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Al-Dwairi RA, Aleshawi A, Abu-zreig L, Al-Shorman W, Al Beiruti S, Alshami AO, Allouh MZ. The Economic Burden of Diabetic Retinopathy in Jordan: Cost Analysis and Associated Factors. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:161-171. [PMID: 38505256 PMCID: PMC10950089 DOI: 10.2147/ceor.s454185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Objective Diabetic retinopathy (DR) is the leading cause of visual loss worldwide in patients with diabetes mellitus (DM). The aims of our study are to describe the costs associated with (DR) and to evaluate its economic impact in Jordan. Methods Retrospectively, we included all patients with DM and classified them according to the severity of DR. Data regarding medical history, ophthalmic history, stage of DR, presence of DME, and the ophthalmic procedures and operations were collected. The total DR-related cost was measured as a direct medical cost for the outpatient and inpatient services. Results Two hundred and twenty-nine patients were included in the study. Only 49.7% of the patients presented without DR, and 21% presented with diabetic macular edema (DME) unilaterally or bilaterally. The DR-related cost was significantly associated with insulin-based regimens, longer duration of DM, higher HbA1c levels, worse stage of DR at presentation, the presence of DME at presentation, the presence of glaucoma, and increased mean number of intravitreal injections, laser sessions, and surgical operations. Multivariate analysis should the presenting stage of DR, presence of DME, and the presence of DME be the independent factors affecting the DR-related cost. Conclusion This study is the first study to be conducted in Jordan and encourages us to establish a screening program for DR for earlier detection and treatment. DM control and treatment compliance will reduce the heavy costs of the already exhausted healthcare and financial system.
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Affiliation(s)
- Rami A Al-Dwairi
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Abdelwahab Aleshawi
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Laith Abu-zreig
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Wafa Al-Shorman
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Seren Al Beiruti
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Ali Omar Alshami
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Mohammed Z Allouh
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
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2
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Abboud M, Nacouzi C, Chahine Z, Atallah A, Hleyhel M. Dietary Knowledge and Eating Habits among Patients with Type 2 Diabetes in Lebanon. Glob Health Epidemiol Genom 2024; 2024:3623555. [PMID: 38356468 PMCID: PMC10864039 DOI: 10.1155/2024/3623555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
Little is known about the dietary knowledge (DK) and eating habits (EHs) of patients with type 2 diabetes (T2D) in Lebanon. Therefore, the aim of this study was to assess the DK and EH of the population with T2D and determine their associated factors. A cross-sectional survey enrolling 351 patients with T2D was carried out, using the snowball sampling technique. The survey used the UK Diabetes and Diet Questionnaire and the Dietary Knowledge questionnaire to assess participants' EH including the frequency of consumption of certain foods and their knowledge of food groups and food choices. While a higher DK index indicated better knowledge, a higher EH index indicated less healthy EH. Independent sample T-test and Mann-Whitney test were used for dichotomous variables, and ANOVA and Kruskal-Wallis tests were used for polytomous variables. Correlation analysis tested the association between two continuous variables. Two multiple linear regression models were used to identify factors associated with DK and EH. Overall, 67% of participants had good or adequate DK, and around 25% and 75% of them had healthy and less healthy EH, respectively. Better knowledge was significantly related to occupation, BMI, presence of comorbidities, and HbA1c testing during the last 3 months. Higher family income, physical activity, family history of diabetes, receiving help in medication administration from family or friends, and higher DK level were factors associated with healthier EH. Nutrition education and awareness campaigns aimed at patients and their families are needed to empower patients with adequate DK and skills to facilitate the adoption of healthy EH.
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Affiliation(s)
- Myriam Abboud
- Department of Health, College of Natural and Health Sciences, Zayed University, Dubai 144534, UAE
| | - Cyrille Nacouzi
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | - Zeina Chahine
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | - Angelica Atallah
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | - Mira Hleyhel
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon
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Al-Ma'aitah OH, Demant D, Jakimowicz S, Perry L. Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis. J Adv Nurs 2022; 78:2257-2276. [PMID: 35621355 PMCID: PMC9541219 DOI: 10.1111/jan.15255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 02/05/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Aims To examine the patient‐related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries. Design A systematic review and meta‐analysis. Data Sources A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer‐reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified. Review Methods Extracted data were analysed using Review Manager 5.4. Results The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self‐management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006). Conclusion These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.
