quickly achieved optimal insulin dosing compared with the standard of care group (median, 15 days [IQR, 6-27 days] vs >56 days [IQR, >29.5 to >56 days]; a significant difference in time-to-event curves; P = .006) and had better insulin adherence (mean [SD], 82.9% [20.6%] vs 50.2% [43.0%]; difference, 32.7% [95% CI, 8.0%-57.4%]; P = .01). Participants in the voice-based conversational AI group were also more likely than those in the standard of care group to achieve glycemic control (13 of 16 [81.3%; 95% CI, 53.7%-95.0%] vs 4 of 16 [25.0%; 95% CI, 8.3%-52.6%]; difference, 56.3% [95% CI, 21.4%-91.1%]; P = .005) and glycemic improvement, as measured by change in mean (SD) fasting blood glucose level (-45.9 [45.9] mg/dL [95% CI, -70.4 to -21.5 mg/dL] vs 23.0 [54.7] mg/dL [95% CI, -8.6 to 54.6 mg/dL]; difference, -68.9 mg/dL [95% CI, -107.1 to -30.7 mg/dL]; P = .001). There was a significant difference between the voice-based conversational AI group and the standard of care group in change in composite survey scores measuring diabetes-related emotional distress (-1.9 points vs 1.7 points; difference, -3.6 points [95% CI, -6.8 to -0.4 points]; P = .03). Conclusions and Relevance In this randomized clinical trial of a voice-based conversational AI application that provided autonomous basal insulin management for adults with type 2 diabetes, participants in the AI group had significantly improved time to optimal insulin dose, insulin adherence, glycemic control, and diabetes-related emotional distress compared with those in the standard of care group. These findings suggest that voice-based digital health solutions can be useful for medication titration. Trial Registration ClinicalTrials.gov Identifier: NCT05081011.
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Affiliation(s)
- Ashwin Nayak
- Division of Hospital Medicine, Stanford University School of Medicine, Stanford, California
| | - Sharif Vakili
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Kristen Nayak
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Margaret Nikolov
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
| | - Michelle Chiu
- Division of Hospital Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Sarah Talamantes
- Department of Medicine, Stanford University, Stanford, California
| | - Stefano Testa
- Department of Medicine, Stanford University, Stanford, California
| | | | - Vinay Giri
- Department of Medicine, Stanford University, Stanford, California
| | - Kevin Schulman
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
- Graduate School of Business, Stanford University, Stanford, California
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Eby EL, Kelly NR, Hertzberg JK, Blodgett MC, Stubbins C, Patel RH, Meadows ES, Benneyworth BD, Faries DE. Predicting Response to Bolus Insulin Therapy in Patients With Type 2 Diabetes. J Diabetes Sci Technol 2023; 17:1573-1579. [PMID: 35596567 PMCID: PMC10658685 DOI: 10.1177/19322968221098057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to develop a predictive model to classify people with type 2 diabetes (T2D) into expected levels of success upon bolus insulin initiation. METHODS Machine learning methods were applied to a large nationally representative insurance claims database from the United States (dNHI database; data from 2007 to 2017). We trained boosted decision tree ensembles (XGBoost) to assign people into Class 0 (never meeting HbA1c goal), Class 1 (meeting but not maintaining HbA1c goal), or Class 2 (meeting and maintaining HbA1c goal) based on the demographic and clinical data available prior to initiating bolus insulin. The primary objective of the study was to develop a model capable of determining at an individual level, whether people with T2D are likely to achieve and maintain HbA1c goals. HbA1c goal was defined at <8.0% or reduction of baseline HbA1c by >1.0%. RESULTS Of 15 331 people with T2D (mean age, 53.0 years; SD, 8.7), 7800 (50.9%) people met HbA1c goal but failed to maintain that goal (Class 1), 4510 (29.4%) never attained this goal (Class 0), and 3021 (19.7%) people met and maintained this goal (Class 2). Overall, the model's receiver operating characteristic (ROC) was 0.79 with greater performance on predicting those in Class 2 (ROC = 0.92) than those in Classes 0 and 1 (ROC = 0.71 and 0.62, respectively). The model achieved high area under the precision-recall curves for the individual classes (Class 0, 0.46; Class 1, 0.58; Class 2, 0.71). CONCLUSIONS Predictive modeling using routine health care data reasonably accurately classified patients initiating bolus insulin who would achieve and maintain HbA1c goals, but less so for differentiation between patients who never met and who did not maintain goals. Prior HbA1c was a major contributing parameter for the predictions.
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Hermanns N, Ehrmann D, Finke-Groene K, Krichbaum M, Roos T, Haak T, Freckmann G, Kulzer B. Use of smartphone application versus written titration charts for basal insulin titration in adults with type 2 diabetes and suboptimal glycaemic control (My Dose Coach): multicentre, open-label, parallel, randomised controlled trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100702. [PMID: 37954005 PMCID: PMC10636267 DOI: 10.1016/j.lanepe.2023.100702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 11/14/2023]
Abstract
Background The majority of people with type 2 diabetes who require insulin therapy use only basal insulin in combination with other anti-diabetic agents. We tested whether using a smartphone application to titrate insulin could improve glycaemic control in people with type 2 diabetes who use basal insulin. Methods This was a 12-week, multicentre, open-label, parallel, randomised controlled trial conducted in 36 diabetes practices in Germany. Eligible participants had type 2 diabetes, a BMI ≥25.0 kg/m2, were on basal insulin therapy or were initiating basal insulin therapy, and had suboptimal glycaemic control (HbA1c >7.5%; 58.5 mmol/mol). Block randomisation with 1:1 allocation was performed centrally. Participants in the intervention group titrated their basal insulin dose using a smartphone application (My Dose Coach) for 12 weeks. Control group participants titrated their basal insulin dose according to a written titration chart. The primary outcome was the baseline-adjusted change in HbA1c at 12 weeks. The intention-to-treat analysis included all randomised participants. Results Between 13 July 2021 and 21 March 2022, 251 study participants were randomly assigned (control group: n = 123; intervention group: n = 128), and 236 completed the follow-up phase (control group: n = 119; intervention group: n = 117). Regarding the HbA1c a model-based adjusted between-group difference of -0.31% (95% CI: 0.01%-0.69%; p = 0.0388) in favour of the intervention group was observed. There were 30 adverse events reported: 16 in the control group, 14 in the intervention group. Of these, 15 adverse events were serious. No event was considered to be related to the investigational device. Interpretation Study results suggest that utilizing this digital health smartphone application for basal insulin titration may have resulted in a comparatively greater reduction in HbA1c levels among individuals with type 2 diabetes, as compared to basal insulin titration guided by a written titration schedule. No negative effect on safety outcomes was observed. Funding Sanofi-Aventis Deutschland GmbH.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
- Diabetes Centre Bad Mergentheim, Theodor-Klotzbuecher-Str. 12, Bad Mergentheim 97980, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, Bamberg 96047, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, Bamberg 96047, Germany
| | - Katharina Finke-Groene
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
| | - Michael Krichbaum
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
| | - Timm Roos
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
| | - Thomas Haak
- Diabetes Centre Bad Mergentheim, Theodor-Klotzbuecher-Str. 12, Bad Mergentheim 97980, Germany
| | - Guido Freckmann
- IfDT - Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH, Helmholtzstr. 20, Ulm 89081, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
- Diabetes Centre Bad Mergentheim, Theodor-Klotzbuecher-Str. 12, Bad Mergentheim 97980, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, Bamberg 96047, Germany
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Hermanns N, Ehrmann D, Finke-Gröne K, Roos T, Freckmann G, Kulzer B. Evaluation of a Digital Health Tool for Titration of Basal Insulin in People With Type 2 Diabetes: Rationale and Design of a Randomized Controlled Trial. J Diabetes Sci Technol 2023:19322968221148756. [PMID: 36602040 DOI: 10.1177/19322968221148756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Optimal insulin titration is essential in helping people with type 2 diabetes mellitus (T2DM) to achieve adequate glycemic control. Barriers of people with diabetes to implementation of titration include lack of self-efficiency and self-management skills, increased diabetes-related distress, low treatment satisfaction, poor well-being, as well as concerns about hypoglycemia and insulin overdose. My Dose Coach is a digital health tool for optimizing titration of basal insulin that combines a smartphone app for patients with T2DM and a Web portal for health care professionals. METHODS/DESIGN This is a prospective, open-label, multicenter, randomized controlled parallel study conducted in approximately 50 centers in Germany that are specialized in the treatment of diabetes. Patients in the intervention group will use the titration app and will be registered on the Web portal by their treating physician. Control group patients will continue their current basal insulin titration without using the app. The primary outcome is the mean change in HbA1c levels at the 12-week follow-up. The secondary outcome measures include patient-reported outcomes such as diabetes-related distress, self-management, empowerment, self-efficacy, treatment satisfaction, and psychological well-being as well as fasting blood glucose values. CONCLUSION This digital health tool has been previously implemented in several independent pilot studies. The findings from this multicenter randomized controlled trial can provide further evidence supporting the effectiveness of this tool in patients with T2DM and serve as a basis for its clinical integration. TRIAL REGISTRATION German Register for Clinical Studies-DRKS-ID: DRKS00024861.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | | | - Timm Roos
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Guido Freckmann
- Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Institut für Diabetes-Technologie, Ulm, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
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Alhagawy AJ, Yafei S, Hummadi A, Abutaleb R, Hakamy M, Alzughbi T, Gharawi N, Moafa M, Mokali A, Alhiqwy I, Altherwi M. Barriers and Attitudes of Primary Healthcare Physicians to Insulin Initiation and Intensification in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16794. [PMID: 36554673 PMCID: PMC9779059 DOI: 10.3390/ijerph192416794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Saudi Arabia is a country with high prevalence of diabetes, uncontrolled diabetes, and diabetes-related complications. Poor glycemic control is multifactorial and could be explained in part by physician and patient reluctance toward insulin or insulin inertia. This study aimed to address physician barriers toward insulin therapy in primary care settings. It included 288 physicians from 168 primary healthcare centers (PHC) in the Jazan region of Saudi Arabia. Participants responded to questionnaire investigating physicians' attitude and barriers to insulin initiation and intensification in PHCs. In physician opinion, the most common barriers among their patients were fear of injection, lack of patient education, fear of hypoglycemia, and difficult administration. Physicians were reluctant to initiate insulin for T2D patients mostly due to patient non-adherence to blood sugar measurement, non-adherence to appointment or treatment, elderly patients, or due to patient refusal. Physicians' fear of hypoglycemia, lack of staff for patient education, and lack of updated knowledge were the primary clinician-related barriers. Exaggerated fears of insulin side effects, patient non-adherence, limited staff for patient's education, patient refusal, and inadequate consultation time were the main barriers to insulin acceptance and prescription.
