1
|
Shaikh S, Vaidya V, Gupta A, Kulkarni R, Joshi A, Kulkarni M, Sharma V, Revankar S. A Review on Affordable Combinations in Type 2 Diabetes Care: Exploring the Cost-Effective Potential of Glipizide + Metformin and Glimepiride + Metformin + Pioglitazone. Cureus 2024; 16:e59850. [PMID: 38854289 PMCID: PMC11157142 DOI: 10.7759/cureus.59850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
Management of type 2 diabetes mellitus (T2DM) largely relies on medication adherence of individuals with diabetes to achieve optimal glycemic control. The economic burden of diabetes could impede adherence, leading to a reduction in treatment efficacy and increased risk of complications. Furthermore, monotherapy in diabetes is losing traction due to its ineffectiveness in achieving early and sustained optimal glycemic control in a significant proportion of the population. Hence, clinicians prefer combination treatment due to their improved efficacy and safety. Considering these factors, the current review highlights the safety and efficacy of the affordable combination therapies, a dual therapy, glipizide + metformin, and a triple-drug combination of glimepiride + metformin + pioglitazone and its applicability in the management of T2DM among individuals with diabetes in India.
Collapse
Affiliation(s)
- Shehla Shaikh
- Endocrinology, Saifee Hospital, Mumbai, IND
- Endocrinology, Sir H. N. Reliance Foundation Hospital, Mumbai, IND
| | - Vishal Vaidya
- Diabetes and Endocrinology, Diacare Clinic, Ahmedabad, IND
| | - Amit Gupta
- Diabetes and Endocrinology, Centre for Diabetes Care, Greater Noida, IND
| | - Raghunath Kulkarni
- Diabetes and Endocrinology, Sevasadhan Superspeciality Centre, Sangli, IND
| | - Ashok Joshi
- Endocrinology and Diabetes, Balaji Hospital, Thane, IND
| | - Medhinee Kulkarni
- Diabetes and Endocrinology, Lifespan Diabetes and Cardiometabolic Clinic, Mumbai, IND
| | - Vidhe Sharma
- Diabetes and Endocrinology, Ruby Hall Clinic Hinjawadi, Pune, IND
| | | |
Collapse
|
2
|
Cherfane M, Boueri M, Issa E, Abdallah R, Hamam A, Sbeity K, Saad A, Abi-Gerges A. Unveiling the unseen toll: exploring the impact of the Lebanese economic crisis on the health-seeking behaviors in a sample of patients with diabetes and hypertension. BMC Public Health 2024; 24:628. [PMID: 38413883 PMCID: PMC10900622 DOI: 10.1186/s12889-024-18116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Against the backdrop of Lebanon's escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis- its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus. METHODS An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26. RESULTS The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4th Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05). CONCLUSION Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.
Collapse
Affiliation(s)
- Michelle Cherfane
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie- Liban), Beirut, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Elio Issa
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Racha Abdallah
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Ali Hamam
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Kassem Sbeity
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Anthony Saad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Aniella Abi-Gerges
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon.
| |
Collapse
|
3
|
Bhatnagar A, Ting DSW, Weng CY. Treatment Options for Diabetic Macular Edema. Int Ophthalmol Clin 2024; 64:57-69. [PMID: 38146881 DOI: 10.1097/iio.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
|
4
|
Heo S, Kang J, Umeakunne E, Lee S, Bertulfo TF, Barbé T, Kim J, Black V, An M, Randolph J. Effects of Meditation Intervention on Self-management in Adult Patients With Type 2 Diabetes: A Systematic Literature Review and Meta-analysis. J Cardiovasc Nurs 2023; 38:581-592. [PMID: 37816085 DOI: 10.1097/jcn.0000000000000973] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetes complications are prevalent and cause adverse effects on the physical, psychological, and economic status of adult patients with type 2 diabetes. Meditation may positively affect self-management and, in turn, reduce diabetes complications. However, the systematic examination of the effects of meditation without additional components on self-management in this population have been rarely examined. PURPOSE The aim of this study was to examine the effects of meditation interventions on self-management (ie, control of glucose, blood pressure, cholesterol, and obesity and self-management) among adult patients with type 2 diabetes in randomized controlled trials. METHODS In this systematic review and meta-analysis, 6 electronic databases were searched using major keywords of meditation , diabetes , and self-management during March 2022. RESULTS Eight studies (9 articles) using mindfulness-based meditation were included. The meta-analysis showed that meditation improved hemoglobin A 1c (effect size = -0.75; 95% confidence interval, -1.30 to -0.21; P = .007) but not fasting blood glucose. Only a few studies examined meditation effects on other types of self-management (eg, blood pressure, body mass index, cholesterol, diet, exercise, foot care, and monitoring of blood glucose), and the effects were inconsistent. In 1 study, meditation improved diabetes self-management. CONCLUSIONS Mindfulness-based meditation reduced hemoglobin A 1c levels in adult patients with type 2 diabetes but did not consistently improve other types of self-management in a few studies examined. This may imply the need for additional intervention components to improve different types of self-management. Further studies are needed to examine the effects of different types of meditations with additional components on different types of self-management.
Collapse
|
5
|
Kutz A, Kim DH, Wexler DJ, Liu J, Schneeweiss S, Glynn RJ, Patorno E. Comparative Cardiovascular Effectiveness and Safety of SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors According to Frailty in Type 2 Diabetes. Diabetes Care 2023; 46:2004-2014. [PMID: 37677118 PMCID: PMC10620535 DOI: 10.2337/dc23-0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate the comparative cardiovascular effectiveness and safety of sodium-glucose cotransporter 2 inhibitors (SGLT-2is), glucagon-like peptide 1 receptor agonists (GLP-1RAs), and dipeptidyl peptidase 4 inhibitors (DPP-4is) in older adults with type 2 diabetes (T2D) across different frailty strata. RESEARCH DESIGN AND METHODS We performed three 1:1 propensity score-matched cohort studies, each stratified by three frailty strata, using data from Medicare beneficiaries (2013-2019) with T2D who initiated SGLT-2is, GLP-1RAs, or DPP-4is. In time-to-event analyses, we assessed the primary cardiovascular effectiveness composite outcome of acute myocardial infarction, ischemic stroke, hospitalization for heart failure, and all-cause mortality. The primary safety outcome was a composite of severe adverse events that have been linked to SGLT-2i or GLP-1RA use. RESULTS Compared with DPP-4is, the overall hazard ratio (HR) for the primary effectiveness outcome associated with SGLT-2is (n = 120,202 matched pairs) was 0.72 (95% CI 0.69-0.75), corresponding to an incidence rate difference (IRD) of -13.35 (95% CI -15.06 to -11.64). IRD ranged from -6.74 (95% CI -8.61 to -4.87) in nonfrail to -27.24 (95% CI -41.64 to -12.84) in frail people (P for interaction < 0.01). Consistent benefits were observed for GLP-1RAs compared with DPP-4is (n = 113,864), with an overall HR of 0.74 (95% CI 0.71-0.77) and an IRD of -15.49 (95% CI -17.46 to -13.52). IRD in the lowest frailty stratum was -7.02 (95% CI -9.23 to -4.81) and -25.88 (95% CI -38.30 to -13.46) in the highest (P for interaction < 0.01). Results for SGLT-2is versus GLP-1RAs (n = 89,865) were comparable. Severe adverse events were not more frequent with SGLT-2is or GLP-1RAs than DPP-4is. CONCLUSIONS SGLT-2is and GLP-1RAs safely improved cardiovascular outcomes and all-cause mortality, with the largest absolute benefits among frail people.
Collapse
Affiliation(s)
- Alexander Kutz
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Deborah J. Wexler
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Robert J. Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
6
|
Lomanto Silva R, Swabe GM, Sattui SE, Magnani JW. Association of patient copayment and medication adherence in systemic lupus erythematosus. Lupus Sci Med 2023; 10:e000966. [PMID: 37852670 PMCID: PMC10603349 DOI: 10.1136/lupus-2023-000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate the association of medication copayment and treatment adherence to hydroxychloroquine and immunosuppressants for SLE. METHODS We conducted a retrospective analysis of health claims data using Optum's de-identified Clinformatics Data Mart Database. Individuals with SLE continuously enrolled for 180 days from 1 July 2010 to 31 December 2019 were included. Adherence was defined as the proportion of days covered ≥80%. Copayment for a 30-day supply of medication was dichotomised as high (≥$10) or low (<$10). We examined the association between copayment and odds of adherence in multivariable-adjusted logistic regression models, including age, sex, race or ethnicity, comorbidities, educational attainment and household income. RESULTS We identified 12 510 individuals (age 54.2±15.5 years; 88.2% female sex), of whom 9510 (76%) were prescribed hydroxychloroquine and 1880 (15%) prescribed hydroxychloroquine and an additional immunosuppressant (azathioprine, methotrexate or mycophenolate mofetil). Median (IQR) 30-day copayments were $8 (4-10) for hydroxychloroquine, $7 (2-10) for azathioprine, $8 (3-11) for methotrexate and $10 (5-20) for mycophenolate mofetil. High copayments were associated with OR of adherence of 0.61 (95% CI 0.55 to 0.68) for hydroxychloroquine, OR 0.44 (95% CI 0.30 to 0.66) for azathioprine and OR 0.69 (95% CI 0.49 to 0.96) for mycophenolate mofetil. For methotrexate, the association was not significant. CONCLUSION In a large, administrative health claims database, we identified that high copayments were associated with reduced adherence to commonly prescribed medications for SLE. Incorporating awareness of the burden of copayments and its consequences into healthcare is essential to promote optimal medication adherence.