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Affiliation(s)
- Odai Hamed Al-Ma'aitah
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samantha Jakimowicz
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
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Cuevas Fernández FJ, Pérez de Armas A, Cerdeña Rodríguez E, Hernández Andreu M, Iglesias Girón MJ, García Marrero MR, Cabrera de León A, García Bello MÁ. [Uncontrolled type 2 diabetes in primary care health center: Modifiable factors and target population]. Aten Primaria 2021; 53:102066. [PMID: 34034078 PMCID: PMC8144534 DOI: 10.1016/j.aprim.2021.102066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/08/2020] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
Objetivos Detectar factores modificables y poblaciones diana asociados al mal control de la diabetes tipo 2 (DM2) en atención primaria. Diseño Estudio descriptivo transversal restrospectivo. Emplazamiento Centro de salud de Barranco Grande, Tenerife. Participantes selección aleatoria de pacientes con DM2 atendidos por 12 médicos de familia y 12 enfermeras. Mediciones principales Además del control de la DM2, se obtuvieron datos sociodemográficos, clínicos, hábitos de vida y seguimiento de medidas preventivas y terapéuticas. Tras análisis bivariado, se ajustó un modelo multivariado multinivel tomando el cupo médico-enfermero como efecto mixto de segundo nivel y el resto como variables de primer nivel. Resultados Fueron reclutados 587 pacientes (46,5% mujeres), tratados con 1,9±1,1 fármacos antidiabéticos, con 4,1% de incumplimiento terapéutico, y padeciendo un 13,8% inercia terapéutica. El 23,7% mostraba mal control de DM2, siendo peor (p<0,05) en sexo masculino, edad <65 años, evolución DM2 ≥5 años, dieta inadecuada, síndrome metabólico, ratio triglicéridos/HDL≥3, complicaciones de la DM2, índice Charlson<5, visitas a enfermera<3/año, sin ECG en el último año y mayor número de fármacos prescritos para DM2. El cupo médico-enfermero se asoció al mal control con un coeficiente intraclase de 0,01. Conclusiones Los hombres menores de 65 años con larga evolución de DM2 son población diana para intensificar intervenciones. El incumplimiento terapéutico, dieta inadecuada, falta de adhesión a los protocolos de seguimiento y ratio triglicéridos/HDL>3 son factores sobre los que intervenir. La asociación del cupo médico-enfermero con el control de la DM2 es débil, probablemente por adecuado seguimiento de los programas preventivos.
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Affiliation(s)
- Francisco J Cuevas Fernández
- Atención Primaria, Centro de Salud de Barranco Grande, Servicio Canario de la Salud, Santa Cruz de Tenerife, España; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España
| | - Adrián Pérez de Armas
- Atención Primaria, Centro de Salud de Barranco Grande, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - Elena Cerdeña Rodríguez
- Atención Primaria, Centro de Salud de Barranco Grande, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - Miguel Hernández Andreu
- Atención Primaria, Centro de Salud de Barranco Grande, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - María José Iglesias Girón
- Atención Primaria, Centro de Salud de Candelaria, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - María Rosario García Marrero
- Atención Primaria, Centro de Salud de Barranco Grande, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - Antonio Cabrera de León
- Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España; Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
| | - Miguel Ángel García Bello
- Unidad de Investigación de Atención Primaria, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
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5
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Moura AM, Antunes M, Martins SO, Raposo JF. A statistical model to identify determinants of glycemic control in patients with type 2 diabetes with different pharmacotherapeutic profiles. PLoS One 2020; 15:e0235376. [PMID: 32629460 PMCID: PMC7338077 DOI: 10.1371/journal.pone.0235376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/14/2020] [Indexed: 12/25/2022] Open
Abstract
AIM To develop a statistical model to identify determinants of glycemic control. MATERIALS AND METHODS A database was extracted from patients' records with at least one glycated hemoglobin (HbA1c) analysis and with antidiabetic therapy established and stabilized. A logistic regression model was designed to identify the statistical significance of factors associated with glycemic control. RESULTS Higher probability of success (HbA1c ≤8% [64 mmol/mol]) was found for those who were older in age, those who were men, and those with higher education levels. Increased values for the following variables were associated with the poorest glycemic control: number of years of T2DM since diagnosis, number of antidiabetic medicines, body mass index, low-density lipoprotein cholesterol, triglycerides, systolic blood pressure and number of diabetes consultations in the last twelve months. The following pharmacotherapeutic treatments were associated with glycemic control (in decreasing order of the results): oral antidiabetic drugs; oral antidiabetic drugs and insulin; insulin. Patients using metformin and a dipeptidyl peptidase-4 inhibitors have a higher probability of success than do patients using metformin and a sulfonylurea, and patients using insulin and metformin have a higher probability of success than do patients using insulin alone. CONCLUSIONS Sociodemographic, clinical and therapeutic parameters can strongly affect glycemic control. Studies based on real-life patient data provide important information on the development of more effective glycemic control.