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Affiliation(s)
- Ali Jaber Alhagawy
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Saeed Yafei
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
- Faculty of Medicine and Health Sciences, Taiz University, Taiz P.O. Box 6803, Yemen
| | - Abdulrahman Hummadi
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Raed Abutaleb
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Hakamy
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Turki Alzughbi
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Nabeel Gharawi
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Manal Moafa
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Asma Mokali
- Family Medicine, Jazan Health Affairs, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ibrahim Alhiqwy
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mousa Altherwi
- Nursing Department, Ministry of Health, Jazan 45142, Saudi Arabia
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Moawd SA. Quality of Life in University Students with Diabetes Distress: Type 1 and Type 2 of Diabetes Differences. J Diabetes Res 2022; 2022:1633448. [PMID: 35782629 PMCID: PMC9249538 DOI: 10.1155/2022/1633448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study constitutes a preliminary trial to clarify the relationship between quality of life (QoL) and diabetes distress (DD in patients with diabetes mellitus (DM) by comparing patients with type 1 and type 2 diabetes. METHODS A cross-sectional study of university students with diabetes (type 1 and type 2) diabetes. One hundred sixty-six students were assigned to participate in this study. A self-report questionnaire on demographic and clinical parameters was taken. Rating worries and anxieties related to diabetes were evaluated using the diabetes distress scale-17, and quality of life was tested using SF-36 v2. RESULTS No significant differences were observed in the level of DD according to sociodemographics in type 1 DM (T1DM) and type 2 DM (T2DM) (p > 0.05). The mean scores for Physical Component Summary (PCS) and Mental Component Summary (MCS) and six subscales of the SF-36 v2 demonstrated no significant differences between T1DM and T2DM (p > 0.05). High scores of diabetes distress were independently associated with lower glycemic control for students with both types of diabetes. Likewise, high scores of distress were associated with lower PCS (p < 0.05). Additionally, the results showed that high scores of diabetes distress were associated with lower MCS (p < 0.05). CONCLUSIONS University students with diabetes showed a high level of DD with no significant differences between both types of diabetes; this consequently affects all components of QoL. Psychological support is the better choice for those students for better health and future career.
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Affiliation(s)
- Samah A. Moawd
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
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A cross-sectional survey to assess reasons for therapeutic inertia in people with type 2 diabetes mellitus and preferred strategies to overcome it from the perspectives of persons with diabetes and general/family practitioners: Results from the MOTION study. Can J Diabetes 2021; 46:337-345.e2. [DOI: 10.1016/j.jcjd.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022]
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Liang W, Lo SHS, Tola YO, Chow KM. The effectiveness of self-management programmes for people with type 2 diabetes receiving insulin injection: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14636. [PMID: 34309961 DOI: 10.1111/ijcp.14636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND People with type 2 diabetes (T2D) receiving insulin injection are reported to encounter challenges to achieve optimal glycaemic control. The evidence on effectiveness of self-management programmes for T2D people receiving insulin injection is far from conclusive. AIM To examine the effectiveness of self-management programmes for people with T2D receiving insulin injection. METHODS Twelve databases were searched from dates of inception to June 2021. All randomised controlled trials (RCTs) and controlled clinical trials examining the effectiveness of self-management programmes were included. The methodological quality was appraised using the Joanna Briggs Institute critical appraisal tools by two independent researchers. Data were summarised narratively or pooled statistically where appropriate. RESULTS Nine RCTs involving 2613 participants were included. At post-intervention, meta-analysis results showed that self-management programmes significantly improved glycated haemoglobin A1c (HbA1c) (mean difference [MD]: -0.21, 95% confidence interval [CI] -0.29 to -0.12, P < .001), self-management behaviours (standardised MD [SMD]: 0.23, 95% CI: 0.12 to 0.33, P < .001) and self-efficacy (SMD: 0.20, 95% CI: 0.09 to 0.31, P = .0002). Only one intensive lifestyle intervention reported significant improvements in body weight and waist circumference. Three RCTs demonstrated significant improvements in body mass index compared with the control group. Only one study demonstrated significant improvements in total cholesterol and triglycerides in favour of the intervention group. At six months post-intervention, pooled results of two studies revealed decreased diabetes-related distress (MD: -2.98, 95% CI: -5.15 to -0.82, P = .007). No significant changes in blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, depression and anxiety were found. CONCLUSIONS Self-management programmes have the potential to improve glycaemic control, weight management, blood lipids, self-management behaviours, self-efficacy and diabetes-related distress of people with T2D receiving insulin injection. More rigorous experimental trials are warranted to examine the effectiveness of self-management programme and its maintenance.
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Affiliation(s)
- Wei Liang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yetunde Oluwafunmilayo Tola
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Mohan V, Mukherjee JJ, Das AK, Seshadri K, Dasgupta A. Initiation and intensification of insulin therapy in type 2 diabetes mellitus: Physician barriers and solutions – An Indian perspective. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Wrzal PK, Mohseni AA, Fournier C, Goldenberg R, Hollahan D, Jin S, Pedersen SD, Vallis M, Bunko A, Myageri V, Kukaswadia A, Neish CS, Ivers NM. Persons With Diabetes and General/Family Practitioner Perspectives Related to Therapeutic Inertia in Type 2 Diabetes Mellitus Using Qualitative Focus Groups and the Theoretical Domains Framework: Results From the MOTION Study. Can J Diabetes 2021; 46:171-180. [DOI: 10.1016/j.jcjd.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
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13
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Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M, Elmers J, Desrichard O, Peytremann-Bridevaux I. Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth 2021; 19:1003-1118. [PMID: 33741836 DOI: 10.11124/jbies-20-00020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. INTRODUCTION A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. INCLUSION CRITERIA Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. METHODS We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. RESULTS We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. CONCLUSIONS Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018084665.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Joan Campbell
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Marie Bugnon
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
| | - Cristina Henry
- Association Vaudoise d'Aide et de Soins À Domicile (AVASAD), Lausanne, Switzerland
| | - Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Magali Serex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Jolanda Elmers
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
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Williams B, Gidal BE, Resnick T, Baker J, Holtzman M, Sparling N, Maher J, Plauschinat C. Influence of titration of antiseizure medications on treatment selection: Results of an online survey with clinicians in the United States. Epilepsy Behav 2021; 117:107840. [PMID: 33626489 DOI: 10.1016/j.yebeh.2021.107840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Most antiseizure medications (ASM) need to be titrated before the optimal dose is achieved. Titration can last several weeks to months. We assessed the impact titration schedules have on ASM treatment-related decisions in the United States (US). METHODS An online survey was conducted with different healthcare providers (HCPs) in the US involved in the treatment and management of patients with epilepsy. The survey contained three sections: the first section with screening questions; the second on key factors that influence a HCP's decision-making when selecting treatments for different types of seizures and different treatment lines; and the third on the HCP's knowledge and perceptions regarding ASM titration for the treatment of patients with epilepsy. RESULTS One-hundred and fifty HCPs (63% neurologists) completed the survey. Most HCPs considered titration schedule to be important, with only 1-3% of HCPs, depending on type of seizure, considering the titration schedule to be "not important at all" when prescribing therapy. Healthcare providers' acceptance of titration increased with shorter durations (≥50% accepted titration periods of ≤2 weeks), and lower number of tablets/capsules per dose (≥50% accepted ≤3 tablets/capsules per dose), doses (≥50% accepted ≤2 doses/day), and steps (≥50% accepted ≤3 steps/dose change). Most HCPs (68-91% depending on type of seizure) considered a titration duration of 6 or more weeks only somewhat acceptable or somewhat or highly unacceptable. Almost all HCPs selected "somewhat familiar", "familiar", or "very familiar" as the attribute that best defines their knowledge level of titration, with only 4% selecting "a little familiar". While 87% of HCPs agreed or strongly agreed that they could easily understand titration schedules, only 27% of them agreed or strongly agreed that patients could easily understand titration schedules and 58% of HCPs considered that adhering to the titration schedule was difficult for patients. Most HCPs agreed or strongly agreed that a complex or long titration schedule renders it difficult to achieve their treatment objectives. CONCLUSIONS Healthcare providers take into account the duration and complexity of the titration period in their ASM prescribing decision-making and prefer shorter and simpler titration schedules, particularly for patients who are experiencing convulsive seizures and starting monotherapy. There was a clear difference between the HCP's belief in their own ability to understand a titration schedule, and their belief that the patient would be able to follow the titration schedule appropriately.
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Affiliation(s)
| | - Barry E Gidal
- University of Wisconsin School of Pharmacy, Madison, WI, United States
| | - Trevor Resnick
- University of Miami School of Medicine, FL, United States; Nicklaus Children's Hospital, Department of Neurology, FL, United States
| | - John Baker
- Colonial Healthcare, Colonial Neurology, SC, United States
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Motilal S. Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study. BMC FAMILY PRACTICE 2020; 21:197. [PMID: 32957991 PMCID: PMC7507810 DOI: 10.1186/s12875-020-01271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physician related factors with respect to insulin therapy can contribute to diabetes mellitus (DM) mismanagement. Patient related factors have been previously explored in a Trinidad survey. The main objective of this study was to explore primary care physicians' (PCPs) related barriers towards insulin therapy. METHODS A cross-sectional study on a convenience sample of PCPs in the public primary care system was done using an online survey. RESULTS Of the 170 PCPs contacted, 75 (44%) responded. There were 47 females (62.7%) and 28 males (37.3%) with a mean age of 35.9 yrs. Nearly 40% of physicians admitted that the education given to patients was inadequate to allow initiation of insulin therapy. Half the respondents admitted to insufficient consultation times and inadequate appointment frequency to allow for intensification of insulin therapy. Forty percent of PCPs admitted that HbA1c results were unavailable to guide their management decisions. Only 6.7% of physicians said they had access to rapid acting insulin, while 5.3% said they had access to insulin pens. CONCLUSION PCPs in Trinidad treating diabetes at the public primary care clinics face several barriers in administering proper insulin therapy. Addressing these factors can improve glycemic control in this population.
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Affiliation(s)
- Shastri Motilal
- Department of Paraclinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine Campus, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad.
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Wrzal PK, Bunko A, Myageri V, Kukaswadia A, Neish CS, Ivers NM. Strategies to Overcome Therapeutic Inertia in Type 2 Diabetes Mellitus: A Scoping Review. Can J Diabetes 2020; 45:273-281.e13. [PMID: 33160883 DOI: 10.1016/j.jcjd.2020.08.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
The objectives of this review were to: 1) examine recent strategies and component interventions used to overcome therapeutic inertia in type 2 diabetes mellitus (T2DM), 2) map strategies to the causes of therapeutic inertia they target and 3) identify causes of therapeutic inertia in T2DM that have not been targeted by recent strategies. A systematic search of the literature published from January 2014 to December 2019 was conducted to identify strategies targeting therapeutic inertia in T2DM, and key strategy characteristics were extracted and summarized. The search identified 46 articles, employing a total of 50 strategies aimed at overcoming therapeutic inertia. Strategies were composed of an average of 3.3 interventions (range, 1 to 10) aimed at an average of 3.6 causes (range, 1 to 9); most (78%) included a type of educational strategy. Most strategies targeted causes of inertia at the patient (38%) or health-care professional (26%) levels only and 8% targeted health-care-system-level causes, whereas 28% targeted causes at multiple levels. No strategies focused on patients' attitudes toward disease or lack of trust in health-care professionals; none addressed health-care professionals' concerns over costs or lack of information on side effects/fear of causing harm, or the lack of a health-care-system-level disease registry. Strategies to overcome therapeutic inertia in T2DM commonly employed multiple interventions, but novel strategies with interventions that simultaneously target multiple levels warrant further study. Although educational interventions are commonly used to address therapeutic inertia, future strategies may benefit from addressing a wider range of determinants of behaviour change to overcome therapeutic inertia.