Collapse
Affiliation(s)
- Raisa Lomanto Silva
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gretchen M Swabe
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sebastian Eduardo Sattui
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
7
|
Celano CM, Massey C, Long J, Kim S, Velasquez O, Healy BC, Wexler DJ, Madva EN, Huffman JC. An Adaptive, Algorithm-based Text Message Intervention to Promote Health Behavior Adherence in Type 2 Diabetes: Treatment Development and Proof-of-Concept Trial. J Diabetes Sci Technol 2023; 17:364-373. [PMID: 34911398 PMCID: PMC10012372 DOI: 10.1177/19322968211065067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most individuals with type 2 diabetes (T2D) struggle to adhere to one or more health behaviors. Text message interventions (TMIs) have the potential to improve adherence but have had mixed effects on diet and activity in T2D. We developed an eight-week, adaptive, algorithm-driven TMI to promote physical activity, diet, self-care, and well-being. Then, in a single-arm trial, we assessed its feasibility, acceptability, and preliminary efficacy in 15 individuals with T2D and suboptimal adherence. METHODS Participants received daily text messages and were asked to rate the utility of each message (0=not helpful, 10=very helpful). These ratings were used by an algorithm to select subsequent messages based on each participant's prior ratings. We assessed intervention feasibility by rates of message transmission/response and acceptability through ratings of message utility and burden. Finally, we examined pre-post changes in diabetes self-care, diet, physical activity, and psychological outcomes and calculated effect sizes (Cohen's d). RESULTS All text messages were delivered, and participants provided ratings for 79% of messages, above our a priori thresholds for feasibility. Participants rated the individual messages and overall TMI as subjectively useful (utility: 8.1 [SD=2.1] and 7.8 [SD=2.0], respectively) and not burdensome (burden: 0.8 [SD=1.8]). The intervention led to significant, medium- to large-sized improvements in self-care (d=0.77), diet (d=0.99), and activity (d=0.61) but minimal change in psychological outcomes. CONCLUSIONS The TMI was feasible and well-accepted, and it led to promising improvements in adherence-related outcomes. These findings should be confirmed in a larger randomized controlled trial.
Collapse
Affiliation(s)
- Christopher M. Celano
- Department of Psychiatry, Harvard
Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
- Christopher M. Celano, MD, Department of
Psychiatry, Massachusetts General Hospital, 125 Nashua Street, Suite 324,
Boston, MA 02114, USA.
| | - Christina Massey
- Department of Psychiatry, Harvard
Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
| | | | - Sonia Kim
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
- Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Olivia Velasquez
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
- Department of Psychiatry, McLean
Hospital, Belmont, MA, USA
| | - Brian C. Healy
- Department of Neurology, Brigham and
Women’s Hospital, Boston, MA, USA
- Departments of Neurology and
Biostatistics, Harvard Medical School, Boston, MA, USA
| | - Deborah J. Wexler
- Department of Medicine (Endocrinology),
Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Massachusetts General
Hospital Diabetes Center, Boston, MA, USA
| | - Elizabeth N. Madva
- Department of Psychiatry, Harvard
Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Harvard
Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
| |
Collapse
|
8
|
Wu J, Shen J, Tao Z, Song Z, Chen ZL. Self-Efficacy as Moderator and Mediator Between Medication Beliefs and Adherence in Elderly Patients with Type 2 Diabetes. Patient Prefer Adherence 2023; 17:217-226. [PMID: 36713972 PMCID: PMC9875572 DOI: 10.2147/ppa.s382362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/07/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes. METHODS This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence. RESULTS Self-efficacy for medication use acted as a moderator (B=-0.063, t=-2.215, p=0.028) and partial mediator (CItotal effect=4.5-16.63, p=0.001; CIindirect=1.524-5.323, p=0.014; CIdirect=2.151-11.817, p=0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence. CONCLUSION Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.
Collapse
Affiliation(s)
- Jianbo Wu
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jie Shen
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Jie Shen; Zhi-Long Chen, Email ;
| | - Zhujun Tao
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zhongjuan Song
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zhi-Long Chen
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| |
Collapse
|
9
|
Fusco N, Sils B, Graff JS, Kistler K, Ruiz K. Cost-sharing and adherence, clinical outcomes, health care utilization, and costs: A systematic literature review. J Manag Care Spec Pharm 2023; 29:4-16. [PMID: 35389285 PMCID: PMC10394195 DOI: 10.18553/jmcp.2022.21270] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND: US health plans are adopting benefit designs that shift greater financial burden to patients through higher deductibles, additional copay tiers, and coinsurance. Prior systematic reviews found that higher cost was associated with reductions in both appropriate and inappropriate medications. However, these reviews were conducted prior to contemporary benefit design and medication utilization. OBJECTIVE: To assess the relationship and factors associated with cost-sharing and (1) medication adherence, (2) clinical outcomes, (3) health care resource utilization (HRU), and (4) costs. METHODS: A systematic review of literature published between January 2010 and August 2020 was conducted to identify the relationship between cost-sharing and medication adherence, clinical outcomes, HRU, and health care costs. Data were extracted using a standardized template and were synthesized by key questions of interest. RESULTS: From 1,995 records screened, 79 articles were included. Most studies, 71 of 79 (90%), reported the relationship between cost-sharing and treatment adherence, persistence and/or discontinuation; 16 (20%) reported data on cost-sharing and HRU or medication initiation, 11 (14%) on costsharing and health care costs, and 6 (8%) on cost-sharing and clinical outcomes. The majority of publications found that, regardless of disease area, increased cost-sharing was associated with worse adherence, persistence, or discontinuation. The aggregate data suggested the greater the magnitude of cost-sharing, the worse the adherence. Among studies examining clinical outcomes, cost-sharing was associated with worse outcomes in 1 study and the remaining 3 found no significant differences. Regarding HRU, higher-cost-sharing trended toward decreased outpatient and increased inpatient utilization. The available evidence suggested higher cost-sharing has an overall neutral to negative impact on total costs. Studies evaluating elimination of copays found either decreased or no impact in total costs. CONCLUSIONS: The published literature shows consistent impacts of higher cost sharing on initiation and continuation of medications, and the greater the cost-sharing, the worse the medication adherence. The evidence is limited regarding the impact of cost-sharing on clinical outcomes, HRU, and costs. Limited evidence suggests increased cost-sharing is associated with more inpatient care and less outpatient care; however, a neutral to no difference was suggested for other outcomes. Although increased costsharing is intended to decrease total costs, studies evaluating reducing or eliminating cost-sharing found that total costs did not rise. Today's growing cost-containment environment should carefully consider the broader impact cost-sharing has on treatment adherence, clinical outcomes, resource use, and total costs. It may be that cost-sharing is a blunt, rather than precise, tool to curb health care costs, affecting both necessary and unnecessary health care use. DISCLOSURES: This study and the development of this article were funded by the National Pharmaceutical Council. Mr Sils is an employee of the National Pharmaceutical Council. Dr Graff is a former employee of the National Pharmaceutical Council. Drs Fusco and Kistler and Ms Ruiz are employees of Xcenda. Xcenda received funding to conduct the literature review.
Collapse
Affiliation(s)
| | - Brian Sils
- National Pharmaceutical Council, Washington, DC
| | | | | | | |
Collapse
|
10
|
Wu Y, Xiong T, Tan X, Chen L. Frailty and risk of microvascular complications in patients with type 2 diabetes: a population-based cohort study. BMC Med 2022; 20:473. [PMID: 36482467 PMCID: PMC9733051 DOI: 10.1186/s12916-022-02675-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cross-sectional studies found that frailty was associated with prevalent diabetic microvascular complications (DMC). Longitudinal evidence in this regard is inconclusive and insufficient. We aimed to prospectively evaluate the association of pre-frailty and frailty with DMC in patients with type 2 diabetes (T2D). METHODS We included 18,062 adults (mean age 59.4 ± 7.2 years, 37.4% female) with T2D at baseline in the UK Biobank. Frailty was defined using the frailty phenotype according to five components (weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength). DMC, defined as diabetic nephropathy, diabetic neuropathy, or diabetic retinopathy, was identified using hospital inpatient records and death registries. Cox proportional hazard regression models considering competing risks were used to evaluate the associations of frailty phenotype with overall DMC events and subtypes. RESULTS Among all participants, 6101 (33.8%) were classified as non-frail, 10,073 (55.8%) were classified as pre-frail, and 1888 (10.4%) were classified as frail. During a median follow-up of 12.0 years, 3678 DMC cases were documented, including 2213 diabetic nephropathy, 1520 diabetic retinopathy, and 673 diabetic neuropathy events. In the multivariable-adjusted model, compared with participants with non-frail, both pre-frailty and frailty were significantly associated with increased risk of overall DMC (HR 1.10, 95% CI: [1.02, 1.18] for pre-frailty and HR 1.52 [95% CI: 1.36, 1.69] for frailty). Similar results were observed in the subtypes of DMC. For each one-point increase in frailty phenotype score, the risk of overall DMC, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy event increased by 13%, 16%, 10%, and 20%, respectively. CONCLUSIONS Both pre-frailty and frailty were associated with an increased risk of DMC in patients with T2D. These findings have important implications for integrating early assessment and surveillance of frailty in diabetes and may favor the identification of at-risk patients.