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Affiliation(s)
- Artur Mendes Moura
- Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
- * E-mail:
| | - Marília Antunes
- Department of Statistics and Operational Research, Faculty of Sciences, University of Lisbon, Lisboa, Portugal
- Centre of Statistics and its Applications of University of Lisbon (CEAUL), Lisboa, Portugal
| | - Sofia Oliveira Martins
- Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - João Filipe Raposo
- Department of Public Health, Nova Medical School, New University of Lisbon, Lisboa, Portugal
- Portuguese Diabetes Association (APDP), Lisboa, Portugal
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6
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Sukkarieh-Haraty O, Egede LE, Abi Kharma J, Bassil M. Diabetes fatalism and its emotional distress subscale are independent predictors of glycemic control among Lebanese patients with type 2 diabetes. ETHNICITY & HEALTH 2019; 24:767-778. [PMID: 28870122 DOI: 10.1080/13557858.2017.1373075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 08/17/2017] [Indexed: 06/07/2023]
Abstract
Background: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is 'a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness'. Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM. Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalism and to identify which of the 3 subscales (emotional distress, spiritual coping and perceived self-efficacy) were associated with HbA1c. Results: The mean age of the participants was 58.24(SD = 13.48) and the majority were females (53.76%), while 32.73% of the sample had diabetes for more than 10 years. Fully adjusted multiple linear regression models showed that higher scores on diabetes fatalism and the emotional distress subscale (P = 0.018) were significantly associated with higher HbA1c values. In addition, having diabetes for more than 11 years (P = 0.05) and a higher number of diabetes complications (P < 0.001) were associated with higher HbA1c levels. However, advanced age (P = 0.055), female gender (P = 0.003), and diabetes education (P = 0.011) were significantly associated with lower HbA1c levels. Conclusion: This is the first study in the Arab region that identifies diabetes fatalism as an independent predictor of glycemic control among Lebanese. Future studies should further investigate this construct to guide interventions that can address it for better diabetes outcomes.
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Affiliation(s)
- Ola Sukkarieh-Haraty
- a Alice Ramez Chagoury School of Nursing, Lebanese American University , Byblos , Lebanon
| | - Leonard E Egede
- b Center for Health Disparities Research, Medical University of South Carolina , Charleston , SC , USA
- c Division of General Internal Medicine, Froedtert & The Medical College of Wisconsin , Milwaukee , WI , USA
| | - Joelle Abi Kharma
- d Department of Natural Sciences, School of Arts and Sciences, Lebanese American University , Beirut , Lebanon
| | - Maya Bassil
- d Department of Natural Sciences, School of Arts and Sciences, Lebanese American University , Beirut , Lebanon
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7
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Mallah Z, Hammoud Y, Awada S, Rachidi S, Zein S, Ballout H, Al-Hajje A. Validation of diabetes medication adherence scale in the Lebanese population. Diabetes Res Clin Pract 2019; 156:107837. [PMID: 31479705 DOI: 10.1016/j.diabres.2019.107837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/25/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
AIM To validate the Diabetes Medication Adherence Scale (DMAS-7), determine its concordance with another validated scales and to assess factors affecting medication adherence. METHODS A cross-sectional study was conducted on a sample of Lebanese patients with diabetes using a questionnaire. The level of adherence was measured using the DMAS-7 and the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted, and the scale was validated in terms of reliability, predictive ability, and construct validity using SPSS version 19. RESULTS Out of 300 eligible patients, the rate of adherence was 33.7%. Measures of validity showed good reliability (Cronbach alpha = 0.627), and good construct validity with LMAS-14 (Spearman's rho = 0.846; Cohen's kappa = 0.711). DMAS-7 was found to be both correlated with LMAS-14 (ICC average measure = 0.675; p-value <0.001) in addition to possessing a better predictive value. Thus, DMAS-7 showed to have good concordance and increased validity compared to LMAS-14. Having an optimal glycated hemoglobin (HbA1C) (OR = 0.779; p = 0.001) and performing regular physical activity (OR 2.328; p = 0.002) increased medication adherence. CONCLUSION The DMAS-7 showed to be reliable and valid instrument superior to LMAS-14 in predicting adherence levels to oral anti-diabetic medications, and thus can be used to achieve better glycemic outcomes.