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Affiliation(s)
- Paulina K Wrzal
- Medical Affairs, Novo Nordisk Canada, Inc, Mississauga, Ontario, Canada.
| | - Andrean Bunko
- Real World Solutions, IQVIA, Mississauga, Ontario, Canada
| | - Varun Myageri
- Real World Solutions, IQVIA, Mississauga, Ontario, Canada
| | | | - Calum S Neish
- Real World Solutions, IQVIA, Mississauga, Ontario, Canada
| | - Noah M Ivers
- Department of Family Medicine, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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17
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Wardian JL. Improving Transition to Insulin Through Clinical Conversations. Clin Diabetes 2020; 38:285-286. [PMID: 32699477 PMCID: PMC7364460 DOI: 10.2337/cd19-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jana L Wardian
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, TX
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Cheng A, Harris S, Giorgino F, Seufert J, Ritzel R, Khunti K, Lauand F, Melas‐Melt L, Westerbacka J, Bosnyak Z, Rosenstock J. Similar glycaemic control and less hypoglycaemia during active titration after insulin initiation with glargine 300 units/mL and degludec 100 units/mL: A subanalysis of the BRIGHT study. Diabetes Obes Metab 2020; 22:346-354. [PMID: 31646724 PMCID: PMC7064957 DOI: 10.1111/dom.13901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
Abstract
AIM To further investigate glycaemic control and hypoglycaemia in BRIGHT, focusing on the titration period. MATERIALS AND METHODS BRIGHT was a multicentre, open-label, randomized, active-controlled, two-arm, parallel-group, 24-week study in insulin-naïve patients with uncontrolled type 2 diabetes initiated on glargine 300 U/mL (Gla-300) (N = 466) or degludec (IDeg-100) (N = 463). Predefined efficacy and safety outcomes were investigated during the initial 12-week titration period. In addition, patients' characteristics and clinical outcomes were assessed descriptively, stratified by confirmed (≤3.9 mmol/L) hypoglycaemia incidence during the initial titration period. RESULTS At week 12, HbA1c was comparable between Gla-300 (7.32%) and IDeg-100 (7.23%), with similar least squares (LS) mean reductions from baseline (-1.37% and - 1.39%, respectively; LS mean difference of 0.02; 95% confidence interval: -0.08 to 0.12). Patients who experienced hypoglycaemia during the initial titration period had numerically greater HbA1c reductions by week 12 than patients who did not (-1.46% vs. -1.28%), and higher incidence of anytime (24 hours; 73.3% vs. 35.7%) and nocturnal (00:00-06:00 hours; 30.0% vs. 11.9%) hypoglycaemia between weeks 13-24. CONCLUSIONS The use of Gla-300 resulted in similar glycaemic control as IDeg-100 during the initial 12-week titration period of the BRIGHT study, when less anytime (24 hours) hypoglycaemia with Gla-300 versus IDeg-100 has been reported. Experiencing hypoglycaemia shortly after initiating Gla-300 or IDeg-100 may be associated with hypoglycaemia incidence in the longer term, potentially impacting glycaemic management.
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Affiliation(s)
- Alice Cheng
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Stewart Harris
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic DiseasesUniversity of Bari Aldo MoroBariItaly
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center – University of FreiburgFaculty of Medicine, University of FreiburgGermany
| | - Robert Ritzel
- Division of Endocrinology, Diabetes and AngiologyKlinikum Schwabing and Klinikum BogenhausenMunichGermany
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | | | | | | | | | - Julio Rosenstock
- Dallas Diabetes Research Center at Medical CityDallasTexasUnited States
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Abstract
Background Insulin-naive patients are often reluctant to receive insulin treatment, and even insulin-treated patients frequently have poor rates of adherence to their prescribed insulin injection regimes. Assessing attitudes toward insulin injection may help in the design of interventions that improve the insulin injection behaviors of patients with type 2 diabetes (T2DM). The concept of decisional balance has been associated with behavior in many studies and may be useful in assessing the attitude of patients with T2DM toward insulin injection. Decisional balance for insulin injection (DBII) has not been widely assessed in patients with T2DM. Purpose The aim of this study was to develop an insulin injection (DBII) scale that is valid for insulin-naive and insulin-treated patients and to test the psychometric characteristics of this scale based on the concept of decisional balance. Methods This cross-sectional study administered an 18-item DBII scale, including pro and con subscales, to 95 insulin-naive and 237 insulin-treated patients in Taiwan. The decisional balance score was calculated as the mean score of the pro subscale minus the mean score of the con subscale. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis; concurrent validity was assessed by examining the association between the score of the DBII scale and the stages of behavioral change and of hemoglobin A1c for, respectively, insulin-naive patients and insulin-treated patients; and reliability was assessed using internal consistency and test–retest reliability. Results A 13-item DBII scale supported by exploratory factor analysis and confirmatory factor analysis was developed. The stages of behavioral change and hemoglobin A1c levels were found to be significantly associated with the scores of decisional balance of the 13-item DBII scale for both insulin-naive and insulin-treated patients. The Cronbach's α ranged between .78 and .92. Conclusions The 13-item DBII scale is appropriately short and possesses satisfactory validity and reliability for both insulin-naive and insulin-treated patients with T2DM. Healthcare providers may use this scale as a checklist to guide clinical discussions related to insulin therapy with both insulin-naive and insulin-treated patients with T2DM across time.
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Lauffenburger JC, Lewey J, Jan S, Lee J, Ghazinouri R, Choudhry NK. Association of Potentially Modifiable Diabetes Care Factors With Glycemic Control in Patients With Insulin-Treated Type 2 Diabetes. JAMA Netw Open 2020; 3:e1919645. [PMID: 31968115 PMCID: PMC6991273 DOI: 10.1001/jamanetworkopen.2019.19645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Numerous factors are associated with the ability of patients with type 2 diabetes to achieve optimal glycemic control. However, many of these factors are not modifiable by quality improvement interventions. In contrast, the structure of how diabetes care is delivered, such as whether patients visit an endocrinologist or how prescriptions are filled, is potentially modifiable, yet its associations with glycemic control have not been rigorously evaluated. OBJECTIVE To investigate the association of diabetes care delivery with glycemic control in patients with type 2 diabetes using insulin. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used baseline claims and laboratory insurer data within a large pragmatic trial to identify individuals with type 2 diabetes using insulin with data for at least 1 hemoglobin A1c (HbA1c) test result from before trial randomization (July 1, 2014, to October 5, 2016) and for key nonmodifiable patient factors as well as diabetes care delivery and behavioral factors measured before the HbA1c test. Analyses were conducted from February 4, 2017, to November 13, 2018. MAIN OUTCOMES AND MEASURES Multivariable modified Poisson regression was used to evaluate the independent associations of nonmodifiable patient factors and potentially modifiable diabetes care delivery and patient behavioral factors with achieving adequate diabetes control (ie, HbA1c level <8%). The extent of measured variation explained in glycemic control by these factors was also explored using pseudo R2 and C statistics. RESULTS Of 1423 patients included, 565 (39.7%) were women, and the mean (SD) age was 56.4 (9.0) years. In total, 690 (48.5%) had HbA1c levels less than 8%. Age (relative risk [RR] per 1-unit increase, 1.01; 95% CI, 1.00-1.02), persistent use of basal insulin (RR, 1.20; 95% CI, 1.00-1.43), more frequent filling of glucose self-testing supplies (RR, 1.01; 95% CI, 1.01-1.02), visiting an endocrinologist (RR, 1.41; 95% CI, 1.19-1.67), and receipt of insulin prescriptions by mail order (RR, 1.23; 95% CI, 1.03-1.48) were all independently associated with adequate control. Measured potentially modifiable diabetes care factors explained more variation in adequate glycemic control than measured nonmodifiable patient factors (C statistic, 0.661 vs 0.598; pseudo R2 = 0.11 vs 0.04). CONCLUSIONS AND RELEVANCE These findings suggest that for patients with type 2 diabetes using insulin, the way in which care is delivered may be more strongly associated with achieving adequate control of HbA1c levels than patient factors that cannot be altered are. Given the potential for intervention, these care delivery factors could be the focus of efforts to improve diabetes outcomes.
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Affiliation(s)
- Julie C. Lauffenburger
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Lewey
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Saira Jan
- Horizon Blue Cross Blue Shield, Newark, New Jersey
- Department of Pharmacy Practice and Administration, Rutgers State University of New Jersey, New Brunswick
| | - Jessica Lee
- Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Roya Ghazinouri
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Niteesh K. Choudhry
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Bramwell SE, Meyerowitz-Katz G, Ferguson C, Jayaballa R, McLean M, Maberly G. The effect of an mHealth intervention for titration of insulin for type 2 diabetes: A pilot study. Eur J Cardiovasc Nurs 2019; 19:386-392. [DOI: 10.1177/1474515119889764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Stabilising blood glucose levels (BGL) after starting or changing insulin and related therapies can be challenging for diabetes services and the patient with type 2 diabetes. Traditionally, a credentialled diabetes educator (CDE) would talk with the patient over the phone to obtain a history of their BGLs over the previous week and provide advice on the insulin dose adjustments as required. This study trialled a smartphone application for sharing BGLs, with the ability to digitally transmit advice back to patients compared with their usual care. Aims: The aim of this study was to compare desirability, efficiency and ease of use. Methods: Participants were enrolled in either the traditional ( n=50) or Health2Sync (H2S) ( n=42) treatment group by patient preference. All insulin stabilisations were conducted by the CDE. Descriptive statistics were used for analysis. Results: The average total time taken to titrate patients was similar in both groups ( p>0.05), however there were fewer failure of contacts reported with H2S ( p<0.01) and time per interaction was also lower ( p<0.01). Sensitivity analysis revealed that, excluding the influence of no contacts, H2S patients had a lower average time for titration ( p<0.01). There was no difference in clinical outcomes as measured by HbA1c between the two groups ( p=0.75). Conclusion: We demonstrated a high acceptance and clinical utility of the H2S application. Clinicians were happy to use H2S and found it easy and convenient for most patients. Importantly, this reduced frequency of contacts with patients, time per interaction and average time for titration ( p<0.01). Patient selection for this communication intervention is important.