Collapse
Affiliation(s)
- Yuanjue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China.,Department of Clinical Nutrition, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Xiong
- Department of Nutrition and Food Hygiene, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Xiao Tan
- Department of Medical Sciences, Uppsala University Hospital, Entrance 40, 75185, Uppsala, Sweden. .,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China. .,Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
11
|
Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, Bernal-Ceballos F, Torre-Saldaña VDL, Galindez-Fuentes A, Castillo-Martínez L. Adherence to antidiabetic treatment in primary health care in individuals with type 2 diabetes. A survey including socio-demographic, patient related and clinical factors. Prim Care Diabetes 2022; 16:780-785. [PMID: 36127243 DOI: 10.1016/j.pcd.2022.09.002] [Citation(s) in RCA: 3] [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: 03/23/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adherence to medications is a critical element in diabetes management. OBJECTIVE To investigate patient-related factors associated with adherence to antidiabetic treatment in patients with type 2 diabetes in primary health-care units. METHODS A cross-sectional study among patients receiving diabetes care in 18 primary care units in Mexico City was conducted. Data were collected from medical records and medical interviews. Adherence to antidiabetic therapy and patient-related factors associated with adherence were evaluated through a self-administered questionnaire. Socio-demographic, clinical, behavioral (self-care activities including a healthy diet, exercise or physical activity, self-monitoring of blood glucose testing, and foot care), and patients-adherence-related factors (health-care provider-patient communication; daily and social activities, and support network; alternative treatment beliefs; comorbidity, diabetes symptoms, and treatment; side effects and treatment access) were compared between the adherent and non-adherent group. RESULTS Of 319 outpatients, 48.3% were adherent to their antidiabetic therapy. In the adjusted analysis, patient-related factors associated to adherence were exercise and physical activity self-care behavior (OR=1.26; 95%CI 1.09-1.46), treatment interference with daily activities (OR=0.27; 95%CI 0.14-0.52), not satisfied with resolution of questions by the physician (OR=0.42; 95%CI 0.19-0.94), independently to increased cardiovascular risk and insulin treatment. CONCLUSION A low proportion of outpatients with T2D with regular primary care were adherent to diabetes treatment and this was associated with patient-related factors like answering patients' treatment-related questions by the physician. This information may be useful to identify patients at risk for low adherence, and to guide the design of quality-of-care strategies, like diabetes education programs to address suboptimal adherence in patients, and health-care professional communication skills training, particularly in primary care health systems.
Collapse
Affiliation(s)
- Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | - Teresa Cuatecontzi-Xochitiotzi
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | | | - Viridiana de la Torre-Saldaña
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | - Ana Galindez-Fuentes
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico.
| | - Lilia Castillo-Martínez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México; Facultad de Medicina, Universidad Nacional Autónoma de México, México.
| |
Collapse
|
12
|
Cho H, Jeoung S, Kang C, Jang S. Comparative analysis of cardio-cerebrovascular complications in immigrants and native-born Koreans with diabetes: Risk factors and perspectives. PLoS One 2022; 17:e0263046. [PMID: 35486634 PMCID: PMC9053795 DOI: 10.1371/journal.pone.0263046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Given the rapidly increasing number of immigrants, it is crucial to address health care issues involving immigrants to facilitate their safe and secure settlement. Especially for common chronic diseases, such as diabetes, immigrants face more complex obstacles to manage their chronic conditions than do native-born residents. Therefore, we aimed to assess differences in the incidence and associated risk factors of cardio-cerebrovascular (CCV) complications of immigrants compared with native-born Koreans with diabetes. Methods Immigrants and native-born Koreans who had new diagnosis of diabetes and simultaneously received anti-diabetic prescriptions in 2012 were defined by using Korean National Health Insurance Claim Database(KNHICD). CCV complications were assessed at a 3-year follow-up from the index date. We assessed differences in the CCV complications and risk factors using multiple cox regression models. Results In total, 4,008 patients (668 of immigrants and 3,340 of native-born Koreans) who had newly diagnosed diabetes and simultaneously received anti-diabetic prescriptions in 2012 were selected. Immigrants with diabetes were at a 1.39 times higher risk of having CCV complications than native-born Koreans with diabetes (95% CI: 1.021–1.881). Patients who had a usual sources of care (USC) presented a significantly reduced risk of cardio-cerebrovascular complication (HR: 0.452; 95% CI: 0.342–0.598) in both immigrants and native Koreans. In subgroup analysis in immigrants, patients having USC showed decreased risk of CCV incidence (HR: 0.35, 95% CI: 0.175–0.703), whereas >60 years old and Charlson comorbidity index (CCI) score >1 presented increased risk of CCV complications. Conclusion Immigrants with diabetes have a higher risk of CCV complications than native-born Koreans with diabetes. However, having a USC significantly decreased the risk of CCV complications. Therefore, the utilization of USC will benefit to reduce diabetic complications in immigrants as well as reduction of overall health care cost burden, it would be necessary to implement USC in diabetes care at the initial disease stage.
Collapse
Affiliation(s)
- Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Sohyun Jeoung
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America
- Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Cinoo Kang
- Department of Biostatics and Epidemiology Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- * E-mail:
| |
Collapse
|
13
|
Does the SDMQ-9 Predict Changes in HbA1c Levels? An Ecuadorian Cohort. Medicina (B Aires) 2022; 58:medicina58030380. [PMID: 35334556 PMCID: PMC8950991 DOI: 10.3390/medicina58030380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Diabetes mellitus affects 422 million people around the world, positioning it as a major health problem. According to the WHO(World Health Organization), 90% corresponds to type 2. The shared-decision making (SDM) is a method used to facilitate patient control, medication, maintenance, and assessment of health status according to their priorities and preferences. With the application of SDM in patients with diabetes, it is expected there will be an increase in treatment adherence and a reduction in HbA1c levels. The aim of this study is to determine the predictors of the change in HbA1c. Material and Methods: A sample of 76 participants attending as endocrinology outpatients was obtained. Data collected within the sample included: sex, age, educational level, body mass index, and the level of SDM using the SDMQ-9. In addition, HbA1c levels were measured twice: at baseline and three months after the first measurement. Results: The linear regression indicates that the level of SDM is a significant predictor of the change in HbA1c, specifically in men. However, the direction of the relationship was a somewhat opposite trend than we expected. Higher levels of SDM imply an increase in HbA1c rather than a reduction. Conclusions: Contrary to the literature, our results shows that elevated levels of perceived SDM may be associated with worse diabetic control. However, more investigation is needed as these results are not generalizable, due to the specific population used and the sample size. Furthermore, to better understand the effect of SDM on the change in HbA1c in patients with poorly controlled diabetes.
Collapse
|
14
|
Evans M, Engberg S, Faurby M, Fernandes JDDR, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review. Diabetes Obes Metab 2022; 24:377-390. [PMID: 34779107 PMCID: PMC9299643 DOI: 10.1111/dom.14603] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
We designed a systematic literature review to identify available evidence on adherence to and persistence with antidiabetic medication in people with type 2 diabetes (T2D). Electronic screening and congress searches identified real-world noninterventional studies (published between 2010 and October 2020) reporting estimates of adherence to and persistence with antidiabetic medication in adults with T2D, and associations with glycaemic control, microvascular and/or macrovascular complications, hospitalizations and healthcare costs. Ninety-two relevant studies were identified, the majority of which were retrospective and reported US data. The proportions of patients considered adherent (median [range] 51.2% [9.4%-84.3%]) or persistent (median [range] 47.7% [16.9%-94.0%]) varied widely across studies. Multiple studies reported an association between greater adherence/persistence and greater reductions in glycated haemoglobin levels. Better adherence/persistence was associated with fewer microvascular and/or macrovascular outcomes, although there was little consistency across studies in terms of which outcomes were improved. More adherent and more persistent patients were typically less likely to be hospitalized or to have emergency department visits/admissions and spent fewer days in hospital annually than less adherent/persistent patients. Greater adherence and persistence were generally associated with lower hospitalization costs, higher pharmacy costs and lower or budget-neutral total healthcare costs compared with lower adherence/persistence. In conclusion, better adherence and persistence in people with T2D is associated with lower rates of microvascular and/or macrovascular outcomes and inpatient hospitalization, and lower or budget-neutral total healthcare expenditure. Education and treatment strategies to address suboptimal adherence and persistence are needed to improve clinical and economic outcomes.