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Affiliation(s)
- Siân E Bramwell
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
| | - Gideon Meyerowitz-Katz
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
- School of Health and Society, Population Wellbeing and Environment Research Lab, University of Wollongong, Australia
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District, Western Sydney University, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
| | - Mark McLean
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
- School of Medicine, University of Western Sydney, Australia
| | - Glen Maberly
- Western Sydney Diabetes (WSD), Integrated and Community Health Directorate, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Australia
- School of Medicine, University of Western Sydney, Australia
- School of Public Health, University of Sydney, Australia
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Hollander PA, Kiljanski J, Spaepen E, Harris CJ. Risk of clinically relevant hypoglycaemia in patients with type 2 diabetes self-titrating insulin glargine U-100. Diabetes Obes Metab 2019; 21:2413-2421. [PMID: 31264764 PMCID: PMC6852247 DOI: 10.1111/dom.13822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/17/2019] [Accepted: 06/26/2019] [Indexed: 01/10/2023]
Abstract
AIMS We evaluated risk factors for clinically relevant hypoglycaemia (blood glucose <3 mmol/L) in patients with type 2 diabetes during insulin glargine self-titration. Data were from two clinical trials in which patients were able to improve glycaemic control by self-titration of insulin glargine using a simple algorithm. MATERIALS AND METHODS We performed post hoc analyses of pooled treatment groups from each of two Phase 3 studies comparing LY2963016 with LANTUS: ELEMENT-2 (double-blind) and ELEMENT-5 (open label). Clinically relevant hypoglycaemia was analysed by category of HbA1c (<7%, 7%-8.5%, >8.5%) at Week 12 (titration period) and at Week 24 (overall study), and by subgroups of age (<65, ≥65 years) and previous insulin use (naïve or not). RESULTS In the ELEMENT-2 study (N = 756), there were no overall differences in rate or incidence of hypoglycaemia among HbA1c categories. In the ELEMENT-5 study (N = 493), patients with HbA1c greater than 8.5% had a lower rate and incidence of hypoglycaemia throughout the study compared to those in the lower HbA1c categories. In both studies, patients 65 years of age or older, compared to those less than 65 years, had a higher rate and incidence of hypoglycaemia during the titration phase, had lower baseline HbA1c, and experienced smaller increases in dose, with no differences in HbA1c post baseline. The rate and incidence of hypoglycaemia was similar between naïve patients and patients previously using basal insulin, across all levels of glycaemic control. With the exception of the older subgroup, hypoglycaemia rates were similar during titration and maintenance periods. CONCLUSION Our results support broader use of self-titration algorithms for patients with type 2 diabetes.
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Affiliation(s)
| | - Jacek Kiljanski
- Department of Diabetes, Eli Lilly and Company, Lilly Corporate CenterIndianapolisIndiana
| | - Erik Spaepen
- Department of Statistics, Eli Lilly Deutschland GmbHBad HomburgGermany
| | - Cynthia J. Harris
- Department of Diabetes, Eli Lilly and Company, Lilly Corporate CenterIndianapolisIndiana
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Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective. Can J Diabetes 2019; 43:515-523. [DOI: 10.1016/j.jcjd.2019.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/06/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022]
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24
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Gagliardino JJ, Elgart J, Forti L, Guaita MS, Chantelot JM. Treat-to-target HbA 1c and lipid profile to prolong β-cell mass/function and optimize treatment goal attainment. Diabetes Metab Res Rev 2019; 35:e3166. [PMID: 30963685 DOI: 10.1002/dmrr.3166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate the relation between different serum lipid fractions and other known barriers to attain the HbA1c ≤ 7.0% (53 mmol/mol) target. METHODS Data on 2719 patients with type 2 diabetes were collected from the five waves of the International Diabetes Mellitus Practice Study implemented in Argentina (2006 to 2012) including demographic/socioeconomic profile, clinical, metabolic (HbA1c and serum lipids) data, and treatment type and also, percentage of treatment goal attainment. Descriptive statistical analyses included ANOVA, χ2 test, and Fisher exact test and univariate and multivariate logistic regression analyses, which identified predictive factors for HbA1c ≤ 7% (53 mmol/mol). RESULTS The average age was 63 years, primary/secondary education, health insurance, 10-year type 2 diabetes duration, most associated with cardiovascular risk factors and some microvascular/macrovascular complications; 94.5% received antihyperglycaemic drugs. Percentage of people on target: HbA1c 51.2%, blood pressure 23.5%, total cholesterol 62.6%, low-density lipoprotein (LDL) cholesterol 38.9%, and triglycerides 61.1%. HbA1c on target depended markedly on treatment type: more of those treated with lifestyle changes and significantly fewer of those receiving insulin. Only 4.1% had all parameters simultaneously on target. Multivariate logistic regression analyses showed that achieving HbA1c ≤ 7.0% (53 mmol/mol) was associated with higher educational level, shorter diabetes duration, and having reached goals for LDL cholesterol and triglycerides, whereas opposite results were obtained with insulin treatment and longer diabetes duration. CONCLUSIONS High LDL cholesterol and triglyceride levels simultaneously potentiate development/progression of chronic complications, exerting this effect in the long term by decreasing β-cell mass/function, thereby making it more difficult to reach HbA1c values able to prevent complications.
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Affiliation(s)
- Juan J Gagliardino
- Cenexa. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Jorge Elgart
- Cenexa. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Luján Forti
- Medical Department, Sanofi, Buenos Aires, Argentina
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Russell‐Jones D, Dauchy A, Delgado E, Dimitriadis G, Frandsen HA, Popescu L, Schultes B, Strojek K, Bonnemaire M, Roborel de Climens A, Davies M. Take Control: A randomized trial evaluating the efficacy and safety of self- versus physician-managed titration of insulin glargine 300 U/mL in patients with uncontrolled type 2 diabetes. Diabetes Obes Metab 2019; 21:1615-1624. [PMID: 30851006 PMCID: PMC6767413 DOI: 10.1111/dom.13697] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
Abstract
AIM To compare the efficacy and safety of self- versus physician-managed titration of insulin glargine 300 U/mL (Gla-300) in people with inadequately controlled type 2 diabetes. METHODS Take Control (EudraCT number: 2015-001626-42) was a 24-week, multi-national, open-label, controlled, two-arm, parallel-group study in insulin-naïve and pre-treated participants, randomized 1:1 to a self- or physician-managed titration of Gla-300. The fasting self-monitored plasma glucose (SMPG) target was 4.4 to 7.2 mmol/L. The primary outcome was non-inferiority of glycated haemoglobin (HbA1c) change from baseline to week 24. Secondary outcomes included SMPG target achievement without hypoglycaemia, hypoglycaemia incidence, adverse events and participant-reported outcomes (PROs). RESULTS At week 24, the least squares (LS) mean HbA1c reduction was 0.97% (10.6 mmol/mol) and 0.84% (9.2 mmol/mol) in the self- and physician-managed groups, respectively, with an LS mean difference of -0.13% [95% confidence interval -0.2619 to -0.0004] (-1.4 mmol/mol [-2.863 to -0.004]), demonstrating non-inferiority (P < 0.0001) and superiority (P = 0.0247) of self- versus physician-managed titration. Significantly more of the self- than physician-managed group achieved SMPG target without hypoglycaemia (67% vs 58%; P = 0.0187). Overall, hypoglycaemia incidence was similar in each group. No safety concerns were reported. In both groups, similar PRO improvements were observed for distress related to diabetes disease burden and for confidence in diabetes self-management, with even more individuals achieving a clinically relevant reduction in emotional burden and fewer individuals with high emotional burden in the self-managed group. CONCLUSIONS Self-managed titration of Gla-300 was superior to physician-managed titration in terms of HbA1c reduction, accompanied by similar total PRO scores, with a clinically relevant reduction in emotional burden, and similar hypoglycaemia frequency.
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Affiliation(s)
- David Russell‐Jones
- Department of Diabetes and EndocrinologyRoyal Surrey County HospitalGuildfordUK
| | | | - Elías Delgado
- Department of MedicineUniversity of OviedoSpain
- Endocrinology and Nutrition ServiceHospital Universitario Central de AsturiasOviedoSpain
- Metabolism UnitInstituto de Investigación Sanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - George Dimitriadis
- National and Kapodistrian University of Athens Medical SchoolAttikon University HospitalAthensGreece
| | | | | | - Bernd Schultes
- eSwiss Medical and Surgical Center, Department of Internal Medicine, EndocrinologyDiabetes and Metabolism, St GallenSwitzerland
| | - Krzysztof Strojek
- Department of Internal DiseasesDiabetology and Cardiometabolic Diseases SMDZ, Zabrze, Silesian Medical UniversityKatowicePoland
| | | | | | - Melanie Davies
- Diabetes Research Centre, University of LeicesterUniversity Hospitals of LeicesterLeicesterUK
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26
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Mirahmadizadeh A, Delam H, Seif M, Banihashemi SA, Tabatabaee H. Factors Affecting Insulin Compliance in Patients with Type 2 Diabetes in South Iran, 2017: We Are Faced with Insulin Phobia. IRANIAN JOURNAL OF MEDICAL SCIENCES 2019; 44:204-213. [PMID: 31182886 PMCID: PMC6525732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients with type 2 diabetes are uncontrolled on maximum oral treatment. The early introduction of insulin can lower diabetes-related complications. This study aimed to evaluate type 2 diabetes patients' demographic characteristics, clinical factors, and attitude toward insulin therapy initiation. METHODS In the present cross-sectional study, 457 patients were selected from 12 diabetes clinics in the southern Iranian city of Shiraz in 2017. Adult patients (>30 y) with type 2 diabetes indicated to use insulin for the first time (insulin-naive) were asked to complete a researcher-designed questionnaire. The data were analyzed using SPSS 19. The relationships between insulin and the tendency to use insulin, demographic characteristics, and clinical data were evaluated using the χ2 or t test and logistic regression. The significance level was considered at 0.05. RESULTS The mean age of the participants was 55.16±8.76 years and 67.4% were female. Despite physician recommendations, 60.2% of the patients were disinclined to use insulin. Those unwilling to initiate insulin therapy had more misconceptions. In the multivariate analysis, the chances of insulin noncompliance were increased by 4.63-fold among the patients without supplementary insurance (P<0.001), by 2.38-fold among those with a nondiabetic diet (P=0.002), and by 6.75-fold among the illiterate ones (P<0.001). CONCLUSION Based on the results, the factors affecting insulin noncompliance in our insulin-naive patients with type 2 diabetes included insurance coverage, illiteracy, and nondiabetic regimens as well as misconceptions about and irrational fear of insulin injection. Overall, our results indicate the need for further education and financial support for patients and health staff.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Noncommunicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Hamed Delam
- Student Research Committee, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Mozhgan Seif
- Department of Epidemiology., School of Health, Shiraz University of Medical Sciences, Shiraz, Iran;
| | | | - Hamidreza Tabatabaee
- Research Center for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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27
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Giugliano D, Maiorino MI, Bellastella G, Esposito K. Clinical inertia, reverse clinical inertia, and medication non-adherence in type 2 diabetes. J Endocrinol Invest 2019; 42:495-503. [PMID: 30291589 DOI: 10.1007/s40618-018-0951-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/05/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Clinical inertia and medication non-adherence are thought to contribute largely to the suboptimal glycemic control in many patients with type 2 diabetes. The present review explores the relations between A1C targets, clinical inertia and medication non-adherence in type 2 diabetes. METHODS We searched PubMed for English-language studies published from 2001 through June 1, 2018. We also manually searched the references of selected articles, reviews, meta-analyses, and practice guidelines. Selected articles were mutually agreed upon by the authors. RESULTS Clinical inertia is the failure of clinicians to initiate or intensify therapy when indicated, while medication non-adherence is the failure of patients to start or continue therapy that a clinician has recommended. Although clinical inertia may occur at all stages of diabetes treatment, the longest delays were reported for initiation or intensification of insulin. Medication non-adherence to antidiabetic drugs may range from 53 to 65% at 1 year and may be responsible for uncontrolled A1C in about 23% of cases. Reverse clinical inertia can be acknowledged as the failure to reduce or change therapy when no longer needed or indicated. Clinical inertia and medication non-adherence are difficult to address: clinician-and patient-targeted educational programs, more connected communications between clinicians and patients, the help of other health professional figures (nurse, pharmacist) have been explored with mixed results. CONCLUSIONS Both clinical inertia and medication non-adherence remain significant barriers to optimal glycemic targets in type 2 diabetes. Moreover, part of clinical inertia may be a way through which clinicians face current uncertainty in medicine, including some dissonance among therapeutic guidelines. Scientific associations should find an agreement about how to measure and report clinical inertia in clinical practice and should exhort clinicians to consider reverse clinical inertia as a cause of persisting inappropriate therapy in vulnerable patients.
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Affiliation(s)
- D Giugliano
- Division of Endocrinology and Metabolic Diseases, Università della Campania L. Vanvitelli, Piazza L. Miraglia, 2, 80138, Naples, Italy.
| | - M I Maiorino
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Università della Campania L. Vanvitelli, Naples, Italy
| | - G Bellastella
- Division of Endocrinology and Metabolic Diseases, Università della Campania L. Vanvitelli, Piazza L. Miraglia, 2, 80138, Naples, Italy
| | - K Esposito
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Università della Campania L. Vanvitelli, Naples, Italy
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Ray KK, Kendall DM, Zhao Z, Peng X, Caballero AE, Polonsky WH, Nordstrom BL, Fan L, Curtis BH, Davies MJ. A multinational observational study assessing insulin use: Understanding the determinants associated with progression of therapy. Diabetes Obes Metab 2019; 21:1101-1110. [PMID: 30565369 PMCID: PMC6590265 DOI: 10.1111/dom.13622] [Citation(s) in RCA: 6] [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: 09/17/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022]
Abstract
AIMS To describe global patterns of insulin treatment and to assess the impact of patient, provider, health system and economic influences on treatment decisions for patients with insulin-treated type 2 diabetes (T2D). METHODS This prospective cohort study of insulin-treated patients with T2D was conducted across 18 countries categorized as high, upper-middle or lower-middle income regions. Information collected from patients included knowledge of diabetes, experiences and interactions with their healthcare provider. Physician information included specialty, practice size, availability of diabetes support services, volume of diabetes patients treated and time spent per patient. Physicians determined an individualized haemoglobin A1c (HbA1c) target for each patient by the start of the study. Changes in T2D therapies and HbA1c were recorded for 2 years. RESULTS Complete treatment data were available for 2528 patients. Median age was 61 years and median duration of diabetes was 11.4 years. Changes to treatment regimen occurred in 90.0% of patients, but changes were less common in countries with a higher economic status (P < 0.001). Most treatment changes involved insulin, with changes in dose the most common. Overall predictors of change in insulin therapy included younger age, use of any insulin regimen other than basal only, higher mean baseline HbA1c and longer duration of T2D. HbA1c levels remained constant regardless of regional economic status. At baseline, 20.6% of patients were at their HbA1c target; at 2 years this was 26.8%. CONCLUSIONS Among insulin-treated patients with T2D, treatment changes were common; however, only approximately one-fourth of individuals achieved their HbA1c target.
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Affiliation(s)
- Kausik K. Ray
- Faculty of MedicineSchool of Public Health, Imperial CollegeLondonUK
| | - David M. Kendall
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
| | - Zhenxiang Zhao
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
| | - Xiaomei Peng
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
| | | | | | | | - Ludi Fan
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
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29
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Bonadonna RC, Giaccari A, Buzzetti R, Aimaretti G, Cucinotta D, Avogaro A, Perseghin G, Larosa M, Bolli GB, Fanelli CG. Italian Titration Approach Study (ITAS) with insulin glargine 300 U/mL in insulin-naïve type 2 diabetes: Design and population. Nutr Metab Cardiovasc Dis 2019; 29:496-503. [PMID: 30952575 DOI: 10.1016/j.numecd.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Fostering patient's self-managing of basal insulin therapy could improve glucose control, by removing patient's and physician's barriers to basal insulin initiation, titration and glucose monitoring. The Italian Titration Approaches Study (ITAS) aims at demonstrating non-inferiority (<0.3% margin) in efficacy of glucose control (change in glycated hemoglobin [HbA1c] after 24 weeks) by the same titration algorithm of insulin glargine 300 U/mL (Gla-300), managed by the (nurse assisted) patient versus the physician, in insulin naïve patients with Type 2 Diabetes Mellitus (T2DM), uncontrolled with previous treatments. METHODS AND RESULTS ITAS is a phase IV, 24-week, national, multicenter, open label, randomized (1:1) parallel group study. 458 patients were enrolled, 359 randomized, and 339 completed the study, in 46 Italian centers. Baseline characteristics and previous medications of the ITT population (N = 355) are reported. Mean ± SD age, T2DM duration, HbA1c, FPG and BMI were 64.0 ± 9.8 years, 11.6 ± 7.6 years, 8.79 ± 0.65%, 170.9 ± 42.3 mg/dL, and 30.3 ± 5.6 kg/m2, respectively. Vascular and metabolic disorders were most frequent (73.8% and 58.3%, respectively). More than 90% of patients were on metformin. CONCLUSION ITAS is the first study to compare two different managers (nurse-assisted patient vs physician) of the same titration algorithm of Gla-300 in insulin naïve patients with T2DM in unsatisfactory glucose control. This study might provide novel evidence on the efficacy/effectiveness of patient-managed titration algorithm of Gla-300 in a pragmatic setting and may reduce barriers to basal insulin initiation and its titration.
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Affiliation(s)
- R C Bonadonna
- Division of Endocrinology and Metabolic Diseases, Department of Medicine and Surgery, University of Parma, AOU of Parma, Italy.
| | - A Giaccari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | | | | | | | - G B Bolli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Italy
| | - C G Fanelli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Italy
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30
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Hussein A, Mostafa A, Areej A, Mona AM, Shimaa A, Najd AG, Futoon A. The perceived barriers to insulin therapy among type 2 diabetic patients. Afr Health Sci 2019; 19:1638-1646. [PMID: 31148993 PMCID: PMC6531943 DOI: 10.4314/ahs.v19i1.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Problems may arise with insulin treatment, due to patients' perspective towards it leading to refusal. OBJECTIVES To evaluate diabetic patients' refusal towards insulin therapy, and to assess patients' perception and perceived barriers towards insulin. METHODS A cross-sectionalstudy, where type 2 diabetics participated in the study during a period, February through March 2017. They were interviewed in person by a questionnaire including three sections; socio-demography, medical history and a health belief model, comprising barriers to use insulin. Five points Likert scale was used to measure patients' perception and barriers towards insulin therapy. RESULTS One fourth (24.4%) of the diabetic patients refused insulin. Among the controlled group, 34.4% refused insulin, while 21% refused insulin among the uncontrolled group. The study showed different barriers towards insulin therapy, including fear of injection, pain, insulin injection needs help from others, fear of hypoglycaemia and embarrassment. CONCLUSION Diabetics showed a negative attitude towards insulin therapy due to social and psychological factors. The results necessitate the development of a strategy to address problems related with a reluctance to initiate insulin and put a strategy to implement education and better interaction with diabetic team to the stigma from phobia from insulin use.
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Affiliation(s)
- Amin Hussein
- King Saud University, Family and Community Medicine
| | | | - Alnomi Areej
- King Saud University, Family and Community Medicine
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31
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Shafie Pour MR, Sadeghiyeh T, Hadavi M, Besharati M, Bidaki R. The barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran. Diabetes Metab Syndr Obes 2019; 12:1349-1354. [PMID: 31496772 PMCID: PMC6689560 DOI: 10.2147/dmso.s200867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/29/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The decision to start insulin therapy is often difficult. Determining the barriers against insulin therapy initiation can facilitate care and treatment strategies. The aim of this study was to evaluate the barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran. METHODS This descriptive study was conducted on 214 patients referred to the Diabetes Center of Yazd University of Medical Sciences in 2015. Participants were randomly selected, and then they completed the insulin noncompliance questionnaire (20 questions). The percentage of adherence and the factors contributing to nonadherence to insulin therapy were analyzed using descriptive statistics, the Kruskal-Wallis test, and the Mann-Whitney test. RESULTS The most prevalent reason for insulin therapy refusal was expecting a new method of diabetes treatment (54.7%), followed by requiring someone else to administer the injection (19.2%), fear of needles, cost, traveling (18.7%), and stress/emotional problems (18.2%). Lack of trust in the physician was the least restrictive reason for nonadherence to insulin therapy. CONCLUSION The most common reason given for insulin therapy refusal was the lack of adequate education. Therefore, specialized educational interventions can help minimize barriers and improve patients' outcomes.
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Affiliation(s)
- MR Shafie Pour
- Department of Internal Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - T Sadeghiyeh
- Department of Psychiatry, Research Center of Addiction and Behavioral Sciences, Hahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - M Hadavi
- Department of Anesthesiology, Paramedical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - M Besharati
- Rafsanjan University of Medical Sciences
, Rafsanjan, Iran
| | - R Bidaki
- Research Center of Addiction and Behavioral Sciences, Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Correspondence: R Bidaki Taft, Yazd, IranTel +09 8322632003; 8991683416 Email
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Psarou A, Cooper H, Wilding JPH. Patients' Perspectives of Oral and Injectable Type 2 Diabetes Medicines, Their Body Weight and Medicine-Taking Behavior in the UK: A Systematic Review and Meta-Ethnography. Diabetes Ther 2018; 9:1791-1810. [PMID: 30120753 PMCID: PMC6167276 DOI: 10.1007/s13300-018-0490-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 01/03/2023] Open
Abstract
UNLABELLED The aim of this review is to identify peoples' perspectives of their glucose-lowering and anti-obesity drugs in relation to diabetes and weight control and to explore how these views affect medication adherence. Theoretical perspectives associated with medicine-taking behavior are also explored. The systematic review was based on a meta-ethnography of qualitative studies identified through a search of 12 medical and social science databases and subsequent citation searches. The quality of all studies was assessed. Sixteen studies were included with data from 360 UK individuals. No relevant studies were identified which focused on anti-obesity and non-insulin injectable drugs. The review revealed that the patients' perspectives and emotional state were influenced by starting and/or changing to a new glucose-lowering medicine. These were also influenced by prior medication experience, disease perceptions and interactions with clinicians. Despite reports of positive experiences with and positive perceptions of medicines, and of participation in strategies to regain life control, medication non-adherence was common. Accepting glucose-lowering medicines impacted on the individual's perception of lifestyle changes, and it was notable that weight loss was not perceived as a strategy to support diabetes management. Synthesis revealed that more than one theory is required to explain medicine-taking behavior. New insights into the underlying factors of poor adherence and the specific practical issues identified in this review can help in the development of patient-centered interventions. FUNDING Diabetes UK.