Collapse
Affiliation(s)
- Marc Evans
- Department of Diabetes and EndocrinologyUniversity Hospital LlandoughPenarthUK
| | | | | | | | | | - William Polonsky
- Behavioral Diabetes InstituteSan DiegoCaliforniaUSA
- Department of MedicineUniversity of CaliforniaSan DiegoCaliforniaUSA
| |
Collapse
|
15
|
Ye M, Vena JE, Johnson JA, Shen-Tu G, Eurich DT. Anti-Hyperglycemic Medication Adherence and Health Services Utilization in People with Diabetes: A Longitudinal Study of Alberta's Tomorrow Project. Patient Prefer Adherence 2022; 16:1457-1467. [PMID: 35722195 PMCID: PMC9199902 DOI: 10.2147/ppa.s362539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the long-term (>2 years) relationship between the time-varying drug adherence and healthcare utilization for patients with diabetes. OBJECTIVE To characterize the relationship between time-varying anti-hyperglycemic medication adherence and healthcare utilization in patients with diabetes, using data from Alberta's Tomorrow Project, a population-based cohort study in Alberta, Canada. METHODS Incident cases of diabetes with at least 24 months of follow-up were included in the study. Anti-hyperglycemic drug adherence was measured by proportion of days covered (PDC) in the past 12 months for each year after diagnosis. The rate of healthcare utilization was assessed for the subsequent 12 months, 36 months and 60 months. A time-varying, negative binomial generalized estimating equation model was used to examine the association between medication adherence and healthcare utilization. RESULTS Among 2155 incident cases of diabetes, average age at diagnosis was 59.6±9.3, 51.0% were female and average duration of follow-up was 7.3±3.7 (range, 2.0-16.2) years. The proportion of patients taking anti-hyperglycemic medications was 47.6% during the first year of diagnosis, which increased to 77.3% by the end of follow-up. Compared to adherent patients (PDC≥0.8), non-adherent patients (PDC<0.8) had substantially higher rate of all-cause hospitalization [incident rate ratio, IRR=1.48 (1.22-1.79), ED visits [1.30 (1.15-1.47)] and GP visits [1.17 (1.08-1.27)] in the subsequent 12 months. However, these associations became weaker with longer follow-up [eg, IRR=1.18 (0.98-1.39) and 1.05 (0.94-1.18) for all-cause hospitalization in the subsequent 36 and 60 months, respectively]. CONCLUSION Poor adherence among diabetic patients was associated with substantially higher rate of healthcare utilization in the short term (eg, 12 months); however, this association weakened over a longer period (eg, 36-60 months).
Collapse
Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta’s Tomorrow Project, CancerCare Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Shen-Tu
- Alberta’s Tomorrow Project, CancerCare Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Correspondence: Dean T Eurich, School of Public Health, University of Alberta, Canada, Email
| |
Collapse
|
16
|
Bekele BB, Bogale B, Negash S, Tesfaye M, Getachew D, Weldekidan F, Yosef T. Public health interventions on prescription redemptions and secondary medication adherence among type 2 diabetes patients: systematic review and meta-analysis of randomized controlled trials. J Diabetes Metab Disord 2021; 20:1933-1956. [PMID: 34900834 DOI: 10.1007/s40200-021-00878-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
Background Despite the inadequate filling of prescriptions among chronic care patients has been a problem, little is known about the intervention effect on it. Objective The aim of this systematic review and meta-analysis (SRMA) was to investigate the effectiveness of various public health interventions on primary and secondary medication adherence among T2DM patients. Methods Searching was done from the major databases; Cochrane Library, Medline/PubMed, EBSCOhost, and SCOPUS. A hand search was made to find grey works of literature. Articles focused on interventions to enhance primary and secondary medication among type 2 diabetes mellitus patients were included. After screening and checking eligibility, the methodological quality was assessed. Secondary medication adherence was synthesized descriptively due to measurement and definition variations across studies. Finally, a meta-analysis was made using the fixed effects model for primary medication adherence. Results 3992 studies were screened for both primary and secondary medication adherences. Among these, 24 studies were included in the analysis for primary (5) and secondary (19) medication adherence. Pooled relative medication redemption difference was RD = 8% (95% CI: 6-11%) among the intervention groups. Age, intervention, provider setting, and IDF region were determinant factors of primary medication adherence. About two-thirds of the studies revealed that interventions were effective in improving secondary medication adherence. Conclusion Both primary and secondary medications were enhanced by a variety of public health interventions for patients worldwide. However, there is a scarcity of studies on primary medication adherence globally, and in resource-limited settings for the type of adherences. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-021-00878-0.
Collapse
Affiliation(s)
- Bayu Begashaw Bekele
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.,Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia.,Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Biruk Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Samuel Negash
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Melkamsew Tesfaye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Dawit Getachew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Fekede Weldekidan
- Department of Public Health, College of Health Science, Ethiopian Defence University, Addis Ababa, Ethiopia
| | - Tewodros Yosef
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| |
Collapse
|
17
|
Denicolò S, Perco P, Thöni S, Mayer G. Non-adherence to antidiabetic and cardiovascular drugs in type 2 diabetes mellitus and its association with renal and cardiovascular outcomes: A narrative review. J Diabetes Complications 2021; 35:107931. [PMID: 33965338 DOI: 10.1016/j.jdiacomp.2021.107931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 01/05/2023]
Abstract
Cardiovascular and renal complications are a major burden for individuals with type 2 diabetes mellitus (T2DM). Besides lifestyle interventions, current guidelines recommend combination drug therapy to prevent or delay the incidence and progression of comorbidities. However, non-adherence to pharmacotherapy is common in chronic conditions such as T2DM and a barrier to successful disease management. Numerous studies have associated medication non-adherence with worse outcome as well as higher health care costs. This narrative review provides (i) an overview on adherence measures used within and outside research settings, (ii) an estimate on the prevalence of non-adherence to antidiabetic and cardiovascular drugs in T2DM, and (iii) specifically focuses on the association of non-adherence to these drugs with renal and cardiovascular outcomes.
Collapse
Affiliation(s)
- Sara Denicolò
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria.
| | - Paul Perco
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Stefanie Thöni
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
18
|
Andanalusia M, Nita Y, Athiyah U. The effect of pillbox use and education by pharmacist toward medication adherence in diabetes mellitus patients in a Primary Health Care Center in Mataram. J Basic Clin Physiol Pharmacol 2021; 32:577-582. [PMID: 34214347 DOI: 10.1515/jbcpp-2020-0500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nonadherence to a long-term therapy, including diabetes mellitus, is one of the global problems that need to be overcome. This study aims to determine the effect of pillbox use and education by pharmacists toward medication adherence in patients with diabetes mellitus in a Primary Health Care Center in Mataram. METHODS This research was an experimental research design with pretest-posttest with control group design. The study was conducted from October to December 2019 at Tanjung Karang Primary Health Care Center, Mataram. Measurement of adherence was done using the Adherence to Refill and Medication Scale questionnaire. The higher the score, the more nonadherence the patients. Patients were divided into three groups, which were the control group, educational intervention group, and pillbox and educational intervention group. Each group consisted of 11 patients. RESULTS Patients' medication adherence increased from 19.54 (SD 4.37) to 15.18 (SD 2.64) in the education and pillbox intervention group (p=0.004). Whereas, in the education and control group, the adherence did not provide a significant change (p>0.05). Based on the difference in adherence scores, it was known that what contributed to changes in compliance was refilling medicine and intentional nonadherence in taking medicine subscale (p=0.024). CONCLUSIONS Providing education and pillbox done by pharmacists at the Primary Health Care Center can increase adherence to the therapy of diabetes mellitus patients. Pharmacists at the Primary Health Care Center can use the intervention model to improve the level of adherence of patients with chronic illness.
Collapse
Affiliation(s)
| | - Yunita Nita
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Umi Athiyah
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
19
|
Norrbacka K, Sicras-Mainar A, Lebrec J, Artime E, Díaz S, Tofé-Povedano S, Hernández I, Romera I. Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes Mellitus: Data from a Real-World Study in Spain. Diabetes Ther 2021; 12:1535-1551. [PMID: 33860927 PMCID: PMC8099971 DOI: 10.1007/s13300-021-01039-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/23/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION This study aimed to describe utilization patterns, persistence, resource utilization and costs in patients with type 2 diabetes mellitus initiating treatment with glucagon-like peptide 1 receptor agonists in routine clinical practice in Spain. METHODS This retrospective study of medical records in the Big-Pac database identified adults starting treatment with once-weekly (QW) dulaglutide, exenatide-QW or once-daily liraglutide between 1 November 2015 and 30 June 2017. Patients were followed for up to 18 months from treatment initiation. Data on clinical characteristics of patients, treatment patterns, average daily dose and costs were obtained for the three cohorts. Persistence over the 18-month period was evaluated using Kaplan-Meier curves. All analyses were descriptive. RESULTS A total of 1402 patients were included in this study (dulaglutide [n = 492], exenatide-QW [n = 438] or liraglutide [n = 472]); 52.8% were men, and the mean (SD) age was 62 (11) years, glycated haemoglobin (HbA1c) was 8.1% (1.2) and body mass index was 35.5 (3.2) kg/m2 at treatment initiation. Persistence at 18 months was 59.1% (95% confidence interval [CI] 54.8-63.4) for dulaglutide, 45.7% (95% CI 41.0-50.4) for exenatide-QW and 46.6% (95% CI 42.1-51.1) for liraglutide. The average (SD) dose was 1.2 (0.4) mg/week for dulaglutide, 1.9 (0.3) mg/week for exenatide-QW and 1.1 (0.3) mg/day for liraglutide. The average reduction in HbA1c levels at 1 year was - 0.68% for patients who initiated dulaglutide, - 0.54% for patients who initiated exenatide-QW and - 0.50% for patients who initiated liraglutide. The mean (SD) total annual health care costs were €4072 (1946) for dulaglutide, €4418 (2382) for exenatide-QW and €4382 (2389) for liraglutide. CONCLUSION Results suggest that patients who started treatment with dulaglutide had higher persistence over 18 months, presented lower HbA1c levels at 12 months and incurred lower annual total healthcare costs than patients who initiated exenatide-QW or liraglutide.
Collapse
Affiliation(s)
| | | | | | - Esther Artime
- Lilly Spain, Avenida de la Industria 30, Alcobendas, Madrid, Spain
| | - Silvia Díaz
- Lilly Spain, Avenida de la Industria 30, Alcobendas, Madrid, Spain
| | | | | | - Irene Romera
- Lilly Spain, Avenida de la Industria 30, Alcobendas, Madrid, Spain
| |
Collapse
|
20
|
Oh SH, Ku H, Park KS. Prevalence and socioeconomic burden of diabetes mellitus in South Korean adults: a population-based study using administrative data. BMC Public Health 2021; 21:548. [PMID: 33743612 PMCID: PMC7980668 DOI: 10.1186/s12889-021-10450-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/16/2021] [Indexed: 01/22/2023] Open
Abstract
Background Diabetes leads to severe complications and imposes health and financial burdens on the society. However, currently existing domestic public health studies of diabetes in South Korea mainly focus on prevalence, and data on the nationwide burden of diabetes in South Korea are lacking. The study aimed to estimate the prevalence and economic burden of diabetes imposed on the South Korean society. Methods A prevalence-based cost-of-illness study was conducted using the Korean national claims database. Adult diabetic patients were defined as those aged ≥20 years with claim records containing diagnostic codes for diabetes (E10-E14) during at least two outpatient visits or one hospitalization. Direct costs included medical costs for the diagnosis and treatment of diabetes and transportation costs. Indirect costs included productivity loss costs due to morbidity and premature death and caregivers’ costs. Subgroup analyses were conducted according to the type of diabetes, age (< 65 vs. ≥65), diabetes medication, experience of hospitalization, and presence of diabetic complications or related comorbidities. Results A total of 4,472,133 patients were diagnosed with diabetes in Korea in 2017. The average annual prevalence of diabetes was estimated at 10.7%. The diabetes-related economic burden was USD 18,293 million, with an average per capita cost of USD 4090 in 2019. Medical costs accounted for the biggest portion of the total cost (69.5%), followed by productivity loss costs (17.9%), caregivers’ costs (10.2%), and transportation costs (2.4%). According to subgroup analyses, type 2 diabetes, presence of diabetic complications or related comorbidities, diabetes medication, and hospitalization represented the biggest portion of the economic burden for diabetes. As the number of complications increased from one to three or more, the per capita cost increased from USD 3991 to USD 11,965. In inpatient settings, the per capita cost was ~ 10.8 times higher than that of outpatient settings. Conclusions South Korea has a slightly high prevalence and economic burden of diabetes. These findings highlight the need for effective strategies to manage diabetic patients and suggest that policy makers allocate more health care resources to diabetes. This is the first study on this topic, conducted using a nationally representative claims database in South Korea. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10450-3.
Collapse
Affiliation(s)
- Sung-Hee Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daehak-ro 80, Buk-gu, Daegu, 41566, Republic of Korea
| | - Hyemin Ku
- NDnex, Saebitgongwon-ro 67, Gwangmyeong-si, Gyeonggi-do, 14348, Republic of Korea
| | - Kang Seo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Deajeon Eulji Medical Center, Eulji University, Dusanseo-ro 95, Seo-gu, Daejeon, 35233, Republic of Korea.
| |
Collapse
|
21
|
Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis. LANCET HEALTHY LONGEVITY 2020; 1:e106-e116. [PMID: 33313578 PMCID: PMC7721684 DOI: 10.1016/s2666-7568(20)30014-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Frailty, a state of increased vulnerability to adverse health outcomes, is important in diabetes management. We aimed to quantify the prevalence of frailty in people with diabetes, and to summarise the association between frailty and generic outcomes (eg, mortality) and diabetes-specific outcomes (eg, hypoglycaemia). Methods In this systematic review and study-level meta-analysis, we searched MEDLINE, Embase, and Web of Science for observational studies published between Jan 1, 2001 (the year of the original publication of the Fried frailty phenotype), to Nov 26, 2019. We included studies that assessed and quantified frailty in adults with diabetes, aged 18 years and older; and excluded conference abstracts, grey literature, and studies not published in English. Data from eligible studies were extracted using a piloted data extraction form. Our primary outcome was the prevalence of frailty in people with diabetes. Secondary outcomes were incidence of frailty and generic and diabetes-specific outcomes. Data were assessed by random-effects meta-analysis where possible and by narrative synthesis where populations were too heterogeneous to allow meta-analysis. This study is registered with PROSPERO, CRD42020163109. Findings Of the 3038 studies we identified, 118 studies using 20 different frailty measures were eligible for inclusion (n=1 375 373). The most commonly used measures of frailty were the frailty phenotype (69 [58%] of 118 studies), frailty (16 [14%]), and FRAIL scale (10 [8%]). Studies were heterogenous in setting (88 studies were community-based, 18 were outpatient-based, ten were inpatient-based, and two were based in residential care facilities), demographics, and inclusion criteria; therefore, we could not do a meta-analysis for the primary outcome and instead summarised prevalence data using a narrative synthesis. Median community frailty prevalence using frailty phenotype was 13% (IQR 9-21). Frailty was consistently associated with mortality in 13 (93%) of 14 studies assessing this outcome (pooled hazard ratio 1·51 [95% CI 1·30-1·76]), with hospital admission in seven (100%) of seven, and with disability in five (100%) of five studies. Frailty was associated with hypoglycaemia events in one study (<1%), microvascular and macrovascular complications in nine (82%) of 11 studies assessing complications, lower quality of life in three (100%) of three studies assessing quality of life, and cognitive impairment in three (100%) of three studies assessing cognitive impairment. 13 (11%) of 118 studies assessed glycated haemoglobin finding no consistent relationship with frailty. Interpretation The identification and assessment of frailty should become a routine aspect of diabetes care. The relationship between frailty and glycaemia, and the effect of frailty in specific groups (eg, middle-aged [aged <65 years] people and people in low-income and lower-middle-income countries) needs to be better understood to enable diabetes guidelines to be tailored to individuals with frailty. Funding Medical Research Council.
Collapse
|
22
|
Böhm AK, Jensen ML, Sørensen MR, Stargardt T. Real-World Evidence of User Engagement With Mobile Health for Diabetes Management: Longitudinal Observational Study. JMIR Mhealth Uhealth 2020; 8:e22212. [PMID: 32975198 PMCID: PMC7679206 DOI: 10.2196/22212] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Patient support apps have risen in popularity and provide novel opportunities for self-management of diabetes. Such apps offer patients to play an active role in monitoring their condition, thereby increasing their own treatment responsibility. Although many health apps require active user engagement to be effective, there is little evidence exploring engagement with mobile health (mHealth). Objective This study aims to analyze the extent to which users engage with mHealth for diabetes and identify patient characteristics that are associated with engagement. Methods The analysis is based on real-world data obtained by Novo Nordisk’s Cornerstones4Care Powered by Glooko diabetes support app. User engagement was assessed as the number of active days and using measures expressing the persistence, longevity, and regularity of interaction within the first 180 days of use. Beta regressions were estimated to assess the associations between user characteristics and engagement outcomes for each module of the app. Results A total of 9051 individuals initiated use after registration and could be observed for 180 days. Among these, 55.39% (5013/9051) used the app for one specific purpose. The average user activity ratio varied from 0.05 (medication and food) to 0.55 (continuous glucose monitoring), depending on the module of the app. Average user engagement was lower if modules required manual data entries, although the initial uptake was higher for these modules. Regression analyses further revealed that although more women used the app (2075/3649, 56.86%), they engaged significantly less with it. Older people and users who were recently diagnosed tended to use the app more actively. Conclusions Strategies to increase or sustain the use of apps and availability of health data may target the mode of data collection and content design and should take into account privacy concerns of the users at the same time. Users’ engagement was determined by various user characteristics, indicating that particular patient groups should be targeted or assisted when integrating apps into the self-management of their disease.