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Affiliation(s)
- Aikaterini Psarou
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Helen Cooper
- Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of Chester, Chester, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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33
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Dreon DM, Hannon TM, Cross B, Carter BJ, Mercer NS, Nguyen JH, Tran A, Melendez PA, Morales N, Nelson JE, Tan MH. Laboratory and Benchtop Performance of a Mealtime Insulin-Delivery System. J Diabetes Sci Technol 2018; 12:817-827. [PMID: 29488399 PMCID: PMC6134303 DOI: 10.1177/1932296818760633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND A basal bolus insulin regimen requires multiple daily insulin injections, which might discourage patient adherence. As a potential solution, a mealtime insulin-delivery system-a 3-day wearable bolus-only patch-was designed to manually administer mealtime insulin discreetly by actuating buttons through clothing, without the need for multiple needle sticks. METHOD Extensive functional testing of the patch included dose accuracy (from initial fill of the device to empty), pressure-vacuum leak testing, last-dose lockout and occlusion detection (safety alert features that lock the dosing buttons when no insulin is delivered), assessments of insulin drug stability, toxicological risk (including chemical testing), and system biocompatibility. RESULTS Dosing accuracy was 2 units ±10% (with U-100 insulin) over a range of environmental conditions, with ≥95% reliability and confidence. The fluid seal performance and the safety alert features performed with ≥95% reliability and ≥95% confidence. The system met acceptable standards for insulin (U-100 lispro and aspart) stability for its intended 3-day use, in addition to the operational requirements. The toxicological risk assessment and demonstrated biocompatibility suggested that the patch is safe for human use. CONCLUSIONS Benchtop performance showed that the bolus-only patch is a safe, accurate, and reliable device for mealtime insulin delivery.
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Affiliation(s)
- Darlene M. Dreon
- Calibra Medical, a Johnson & Johnson
Company, Wayne, PA, USA
- Darlene M. Dreon, DrPH, Calibra Medical, 965
Chesterbrook Blvd, Wayne, PA 19087, USA.
| | | | - Brett Cross
- Calibra Medical, a Johnson & Johnson
Company, Wayne, PA, USA
| | - Brett J. Carter
- Calibra Medical, a Johnson & Johnson
Company, Wayne, PA, USA
| | | | - Jason H. Nguyen
- Calibra Medical, a Johnson & Johnson
Company, Wayne, PA, USA
| | - Andy Tran
- Calibra Medical, a Johnson & Johnson
Company, Wayne, PA, USA
| | | | - Nancy Morales
- LifeScan, LLC, a Johnson & Johnson
Company, Wayne, PA, USA
| | | | - Meng H. Tan
- Division of Metabolism, Endocrinology
and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor,
MI, USA
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Holmes-Truscott E, Browne JL, Ventura AD, Pouwer F, Speight J. Diabetes stigma is associated with negative treatment appraisals among adults with insulin-treated Type 2 diabetes: results from the second Diabetes MILES - Australia (MILES-2) survey. Diabet Med 2018; 35:658-662. [PMID: 29417612 DOI: 10.1111/dme.13598] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 01/05/2023]
Abstract
AIM To explore factors associated with negative insulin appraisals among adults with Type 2 diabetes, including perceived and experienced diabetes stigma. METHODS The second Diabetes MILES - Australia study (MILES-2) is a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 456 adults with insulin-treated Type 2 diabetes (38% women; mean ± sd age: 61.2 ± 8.8 years; diabetes duration: 14.5 ± 7.5 years; years using insulin: 6.4 ± 5.5). Participants completed validated measures of perceived and experienced diabetes stigma (Type 2 Diabetes Stigma Assessment Scale), insulin appraisals [Insulin Treatment Appraisal Scale (ITAS)] and known correlates of insulin appraisals: diabetes-specific distress (Problem Areas In Diabetes scale) and diabetes-specific self-efficacy (Confidence in Diabetes Self-care scale). A multiple linear regression was conducted (N = 279) to determine the contribution of those variables found to be associated with ITAS Negative scores. RESULTS Univariable analyses revealed negative insulin appraisals were associated with demographic and self-care characteristics (age, employment status, BMI, years using insulin, injections per day), self-efficacy, diabetes-specific distress and diabetes stigma (all P < 0.01). Number of injections per day [regression coefficient [95% confidence interval]: 0.74 [0.08, 1.40]; P = 0.028], self-efficacy [-0.12 [-0.19, -0.06]; P < 0.001] and diabetes stigma [0.39 (0.31, 0.46); P < 0.001) significantly and independently contributed to the final multivariable model, explaining 58% of the variance in ITAS Negative scores. The independent contribution of diabetes-specific distress was suppressed following the inclusion of diabetes stigma. CONCLUSIONS This study represents the first step in understanding the relationship between perceived and experienced diabetes stigma and negative insulin appraisals, and provides quantitative evidence for the strong, independent relationship between these two important constructs.
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Affiliation(s)
- E Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - J L Browne
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - A D Ventura
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - F Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - J Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- AHP Research, Hornchurch, UK
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35
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A holistic conceptual framework model to describe medication adherence in and guide interventions in diabetes mellitus. Res Social Adm Pharm 2018; 14:391-397. [DOI: 10.1016/j.sapharm.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/06/2017] [Indexed: 11/23/2022]
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36
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Kalirai S, Stephenson J, Perez-Nieves M, Grabner M, Hadjiyianni I, Geremakis C, Pollom RD, Reed B, Fisher L. Primary care physician perspectives on basal insulin initiation and maintenance in patients with type 2 diabetes mellitus. Prim Care Diabetes 2018; 12:155-162. [PMID: 29100717 DOI: 10.1016/j.pcd.2017.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/24/2017] [Accepted: 10/08/2017] [Indexed: 01/06/2023]
Abstract
AIMS To describe primary care physicians' (PCPs) perceptions of patient reactions and concerns about insulin initiation and identify opportunities for increased support. METHODS Cross-sectional, online survey of PCPs prescribing basal insulin to adults with type 2 diabetes mellitus (T2DM). PCPs were identified from administrative claims of a large commercial health plan and descriptive results of PCP responses were reported. RESULTS PCPs (N=100) treated an average of 17 patients receiving insulin during a typical week. More than 85% of insulin initiation recommendations originated with PCPs. Most offered glucose monitoring instructions (96%) and advice on diet, exercise, and diabetes management (96%); 35% provided insulin titration algorithms; 93% reported that patients often or always took their insulin daily within 3 months of initiation; 31% of PCPs reported monthly office contacts with patients for the first 3 months; 16% reported no outreach efforts; fewer than 20% connected patients with support groups. When starting basal insulin, PCPs reported patients feeling personal failure regarding their diabetes treatment (33% often/always) and lacking confidence in their ability to manage insulin therapy (38% often/always). CONCLUSIONS Study results identify additional opportunities for assisting patients in making the transition to insulin, including more frequent direct outreach to monitor insulin usage.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lawrence Fisher
- Department of Family and Community Medicine, UC San Francisco, San Francisco, CA, USA
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37
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Berard L, Antonishyn N, Arcudi K, Blunden S, Cheng A, Goldenberg R, Harris S, Jones S, Mehan U, Morrell J, Roscoe R, Siemens R, Vallis M, Yale JF. Insulin Matters: A Practical Approach to Basal Insulin Management in Type 2 Diabetes. Diabetes Ther 2018; 9:501-519. [PMID: 29476414 PMCID: PMC6104258 DOI: 10.1007/s13300-018-0375-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Indexed: 12/14/2022] Open
Abstract
It is currently estimated that 11 million Canadians are living with diabetes or prediabetes. Although hyperglycemia is associated with serious complications, it is well established that improved glycemic control reduces the risk of microvascular complications and can also reduce cardiovascular (CV) complications over the long term. The UKPDS and ADVANCE landmark trials have resulted in diabetes guidelines recommending an A1C target of ≤ 7.0% for most patients or a target of ≤ 6.5% to further reduce the risk of nephropathy and retinopathy in those with type 2 diabetes (T2D), if it can be achieved safely. However, half of the people with T2D in Canada are not achieving these glycemic targets, despite advances in diabetes pharmacological management. There are many contributing factors to account for this poor outcome; however, one of the major factors is the delay in treatment advancement, particularly a resistance to insulin initiation and intensification. To simplify the process of initiating and titrating insulin in T2D patients, a group of Canadian experts reviewed the evidence and best clinical practices with the goal of providing guidance and practical recommendations to the diabetes healthcare community at large. This expert panel included general practitioners (GPs), nurses, nurse practitioners, endocrinologists, dieticians, pharmacists, and a psychologist. This article summarizes the panel recommendations.
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Affiliation(s)
- Lori Berard
- Winnipeg Regional Health Authority, Winnipeg Diabetes Research Group, Health Sciences Centre, Winnipeg, MB, Canada.
| | - Noreen Antonishyn
- Department of Endocrinology, Alberta Health Services, Edmonton, AB, Canada
| | - Kathryn Arcudi
- Diabetes Clinic, The Montreal West Island Integrated University Health and Social Services Centre (Lakeshore General Hospital), Pointe-Claire, QC, Canada
| | - Sarah Blunden
- Diabetes Education, LMC Diabetes and Endocrinology, Montreal, QC, Canada
| | - Alice Cheng
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
- Trillium Health Partners, Credit Valley Hospital, Mississauga, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Stewart Harris
- Department of Family Medicine, Western University, London, ON, Canada
| | | | - Upender Mehan
- The Centre for Family Medicine, Kitchener, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - James Morrell
- Diabetes Services, Island Health, Victoria, BC, Canada
| | - Robert Roscoe
- Diabetes Education Centre, Saint John Regional Hospital, Saint John, NB, Canada
| | | | - Michael Vallis
- Behaviour Change Institute, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
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38
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Lee KP. Translation and validation of the Insulin Treatment Appraisal Scale in Hong Kong primary care patients. J Diabetes Investig 2018; 9:311-320. [PMID: 28626953 PMCID: PMC5835470 DOI: 10.1111/jdi.12704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/22/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
AIMS/INTRODUCTION Patients with type 2 diabetes mellitus often delay the initiation or titration of insulin treatment due to psychological factors. This phenomenon is referred to as psychological insulin resistance (PIR). The Insulin Treatment Appraisal Scale (ITAS) is a 20-item instrument for assessing PIR. A previous Chinese version of the ITAS (C-ITAS) was found to be subject to problems arising from its translation. The present study aimed to translate and validate this instrument, which will facilitate research and aid in counseling in a clinical setting. MATERIALS AND METHODS The C-ITAS was modified to develop the Hong Kong version of the C-ITAS (C-ITAS-HK) according to published guidelines for the translation of transcultural research. A total of 328 diabetes mellitus patients who were followed-up in 10 different publically funded primary care outpatient clinics were recruited for self-administration of the C-ITAS-HK. Demographic data were recorded, and clinical data (e.g., presence of diabetes mellitus complications) were obtained from case records. The C-ITAS-HK results were subjected to psychometric analysis, including the assessment of Cronbach's alpha, factor analysis and test-retest reliability. RESULTS Factor analysis supported a two-factor structure with good internal consistency (whole scale 0.846, negative subscale 0.882, positive subscale 0.619). The test-retest reliability correlation coefficients for all items were positive, at 0.871, 0.782, and 0.692 for the whole scale, negative subscale and positive subscale, respectively. The ITAS scores differed significantly between participants with PIR and those without in the expected direction, suggesting good discriminant validity. CONCLUSIONS The C-ITAS-HK is a valid tool for measuring and assessing PIR in the Hong Kong primary care diabetes mellitus population.