Collapse
Affiliation(s)
- Anna-Katharina Böhm
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | | | | | - Tom Stargardt
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| |
Collapse
|
23
|
Wu J, Tao Z, Song Z, Zhang Y, Sun H, Wang J, Shen J. Validation and psychometric properties of the self-efficacy for Appropriate Medication Use Scale in elderly Chinese patients. Int J Clin Pharm 2020; 43:586-594. [PMID: 33044679 DOI: 10.1007/s11096-020-01167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
Background Self-efficacy for appropriate medication use is an important construct when evaluating the optimal use of medications. However, no instrument that assesses this construct in elderly Chinese patients has been shown to have valid psychometric properties. Objective To investigate the psychometric properties of the Chinese version of the self-efficacy for Appropriate Medication Use Scale in elderly patients with type 2 diabetes. Setting Geriatric patients were recruited from the endocrinology department of a tertiary hospital in Shanghai, China. Method Self-efficacy was assessed by the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in subjects who were at least 65 years old. Exploratory and confirmatory factor analyses were used to develop a psychometrically sound model of the scale. Main outcome measures Internal and test-retest reliability; convergent and discriminant validity of the scale; model fit indices of the factor model. Results The two-factor model of the self-efficacy for Appropriate Medication Use Scale was not suitable for elderly patients with respect to both item factor loadings and model fit indices. Conceptually overlapping scale items emerged when the scale was used in these patients. The final model developed appeared to achieve an ideal model fit and presented acceptable convergent and discriminant validity. Conclusions This study presented a Chinese version of the self-efficacy for Appropriate Medication Use Scale with psychometrically sound properties that will enable pharmacists, nurses and physicians to prospectively evaluate the impact of medication self-efficacy on a variety of health outcomes in elderly patients with type 2 diabetes.
Collapse
Affiliation(s)
- Jianbo Wu
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Zhujun Tao
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Zhongjuan Song
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Yunxuan Zhang
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China
| | - Hua Sun
- Department of Endocrinology, Huadong Hospital, Fudan University, Shanghai, China
| | - Jiaofeng Wang
- Department of Geriatrics, Huadong Hospital, Fudan University, Shanghai, China
| | - Jie Shen
- Department of Pharmacy, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, 200040, China.
| |
Collapse
|
24
|
Sayeed KA, Qayyum A, Jamshed F, Gill U, Usama SM, Asghar K, Tahir A. Impact of Diabetes-related Self-management on Glycemic Control in Type II Diabetes Mellitus. Cureus 2020; 12:e7845. [PMID: 32483496 PMCID: PMC7253072 DOI: 10.7759/cureus.7845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Self-care activities are behaviors adopted in order to enhance one's health. Self-care behaviors and activities are studied in their role to enhance glycemic control, reduce diabetes-related complications, and contribute to enhancing overall quality of life in people with diabetes. The aim of this observational study was to evaluate the impact of diabetes self-care activities and behaviors on glycemic control in people with diabetes. METHODS This observational, cross-sectional study was conducted at the outpatient department of a secondary care hospital in Karachi, Pakistan from 1st September 2019 till 30th November 2019. Patients with known type II diabetes of age ≥45 years visiting the hospital for routine follow-up visit were included. Diabetes Self-Management Questionnaire (DSMQ) in Urdu version was used to assess their status of self-management. For data entry and statistical analysis SPSS for Windows version 21.0 was used. RESULTS There were 174 (54.9%) males and 152 (47.9%) were of age 45-60 years. Glycemic control was good (HbA1c <7%) in 125 (39.4%) and poor (HbA1c ≥7%) in 192 (60.6%) patients. Patients with good glycemic control scored significantly better on DSMQ overall (5.53 ± 0.35 vs. 4.32 ± 0.61; p<0.0001), and on three sub-scales - dietary control (4.24 ± 1.04 vs. 3.63 ± 0.98; p<0.0001), physical activity (4.16 ± 0.56 vs. 3.47 ± 1.17; p<0.0001), and healthcare use (4.22 ± 0.78 vs. 3.98 ± 0.65; p=0.003). Conclusions: The self-care activities that impact glycemic control in patients with diabetes include dietary control, physical activity, and healthcare use.
Collapse
Affiliation(s)
- Khalid A Sayeed
- Internal Medicine, Liaquat College of Medicine and Dentistry, Darul Sehat Hospital, Karachi, PAK
| | - Azwa Qayyum
- Pharmacology, Amna Inayat Medical College, Sheikhupura, PAK
| | - Fatima Jamshed
- Pediatrics, Jinnah Sindh Medical University, Karachi, PAK
| | - Usman Gill
- Emergency Medicine, Hayyat Memorial Teaching Hospital, Lahore, PAK.,Emergency Medicine, Akhtar Saeed Medical College, Lahore, PAK
| | | | - Kanza Asghar
- Surgery, Hayyat Memorial Teaching Hospital, Lahore, PAK
| | - Amber Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| |
Collapse
|
25
|
|
26
|
Shao SC, Lin YH, Chang KC, Chan YY, Hung MJ, Kao Yang YH, Lai ECC. Sodium glucose co-transporter 2 inhibitors and cardiovascular event protections: how applicable are clinical trials and observational studies to real-world patients? BMJ Open Diabetes Res Care 2019; 7:7/1/e000742. [PMID: 32043472 PMCID: PMC6954814 DOI: 10.1136/bmjdrc-2019-000742] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/08/2019] [Accepted: 11/22/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study evaluated the characteristics of new users of sodium glucose co-transporter 2 inhibitors (SGLT2i) in clinical practice to assess the applicability of the findings from clinical trials (Empagliflozin, Cardiovascular Outcomes and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58 trial, Canagliflozin Cardiovascular Assessment Study (CANVAS) program and the Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes (VERTIS-CV) trial) and multinational observational studies (CVD-REAL Nordic study and CVD-REAL 2 study). RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using the largest electronic medical records database from seven hospitals in Taiwan. We included adult patients with type 2 diabetes initiating canagliflozin, dapagliflozin and empagliflozin between 1 January 2018 and 31 August 2019. We compared the patient characteristics with SGLT2i to examine the data representativeness of clinical trials and to evaluate channeling uses between canagliflozin, dapagliflozin and empagliflozin. RESULTS We identified a cohort of 11 650 patients newly initiating SGLT2i, 49.9% of whom received empagliflozin. However, only 18.7%, 19.2%, 50.4% and 57.3% of real-world SGLT2i new users were included in the EMPA-REG OUTCOME trial, VERTIS-CV trial, DECLARE-TIMI 58 trial and CANVAS program, respectively. Reasons for exclusion were largely reduced cardiovascular disease risks in real-world patients, namely 72.8%, 73.6% and 34.2% for EMPA-REG OUTCOME trial, VERTIS-CV trial and DECLARE-TIMI 58 trial and CANVAS program, respectively. However, hemoglobin A1c out of range accounted for the most frequent reason (25.0%) for exclusion of real-world patients from the CANVAS program. We found channeling uses in different SGLT2i, for example, more patients receiving empagliflozin (15.3%) and canagliflozin (19.6%) had poorer renal functions (eg, estimated glomerular filtration rate <60 mL/min/1.73 m2), compared with dapagliflozin (9.3%). CONCLUSIONS The findings provide clear evidence that results from current studies may be less applicable to real-world patients. Further studies are required to support the concept of real-world cardiovascular event protection through SGLT2i.