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Affiliation(s)
- Kam Pui Lee
- Jockey Club School of Public Health and Primary CareThe Chinese University of Hong KongShatinHong Kong
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39
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Russell‐Jones D, Pouwer F, Khunti K. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab 2018; 20:488-496. [PMID: 29053215 PMCID: PMC5836933 DOI: 10.1111/dom.13132] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/28/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022]
Abstract
Poor glycaemic control in type 2 diabetes (T2D) is a global problem despite the availability of numerous glucose-lowering therapies and clear guidelines for T2D management. Tackling clinical or therapeutic inertia, where the person with diabetes and/or their healthcare providers do not intensify treatment regimens despite this being appropriate, is key to improving patients' long-term outcomes. This gap between best practice and current level of care is most pronounced when considering insulin regimens, with studies showing that insulin initiation/intensification is frequently and inappropriately delayed for several years. Patient- and physician-related factors both contribute to this resistance at the stages of insulin initiation, titration and intensification, impeding achievement of optimal glycaemic control. The present review evaluates the evidence and reasons for this delay, together with available methods for facilitation of insulin initiation or intensification.
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Affiliation(s)
- David Russell‐Jones
- Department of Diabetes and EndocrinologyRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Kamlesh Khunti
- College of Medicine, Biological Sciences and Psychology, Leicester Diabetes CentreUniversity of LeicesterUK
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40
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Peyrot M, Dreon D, Zraick V, Cross B, Tan MH. Patient Perceptions and Preferences for a Mealtime Insulin Delivery Patch. Diabetes Ther 2018; 9:297-307. [PMID: 29327220 PMCID: PMC5801251 DOI: 10.1007/s13300-017-0365-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION A basal-bolus insulin regimen is needed to achieve glycated hemoglobin A1c (HbA1c) below 7.0% in people with type 1 (T1D) or type 2 (T2D) diabetes who have significant loss of beta-cell function. Nonadherence to therapy is common and negatively affects the ability to reach treatment goals. We examined patient assessment of a new, wearable mealtime insulin-delivery system (patch) relative to their current mealtime insulin-delivery system (syringe, pen, or pump). The patch is designed to deliver only boluses of fast-acting insulin (no basal insulin), mechanically controlled by the patient. METHODS Adults (n = 101) with T1D or T2D assessed their current mealtime insulin-delivery system and then assessed simulated (no active medication) patch use over a 3-day period. Participants evaluated mealtime insulin-delivery systems using eight measures from five domains (convenience, interference with daily activities, diabetes-related worry, psychological well-being, and overall satisfaction/preference) on the self-administered Insulin Delivery System Rating Questionnaire. User ratings of their current insulin-delivery systems (syringe, pen, pump) were compared with those for the patch by repeated measure analysis of variance and one-sample t tests. RESULTS Participants had significant (p < 0.05) preference for patch over syringe in all eight comparisons, and over pen in five out of eight comparisons, with no significant preference for pen. Although there was a preference for patch over pump in six out of eight comparisons, only one showed a significant preference for patch, and one for pump. Significantly more participants reported that they would like to switch to the patch than continue using a syringe (78% vs 22%) or pen (76% vs 24%) but this difference was not significant for the group using a pump (52% vs 48%). CONCLUSIONS Participants preferred using the patch over pens and syringes. Its ease of use and discreet method of insulin delivery may contribute to improved patient adherence to mealtime insulin regimens among people currently using injection devices. FUNDING Calibra Medical.
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Affiliation(s)
- Mark Peyrot
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA.
| | | | | | | | - Meng H Tan
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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41
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Berard L, Bonnemaire M, Mical M, Edelman S. Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey. Diabetes Obes Metab 2018; 20:301-308. [PMID: 28719066 PMCID: PMC5811840 DOI: 10.1111/dom.13064] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 01/15/2023]
Abstract
AIMS Basal insulin (BI) treatment initiation and dose titration in type 2 diabetes (T2DM) are often delayed. Such "clinical inertia" results in poor glycaemic control and high risk of long-term complications. This survey aimed to determine healthcare professional (HCP) and patient attitudes to BI initiation and titration. METHODS An online survey (July-August 2015) including HCPs and patients with T2DM in the USA, France and Germany. Patients were ≥18 years old and had been on BI for 6 to 36 months, or discontinued BI within the previous 12 months. RESULTS Participants comprised 386 HCPs and 318 people with T2DM. While >75% of HCPs reported discussing titration at the initiation visit, only 16% to 28% of patients remembered such discussions, many (32%-42%) were unaware of the need to titrate BI, and only 28% to 39% recalled mention of the time needed to reach glycaemic goals. Most HCPs and patients agreed that more effective support tools to assist BI initiation/titration are needed; patients indicated that provision of such tools would increase confidence in self-titration. HCPs identified fear of hypoglycaemia, failure to titrate in the absence of symptoms, and low patient motivation as important titration barriers. In contrast, patients identified weight gain, the perception that titration meant worsening disease, frustration over the time to reach HbA1c goals and fear of hypoglycaemia as major factors. CONCLUSION A disconnect exists between HCP- and patient-perceived barriers to effective BI titration. To optimize titration, strategies should be targeted to improve HCP-patient communication, and provide support and educational tools.
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Affiliation(s)
- Lori Berard
- Winnipeg Regional Health Authority Health Sciences CentreWinnipegManitobaCanada
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42
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[Why don't doctors use early insulinization therapy in patients with diabetes mellitus type 2?: A qualitative approach in a Mexican city]. Salud Colect 2018; 13:693-712. [PMID: 29340447 DOI: 10.18294/sc.2017.1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022] Open
Abstract
Early insulinization therapy is regarded as an efficient aid to improve long term control and quality of life in patients with diabetes mellitus type 2 (DM2). Nevertheless, both patients and medical staff confront barriers in using this therapeutic tool. This study employs a qualitative approach to explore the barriers to early insulinization among medical staff from the public sector in the city of Xalapa, Veracruz, México. Between 2015 and 2016, in-depth interviews were conducted with general and specialist physicians offering primary health care to patients with DM2. The transcribed interviews were analyzed to extract and organize categories and subcategories of barriers among medical staff. These barriers were then grouped into three categories and exemplified with interview excerpts: barriers coming from the medical staff itself, barriers emerging from the doctor-patient interaction, and institutional barriers. Uses for the classification obtained are discussed, as are some of the solutions proposed by study participants.
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Jaam M, Hadi MA, Kheir N, Mohamed Ibrahim MI, Diab MI, Al-Abdulla SA, Awaisu A. A qualitative exploration of barriers to medication adherence among patients with uncontrolled diabetes in Qatar: integrating perspectives of patients and health care providers. Patient Prefer Adherence 2018; 12:2205-2216. [PMID: 30410316 PMCID: PMC6200070 DOI: 10.2147/ppa.s174652] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To develop an in-depth understanding of the barriers to medication adherence among patients with uncontrolled diabetes attending primary health care (PHC) centers in Qatar by exploring and integrating patients' and health care providers' perspectives. PARTICIPANTS AND METHODS A descriptive qualitative methodology was used in this study. A trained researcher conducted semi-structured face-to-face interviews at two PHC centers. Patients with uncontrolled diabetes (with varied sociodemographic characteristics) and their respective health care providers (physicians, pharmacists, nurses, dieticians, and others) were purposively selected from the two PHC centers. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic content analysis. RESULTS Thirty interviews (14 patients and 16 health care providers) were conducted. A number of barriers to medication adherence were identified and classified broadly under three main themes: 1) patient-related factors, which included patients' individual characteristics and patients' perception, attitude, and behavior; 2) patient-provider factors, which included communication and having multiple health care providers caring for the patient; and 3) societal and environmental factors, which included social pressure and traveling to visit friends and relatives. CONCLUSION Patients with uncontrolled diabetes face multiple barriers to medication adherence. Similar themes emerged from both patients and their care providers. This research highlights the need for concerted multidimensional efforts and series of interventions to overcome these barriers. One vital intervention is expanding the scope of pharmacists' role within the PHC centers through providing medication reconciliation, patient-tailored medication counseling, and medicines use review, which may improve treatment outcomes among patients with diabetes.
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Affiliation(s)
- Myriam Jaam
- College of Pharmacy, Qatar University, Doha, Qatar,
| | | | - Nadir Kheir
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | | | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar,
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Devine F, Edwards T, Feldman SR. Barriers to treatment: describing them from a different perspective. Patient Prefer Adherence 2018; 12:129-133. [PMID: 29398908 PMCID: PMC5775743 DOI: 10.2147/ppa.s147420] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Poor adherence is the result of many barriers. Most of the adherence research has focused on the patients' hurdles to adherence, instead of the responsibility the physician has for assuring adherence to treatment. OBJECTIVE The purpose of this review is to identify barriers to medication adherence and refocus how we describe those barriers in terms of physician behavior hurdles. METHODS PubMed was systematically searched for systematic reviews published between January 01, 2010, and December 06, 2017, that provided barriers to medication adherence. The searches were limited to reviews having adherence to medication prescribed in the outpatient setting as the main topic. RESULTS Thirty-one reviews were included in this review, covering 13 different disease categories. Fifty-eight different barriers to adherence to medications for chronic conditions were identified. Nineteen barriers were cited 6 or more times, and these were further categorized based on the World Health Organization's 5 dimensions of adherence and the number of times cited. CONCLUSION This review provides clear evidence that adherence to medication is affected by multiple barriers. To facilitate this, adherence barriers can be framed as physician/health system hurdles. With that focus in mind, we may put the responsibility where we have the most control.