Collapse
Affiliation(s)
- Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Han Lin
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kai-Cheng Chang
- Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yuk-Ying Chan
- Department of Pharmaceutical Materials Management, Chang Gung Medical Foundation, Taoyuan, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yea-Huei Kao Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| |
Collapse
|
27
|
Bailey SC, Wallia A, Wright S, Wismer GA, Infanzon AC, Curtis LM, Brokenshire SA, Chung AE, Reuland DS, Hahr AJ, Hornbuckle K, Lockwood K, Hall L, Wolf MS. Electronic Health Record-Based Strategy to Promote Medication Adherence Among Patients With Diabetes: Longitudinal Observational Study. J Med Internet Res 2019; 21:e13499. [PMID: 31638592 PMCID: PMC6829279 DOI: 10.2196/13499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/29/2019] [Accepted: 06/15/2019] [Indexed: 01/17/2023] Open
Abstract
Background Poor medication adherence is common; however, few mechanisms exist in clinical practice to monitor how patients take medications in outpatient settings. Objective This study aimed to pilot test the Electronic Medication Complete Communication (EMC2) strategy, a low-cost, sustainable approach that uses functionalities within the electronic health record to promote outpatient medication adherence and safety. Methods The EMC2 strategy was implemented in 2 academic practices for 14 higher-risk diabetes medications. The strategy included: (1) clinical decision support alerts to prompt provider counseling on medication risks, (2) low-literacy medication summaries for patients, (3) a portal-based questionnaire to monitor outpatient medication use, and (4) clinical outreach for identified concerns. We recruited adult patients with diabetes who were prescribed a higher-risk diabetes medication. Participants completed baseline and 2-week interviews to assess receipt of, and satisfaction with, intervention components. Results A total of 100 patients were enrolled; 90 completed the 2-week interview. Patients were racially diverse, 30.0% (30/100) had a high school education or less, and 40.0% (40/100) had limited literacy skills. About a quarter (28/100) did not have a portal account; socioeconomic disparities were noted in account ownership by income and education. Among patients with a portal account, 58% (42/72) completed the questionnaire; 21 of the 42 patients reported concerns warranting clinical follow-up. Of these, 17 were contacted by the clinic or had their issue resolved within 24 hours. Most patients (33/38, 89%) who completed the portal questionnaire and follow-up interview reported high levels of satisfaction (score of 8 or greater on a scale of 1-10). Conclusions Findings suggest that the EMC2 strategy can be reliably implemented and delivered to patients, with high levels of satisfaction. Disparities in portal use may restrict intervention reach. Although the EMC2 strategy can be implemented with minimal impact on clinic workflow, future trials are needed to evaluate its effectiveness to promote adherence and safety.
Collapse
Affiliation(s)
- Stacy Cooper Bailey
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amisha Wallia
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah Wright
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Guisselle A Wismer
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alexandra C Infanzon
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Laura M Curtis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Samantha A Brokenshire
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Arlene E Chung
- Division of General Internal Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States.,Program on Health & Clinical Informatics, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Daniel S Reuland
- Division of General Internal Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Allison J Hahr
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | | | - Lori Hall
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
28
|
Afroz A, Zhang W, Wei Loh AJ, Jie Lee DX, Billah B. Macro- and micro-vascular complications and their determinants among people with type 2 diabetes in Bangladesh. Diabetes Metab Syndr 2019; 13:2939-2946. [PMID: 31425960 DOI: 10.1016/j.dsx.2019.07.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/29/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To identify the prevalence of micro- and macro-vascular complications and their associated factors for type 2 diabetes mellitus in Bangladesh. METHODS This retrospective and cross-sectional study was conducted in six diabetes hospitals, covered urban and rural population. From April to September in 2017, a total of 1253 type 2 diabetes patients aged ≥18 years were recruited. Participants answered a pre-tested electronic questionnaire, and their medical records were reviewed for documented diabetes complications. RESULTS Mean age was 55.1 (±12.6) years. Among macrovascular complications, the prevalence of coronary artery disease was found to be 30.5%, 10.1% for stroke and 12.0% for diabetic foot. Among microvascular complications, nephropathy was prevalent among 34.2%, retinopathy among 25.1% and neuropathy among 5.8% of patients. Risk factors found to be associated with one or more of the complications were female gender, higher age, lower education level, an urban area of residence, higher household income, smoking, physical inactivity, hypertension, poor glycaemic control, poor adherence to treatment, longer duration of diabetes, and insulin use. CONCLUSION Diabetes complications are highly prevalent among type 2 diabetes population in Bangladesh. Prevention strategies should focus on increasing physical activity, weight loss, smoking cessation, and more strict control of hypertension and glycaemic level.
Collapse
Affiliation(s)
- Afsana Afroz
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wen Zhang
- Monash University, Melbourne, Australia
| | | | | | - Baki Billah
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| |
Collapse
|
29
|
Pereira MDG, Ferreira G, Machado JC, Pedras S. Beliefs about medicines as mediators in medication adherence in type 2 diabetes. Int J Nurs Pract 2019; 25:e12768. [PMID: 31328394 DOI: 10.1111/ijn.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 02/01/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
AIMS This study analysed whether beliefs about medicines mediated the relationship between illness representations and medication adherence. BACKGROUND Adherence to medication is required in diabetes treatment, contributing to decreased blood glycaemic levels. The knowledge and perception of patients about diabetes as well as the beliefs about medicines are considered to be key factors for medication adherence. DESIGN The study used a cross-sectional design that included 387 patients recently diagnosed with type 2 diabetes. METHODS Participants were assessed, between 2010 and 2013, and answered the Medication Adherence Scale, the Beliefs about Medicines Questionnaire, and the Brief Illness Perception Questionnaire. RESULTS The results of the path analysis showed that beliefs about medicines had a mediating role on self-report medication adherence with the exception of beliefs about specific concerns with medicines. Therefore, both general beliefs and specific needs about medicines mediated the relationship between diabetes consequences and self-report medication adherence as well as between treatment control and self-report medication adherence. Needs about medicines mediated the relationship between personal control and self-report medication adherence. CONCLUSION Health professionals should target beliefs about medicines besides illness representations regarding medication adherence. The current study may help optimize adherence to medication in early-diagnosed type 2 diabetes patients.
Collapse
Affiliation(s)
| | - Gabriela Ferreira
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - José C Machado
- Institute of Social Sciences, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Susana Pedras
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| |
Collapse
|
30
|
Guerci B, Chanan N, Kaur S, Jasso-Mosqueda JG, Lew E. Lack of Treatment Persistence and Treatment Nonadherence as Barriers to Glycaemic Control in Patients with Type 2 Diabetes. Diabetes Ther 2019; 10:437-449. [PMID: 30850934 PMCID: PMC6437240 DOI: 10.1007/s13300-019-0590-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 01/01/2023] Open
Abstract
Treatment persistence (continuing to take medication for the prescribed period) and treatment adherence (complying with the prescription in terms of drug schedules and dosage) are both important when treating chronic diseases such as type 2 diabetes (T2D). They can be indicators of patient satisfaction with treatment. In T2D, the achievement of optimal outcomes requires both persistence with and adherence to prescribed therapy. Poor persistence with and adherence to T2D medication can have profound consequences for the patient, including non-achievement of glycaemic goals and an increased risk of long-term complications and mortality. Therefore, poor treatment persistence and adherence may also have economic consequences, including increased healthcare resource utilization and healthcare costs. Treatment persistence and adherence are affected by several factors, including the mode of administration, administration frequency/regimen complexity, and patient expectations. The aims of this review are as follows: to provide an overview of persistence with and adherence to different antidiabetes therapies for patients with T2D in the real-world setting; examine factors contributing to poor treatment persistence and adherence; and assess available data on the impact of poor treatment persistence and/or adherence on clinical and economic outcomes. Numerous potential targets for improving treatment persistence and/or adherence are identified, including developing less complex treatment regimens with lower pill burdens or less frequent injections, improving the convenience of drug-delivery systems, such as the use of insulin pen devices rather than the conventional vial and syringe, and developing therapies with an improved safety profile to alleviate patient fears of adverse effects, such as weight gain and risk of hypoglycaemia.Funding: Sanofi.
Collapse
Affiliation(s)
- Bruno Guerci
- Brabois Hospital and CIC INSERM ILCV, University Hospital of Nancy, Vandoeuvre Lès Nancy, France.
| | | | | | | | | |
Collapse
|
31
|
The impact of a medication record sharing program among diabetes patients under a single-payer system: The role of inquiry rate. Int J Med Inform 2018; 116:18-23. [PMID: 29887231 DOI: 10.1016/j.ijmedinf.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/14/2018] [Accepted: 05/18/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Taiwan's single health insurer introduced a medication record exchange platform, the PharmaCloud program, in 2013. This study aimed to evaluate the effects of the medication record inquiry rate on medication duplication among patients with diabetes. MATERIALS AND METHODS A retrospective pre-post design with a comparison group was conducted using nationwide health insurance claim data of diabetic patients from 2013 to 2014. Patients whose medication record inquiry rate fell within the upper 25th percentile were classified as the high-inquiry group, and the others as the low-inquiry group. The dependent variables were the likelihood of receiving duplicated medication and the overlapped medication days of the study subjects. Generalized estimation equations with difference-in-difference analysis were calculated to examine the net effect of the PharmaCloud inquiry rate for a matched sub-sample. RESULTS In total, 106,508 patients with diabetes were randomly selected. From 2013 to 2014, the medication duplication rate was reduced 7.76 percentile (54.12%-46.36%) for the high-inquiry group and 9.58 percentile (63.72%-54.14%) for the low-inquiry group; the average medication overlap periods were shortened 4.36 days (8.49-4.13) and 6.29 days (11.28-4.99), respectively. The regression models showed patients in the high-inquiry group were more likely to receive duplicated medication (OR = 1.11, 95% C.I. = 1.07-1.16) and with longer overlapped days (7.53%, P = 0.0081) after the program. CONCLUSION The medication record sharing program has reduced medication duplication among diabetes patients. However, higher inquiry rate did not lead to greater reduction in medication duplication; the overall effect might be due to enhanced internal control via prescription alert system in hospitals rather physician's review of the records.