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Affiliation(s)
| | - Taylor Edwards
- Center for Dermatology Research, Department of Dermatology
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology
- Department of Pathology
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Correspondence: Steven R Feldman, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA, Tel +1 336 716 7740, Fax +1 336 716 7732, Email
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Jaam M, Awaisu A, Ibrahim MI, Kheir N. Synthesizing and Appraising the Quality of the Evidence on Factors Associated with Medication Adherence in Diabetes: A Systematic Review of Systematic Reviews. Value Health Reg Issues 2017; 13:82-91. [PMID: 29073997 DOI: 10.1016/j.vhri.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nonadherence to medications is a common phenomenon in patients with diabetes. Several studies and systematic reviews have investigated the barriers to medication adherence in diabetes. However, no study has evaluated the quality of the existing literature and synthesized the plethora of evidence with a goal to design holistic conceptual frameworks and interventions. OBJECTIVES The aims of this review were to systematically evaluate existing systematic reviews focusing on factors associated with medication adherence in diabetes in an effort to synthesize the evidence, determine their methodological quality, and identify the gaps in the current literature. METHODS Fourteen databases and gray literature sources were systematically searched through June 2016. Systematic reviews reporting factors associated with medication adherence (barriers and facilitators) in patients with diabetes were selected on the basis of predetermined criteria. Studies were appraised for quality using AMSTAR (A Measurement Tool to Assess Systematic Reviews). RESULTS Seventeen systematic reviews including 542 primary studies, most of which were cross-sectional quantitative studies, were included. All the reviews were rated as moderate to low quality and exhibited common methodological pitfalls. Factors influencing medication adherence identified were categorized as patient-, medication-, disease-, health care provider-, health care system-, and social-related factors. CONCLUSIONS Factors influencing medication adherence are multifactorial with remarkably consistent findings across the existing reviews; yet, most reviews were judged to be of low to moderate quality. Further comprehensive and well-conducted original studies and systematic reviews on this topic shall be conducted taking into consideration the drawbacks of existing ones.
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Affiliation(s)
- Myriam Jaam
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
| | | | - Nadir Kheir
- College of Pharmacy, Qatar University, Doha, Qatar; School of Pharmacy, the University of Auckland, Auckland, New Zealand
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Raccah D, Huet D, Dib A, Joseph F, Landers B, Escalada J, Schmitt H. Review of basal-plus insulin regimen options for simpler insulin intensification in people with Type 2 diabetes mellitus. Diabet Med 2017; 34:1193-1204. [PMID: 28574177 PMCID: PMC5599968 DOI: 10.1111/dme.13390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Abstract
AIMS To identify simple insulin regimens for people with Type 2 diabetes mellitus that can be accepted and implemented earlier in primary and specialist care, taking into consideration each individual's needs and capabilities. METHODS Using randomized clinical trials identified by a search of the PubMed database, as well as systematic reviews, meta-analyses and proof-of-concept studies, this review addresses topics of interest related to the progressive intensification of a basal insulin regimen to a basal-plus regimen (one basal insulin injection plus stepwise addition of one to three preprandial short-acting insulin injections/day) vs a basal-bolus regimen (basal insulin plus three short-acting insulin injections per day) in people with Type 2 diabetes. The review explores approaches that can be used to define the meal for first prandial injection with basal-plus regimens, differences among insulin titration algorithms, and the importance of self-motivation and autonomy in achieving optimum glycaemic control. RESULTS A basal-plus regimen can provide glycaemic control equivalent to that obtained with a full basal-bolus regimen, with fewer injections of prandial insulin. The first critical step is to optimize basal insulin dosing to reach a fasting glucose concentration of ~6.7 mmol/l; this allows ~40% of patients with baseline HbA1c >75 mmol/mol (9%) to be controlled with only one basal insulin injection per day. CONCLUSIONS Compared with a basal-bolus regimen, a basal-plus insulin regimen is as effective but more practical, and has the best chance of acceptance and success in the real world.
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Affiliation(s)
- D. Raccah
- Department of DiabetesSainte Marguerite HospitalMarseille
| | - D. Huet
- Department of DiabetesSaint‐Joseph HospitalParis
| | - A. Dib
- Eli Lilly FranceNeuilly sur SeineFrance
| | - F. Joseph
- Countess of Chester HospitalChesterUK
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Jaam M, Ibrahim MIM, Kheir N, Awaisu A. Factors associated with medication adherence among patients with diabetes in the Middle East and North Africa region: A systematic mixed studies review. Diabetes Res Clin Pract 2017; 129:1-15. [PMID: 28499162 DOI: 10.1016/j.diabres.2017.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/07/2017] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
Multiple systematic reviews were conducted investigating factors associated with medication adherence worldwide. However, investigations from the Middle East and North Africa (MENA) region were largely underrepresented in those reviews. Therefore, the objective of this systematic review is to identify the factors influencing medication adherence among patients with diabetes in the MENA region. A systematic literature search was conducted through Cochrane Library, EBSCO, EMBASE, Google Scholar, ISI Web of Science, PubMed, ScienceDirect, SCOPUS, and ProQuest. Studies were included if they determined factors associated with medication adherence among patients with diabetes within the MENA region. Quality was assessed using Crow Critical Appraisal Tool. Thirty primary studies from 10 MENA countries were included. The factors associated with medication adherence were categorized into demographics-related; disease- and medication-related; perception, attitude and psychological feelings-related; and societal-related factors. Positively associated factors included knowledge about the disease and medications, regular follow-up visits, and patients' positive beliefs about effectiveness and motivations about medications, while negatively associated factors included forgetfulness, side effects, and polypharmacy. Factors associated with medication adherence among patients with diabetes in the MENA region are highly diverse. The identified factors can serve as potential targets for culturally-relevant interventions to improve medication adherence and overall health outcomes.
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Affiliation(s)
- Myriam Jaam
- College of Pharmacy, Qatar University, Doha, Qatar
| | | | - Nadir Kheir
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
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Holmes-Truscott E, Pouwer F, Speight J. Assessing Psychological Insulin Resistance in Type 2 Diabetes: a Critical Comparison of Measures. Curr Diab Rep 2017; 17:46. [PMID: 28508930 DOI: 10.1007/s11892-017-0873-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This study aims to examine the operationalisation of 'psychological insulin resistance' (PIR) among people with type 2 diabetes and to identify and critique relevant measures. RECENT FINDINGS PIR has been operationalised as (1) the assessment of attitudes or beliefs about insulin therapy and (2) hypothetical or actual resistance, or unwillingness, to use to insulin. Five validated PIR questionnaires were identified. None was fully comprehensive of all aspects of PIR, and the rigour and reporting of questionnaire development and psychometric validation varied considerably between measures. Assessment of PIR should focus on the identification of negative and positive attitudes towards insulin use. Actual or hypothetical insulin refusal may be better conceptualised as a potential consequence of PIR, as its assessment overlooks the attitudes that may prevent insulin use. This paper provides guidance on the selection of questionnaires for clinical or research purpose and the development of new, or improvement of existing, questionnaires.
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Affiliation(s)
- E Holmes-Truscott
- School of Psychology, Deakin University, Geelong, VIC, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - F Pouwer
- Department of Psychology, University of Southern Denmark, Odense M, Denmark
| | - J Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- AHP Research, Hornchurch, Essex, UK
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Diabetes-related distress and its associated factors among patients with type 2 diabetes mellitus in China. Psychiatry Res 2017; 252:45-50. [PMID: 28246057 DOI: 10.1016/j.psychres.2017.02.049] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 12/11/2022]
Abstract
Diabetes-related distress is one of the psychological disorders affecting patients with diabetes, yet there are few studies about diabetes-related distress in Chinese patients. To assess the level of psychological distress and examine its associated factors, we conducted a cross-sectional analysis of patients with type 2 diabetes mellitus from a Chinese tertiary hospital. The Diabetes Distress Scale (DDS) and the General Self-Efficacy Scale (GSES) were administered. There were 210 (57.85%) patients with little or no diabetes-related distress, 84 (23.14%) with moderate diabetes-related distress and 69 (19.01%) with high diabetes-related distress. Stepwise multiple linear regression showed that sleep time was significantly related to the DDS total score and the subscale scores of emotional burden (EB) (β=-0.190, -0.379), respectively. GSES was associated with the DDS total score (β=-0.128) and the EB score (β=-0.153). Oral medication plus insulin was significantly related to regimen-related distress (RD) (β=0.137), physician-related distress (PD) (β=0.152) and interpersonal distress (ID) (β=0.103). Physical activity (β=-0.185) and making meal plan with health care professionals(HCP) (β=-0.169) were associated with RD. The prevalence of diabetes-related distress among patients with type 2 diabetes mellitus was high in China. DDS and EB were associated with poorer sleep time and lower self-efficacy. Interventions to improve sleep are needed. Qualitative and longitudinal studies are required to understand why type 2 diabetic patients are not getting enough sleep.
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50
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Kuo CR, Quan J, Kim S, Tang AHY, Heuerman DP, Murphy EJ. Group visits to encourage insulin initiation: targeting patient barriers. J Clin Nurs 2017; 26:1705-1713. [PMID: 27602873 DOI: 10.1111/jocn.13577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2016] [Indexed: 02/03/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effect of an 'insulin introduction' group visit on insulin initiation and A1C in adults with type 2 diabetes. BACKGROUND The clinical course of type 2 diabetes involves eventual beta-cell failure and the need for insulin therapy. Patient psychological insulin resistance, provider-related delays and system barriers to timely initiation of insulin are common. Group visits are widely accepted by patients and represent a potential strategy for improving insulin initiation. DESIGN A single two-hour group visit in English or Spanish, facilitated by advanced practice nurses, addressed psychological insulin resistance and encouraged mock injections to overcome needle anxiety. METHODS A retrospective review of 273 patients referred from 2008-2012, determined characteristics of group attenders, rates of mock self-injection, rates of insulin initiation and changes in A1C from baseline to 2-6 and 7-12 months postgroup. Change in A1C was compared to patients referred to the group who did not attend ('nonattenders'). RESULTS Of 241 patients eligible for analysis, 87·6% were racial/ethnic minorities with an average A1C of 9·99%. Group attendance rate was 66%; 92% performed a mock injection, 55% subsequently started insulin. By 2-6 months, A1C decreased by 1·37% among group attenders, and by 1·6% in those who did a mock injection and started insulin. Fewer nonattenders started insulin in primary care (40%), experiencing an A1C reduction of 0·56% by 2-6 months. A1C improvements were sustained by 7-12 months among group attenders and nonattenders who started insulin. RELEVANCE TO CLINICAL PRACTICE Nurses can effectively address patient fears and engage patients in reframing insulin therapy within group visits. CONCLUSIONS This one-time nurse-facilitated group visit addressing psychological barriers to insulin in a predominantly minority patient population resulted in increased insulin initiation rates and clinically meaningful A1C reductions.
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Affiliation(s)
- Charlotte R Kuo
- Diabetes Clinic, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Judy Quan
- Division of General Internal Medicine, University of California, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Sarah Kim
- University of California, San Francisco, CA, USA.,Division of Endocrinology, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Audrey Hui-Yu Tang
- Family Health Center, Diabetes Clinic, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Deborah Payne Heuerman
- General Medicine Clinic, Diabetes Clinic, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Elizabeth J Murphy
- University of California, San Francisco, CA, USA.,Division of Endocrinology, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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