Collapse
|
32
|
Sung SF, Lai ECC, Wu DP, Hsieh CY. Previously undiagnosed risk factors and medication nonadherence are prevalent in young adults with first-ever stroke. Pharmacoepidemiol Drug Saf 2017; 26:1458-1464. [PMID: 28691203 DOI: 10.1002/pds.4250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/13/2017] [Accepted: 06/05/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The incidence of stroke and prevalence of traditional vascular risk factors (VRFs) in young adults (age < 55 y) are both increasing. Young patients tend to be unaware of their VRFs and to have lower medication adherence. We examined how age affects the prevalence of previously undiagnosed VRFs and the extent of medication nonadherence among stroke patients. METHODS Using Taiwan's National Health Insurance Research Database, we identified consecutive adult patients with first-ever stroke between 2000 and 2013. Diagnosis of hypertension, diabetes, and hyperlipidemia was ascertained using validated methods. We investigated (1) the proportion of patients who had undiagnosed VRFs within 3 years before stroke and (2) the proportion of nonadherence to medications among patients who had a previously diagnosed VRF. RESULTS Among stroke patients with hypertension (n = 9722), diabetes (n = 4751), and hyperlipidemia (n = 4486), 24.9%, 20.8%, and 55.0%, respectively, had not been diagnosed before stroke, whereas 56.0%, 66.7%, and 32.5%, respectively, had been diagnosed at least 1 year before stroke. The proportions of medication nonadherence were 71.5%, 64.3%, and 88.4% in patients with previously diagnosed hypertension, diabetes, and hyperlipidemia, respectively. In multivariate analysis, younger age was independently associated with undiagnosed hypertension before stroke as well as medication nonadherence in patients with previously diagnosed hypertension or diabetes. CONCLUSIONS Previously undiagnosed hypertension and nonadherence to treatment of hypertension and diabetes were more prevalent in young adult patients with first-ever stroke in Taiwan. Interventions targeting young people to promote early detection and adequate control of VRFs should be encouraged.
Collapse
Affiliation(s)
- Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Darren Philbert Wu
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| |
Collapse
|
33
|
Qin L, Chen S, Flood E, Shaunik A, Romero B, de la Cruz M, Alvarez C, Grandy S. Glucagon-like Peptide-1 Receptor Agonist Treatment Attributes Important to Injection-Naïve Patients with Type 2 Diabetes Mellitus: A Multinational Preference Study. Diabetes Ther 2017; 8:321-334. [PMID: 28155131 PMCID: PMC5380493 DOI: 10.1007/s13300-017-0230-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Glucagon-like peptide-1 receptor agonists (GLP-1RAs) differ in efficacy, side effects, dosing frequency, and device-related attributes. This study assessed the relative importance of treatment-related attributes in influencing preferences for GLP-1RAs among injection-naïve patients with type 2 diabetes mellitus (T2DM). METHODS Injection-naïve T2DM patients from five countries completed a Web-based discrete choice experiment (DCE) survey. Patients chose between hypothetical treatment profiles reflecting important and differentiating attributes of GLP-1RAs. Eight attributes were included: efficacy, side effects, device size, needle size, titration, preparation, evidence of long-term efficacy/safety, and dosing frequency. Odds ratios (ORs) and 95% confidence intervals were calculated using a conditional logit model to indicate the likelihood of choosing a treatment with a given attribute level versus a reference attribute level. The influence of individual attributes when considering full treatment profiles was examined using exenatide once weekly (QW) and liraglutide once daily (QD) as case examples. RESULTS A total of 1482 patients with T2DM completed the DCE survey. Side effects, efficacy, and dosing frequency were the three most important attributes influencing preferences; needle size, device size, and required preparation were least important. Total sample analysis indicated that a profile of GLP-1RA approximating exenatide QW (single pen) was preferred over a profile approximating liraglutide QD (OR 3.36; p < 0.001), when efficacy was assumed to be equal. CONCLUSION The most influential drivers of treatment preferences for a hypothetical GLP-RA profile were side effects, efficacy, and dosing frequency among injection-naïve T2DM patients. Preference elicitation can promote patient-centered care and inform new generations of T2DM treatments, which can lead to improved adherence and health outcomes.
Collapse
Affiliation(s)
- Lei Qin
- AstraZeneca, Gaithersburg, MD, USA.
| | | | - Emuella Flood
- ICON plc, Clinical Outcomes Assessments, Gaithersburg, MD, USA
| | | | - Beverly Romero
- ICON plc, Clinical Outcomes Assessments, Gaithersburg, MD, USA
| | | | - Cynthia Alvarez
- ICON plc, Medical Affairs Statistical Analysis, San Diego, CA, USA
| | | |
Collapse
|
34
|
Qin L, Chen S, Flood E, Shaunik A, Romero B, de la Cruz M, Alvarez C, Grandy S. Glucagon-Like Peptide-1 Receptor Agonist Treatment Attributes Important to Injection-Experienced Patients with Type 2 Diabetes Mellitus: A Preference Study in Germany and the United Kingdom. Diabetes Ther 2017; 8:335-353. [PMID: 28236271 PMCID: PMC5380499 DOI: 10.1007/s13300-017-0237-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION This study assessed the relative importance of treatment-related attributes in influencing patient preferences for glucagon-like peptide-1 receptor agonists (GLP-1RAs) among injection-experienced type 2 diabetes mellitus (T2DM) patients in Germany and the United Kingdom. METHODS T2DM patients experienced with injecting once-weekly (QW) exenatide or once-daily (QD) liraglutide completed an online discrete-choice experiment (DCE) survey. Patients chose between hypothetical blinded treatment profiles reflecting attributes of GLP-1RAs. The DCE survey included eight attributes: efficacy, side effects, device size, needle size, titration, injection preparation, long-term efficacy/safety, and dosing frequency. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a conditional logit model indicating the likelihood of choosing a treatment with a given attribute level versus a reference attribute level. RESULTS 510 GLP-1RA injection-experienced patients completed the survey; 45.3% respondents were being treated with exenatide QW and 54.7% respondents were being treated with liraglutide QD. In terms of GLP-1RA attributes, patients indicated a preference for a treatment with greater efficacy (i.e., a 1.5-point improvement in HbA1c) (OR 2.58; 95% CI 2.37, 2.80; p < 0.001), fewer side effects (OR 2.67; 95% CI 2.52, 2.82; p < 0.001), once-weekly rather than once-daily administration (OR 2.26; 95% CI 2.13, 2.39; p < 0.001), and the preparation required for a multi-use pen (OR 1.71; 95% CI 1.55, 1.88; p < 0.001). Needle size, device size, and titration were not significant drivers of patient preference. CONCLUSIONS Among GLP-1RA injection-experienced patients, key drivers of treatment preference for a hypothetical GLP-RA profile were side effects, efficacy, dosing frequency, and required preparation. Understanding patient preferences is important for optimizing treatment decision-making and improving treatment adherence. FUNDING AstraZeneca.
Collapse
Affiliation(s)
- Lei Qin
- AstraZeneca, Gaithersburg, MD, USA.
| | | | - Emuella Flood
- ICON plc, Clinical Outcomes Assessment, Gaithersburg, MD, USA
| | | | - Beverly Romero
- ICON plc, Clinical Outcomes Assessment, Gaithersburg, MD, USA
| | | | - Cynthia Alvarez
- ICON plc, Medical Affairs Statistical Analysis, San Diego, CA, USA
| | | |
Collapse
|
35
|
Yashkin AP, Sloan F. Adherence to Guidelines for Screening and Medication Use: Mortality and Onset of Major Macrovascular Complications in Elderly Persons With Diabetes Mellitus. J Aging Health 2016; 30:503-520. [PMID: 28553792 DOI: 10.1177/0898264316684270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study is to investigate relationships between adherence to recommended screening and medication use and severe macrovascular complications and all-cause mortality among persons aged above 68 years with diabetes mellitus (DM). METHOD Data came from a 5% Medicare claims sample of beneficiaries initially diagnosed with DM during 2006-2008; follow-up was up to 7 years. RESULTS Adherence to screening guidelines led to reduced mortality-hazard ratio (HR) = 0.57, 95% confidence interval [CI] = [0.56, 0.58]; congestive heart failure [CHF], HR = 0.89, CI = [0.87, 0.91]; acute myocardial infarction [AMI], HR = 0.90, CI = [0.85, 0.95]; and stroke/transient ischemic attack [Stroke/TIA], HR = 0.92, CI = [0.87, 0.97]-during follow-up. Recommended medication use led to lower mortality: HR = 0.72, CI = [0.70, 0.73]; CHF, HR = 0.67, CI = [0.66, 0.69]; AMI, HR = 0.68, CI = [0.65, 0.71]; and Stroke/TIA, HR = 0.79, CI = [0.76, 0.83]. DISCUSSION Elderly persons newly diagnosed with diabetes who adhered to recommended care experienced reduced risk of mortality and severe macrovascular complications.
Collapse
|