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Affiliation(s)
- Zahraa Mallah
- Research Clinical Pharmacy and Pharmaco-epidemiology, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Yasmin Hammoud
- Research Clinical Pharmacy and Pharmaco-epidemiology, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Sanaa Awada
- Pharmacokinetics, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Samar Rachidi
- Clinical Pharmacy, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Salam Zein
- Clinical Pharmacy, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Hajar Ballout
- Saint Georges Hospital, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical Pharmacy, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon.
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8
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Ayoub D, Mroueh L, El-Hajj M, Awada S, Rachidi S, Zein S, Al-Hajje A. Evaluation of antidiabetic medication adherence in the Lebanese population: development of the Lebanese Diabetes Medication Adherence Scale. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:468-476. [DOI: 10.1111/ijpp.12558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
Abstract
Objective
To evaluate factors affecting adherence to oral antidiabetic treatment in the Lebanese population and to develop the Diabetes Medication Adherence Scale (DMAS) based on these factors.
Methods
A cross-sectional study was conducted on a sample of Lebanese diabetic patients. Data were collected using a structured questionnaire. The level of adherence was measured using the Lebanese Medication Adherence Scale (LMAS-14). Bivariate analyses and multivariable analysis was done using SPSS. Psychometric evaluation of DMAS included an assessment of internal consistency, factor analysis, evaluation of sensitivity and specificity. Criterion-related validity was assessed by comparison with LMAS-14 measure of adherence.
Key findings
A total of 500 patients were recruited. 39.2% were adherent to treatment. Long working hours, increased number of oral antidiabetic medication per day, drug discontinuation when travelling, longer duration of diabetes and treatment burden were among factors that decreased adherence. While understanding the treatment regimen, following up physician recommendations and following up the recommended diet contributed to good medication adherence. The final 7-item scale (DMAS) had a good internal consistency (Cronbach’s α = 0.612) and a good correlation and agreement with LMAS-14 (Spearman’s rho = 0.699, Cohen’s kappa = 0.566). Patients with high DMAS scores were significantly more likely to have controlled glycaemia (P < 0.05). Sensitivity and specificity reached 70.39% and 51.47%, respectively.
Conclusion
Adherence to oral antidiabetic treatment is suboptimal in Lebanon. The DMAS is a reliable instrument for assessing adherence and predicting poor glycaemic control in clinical practice, but requires further validation in other populations.
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Affiliation(s)
- Dana Ayoub
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Lara Mroueh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Maya El-Hajj
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Sanaa Awada
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Salam Zein
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
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9
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Mroueh L, Ayoub D, El-Hajj M, Awada S, Rachidi S, Zein S, Al-Hajje A. Evaluation of medication adherence among Lebanese diabetic patients. Pharm Pract (Granada) 2019; 16:1291. [PMID: 30637030 PMCID: PMC6322979 DOI: 10.18549/pharmpract.2018.04.1291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/22/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Diabetes type 2 is considered one of the main public health concerns. Lack of
adherence to treatment leads to poor therapeutic outcome, poor glycemic
control, and high risk for developing diabetes complications. Objectives: The aim of this study is to evaluate adherence to oral antidiabetic
medication in Diabetes type 2 Lebanese patients, and to evaluate factors
leading to low adherence. Methods: A cross-sectional study was conducted in outpatients endocrinology clinics of
two hospitals and four private clinics located in Beirut-Lebanon. Data was
collected using a well-structured questionnaire by trained pharmacists.
Adherence level was measured by the Lebanese Medication Adherence Scale
(LMAS-14). Bivariate and multivariate analyses were conducted using SPSS
version 20. Results: Overall, 245 patients were included in the study with the majority being
females (54.3%) and obese (47.8%). Only 29% of the
participants had controlled glycemia (HbA1c <7%) with
31.8% of subjects had high adherence to their medication compared to
68.2% with low adherence. Increased working hours/day was associated
with a decrease in adherence to oral antidiabetic medication (OR=0.31;
95% CI 0.11:0.88; p=0.029). Other factors significantly associated
with decreased adherence to treatment were forgetfulness, high drug costs,
complex treatment regimens, experiencing side effects, and perception of
treatment inefficacy. Postponing physician office visits also decreased the
probability of being adherent to oral antidiabetic medication (OR=0.36;
95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of
hypo/hyperglycemia and the sensation of treatment burden also decreased
medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and
OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively). Conclusions: Adherence to oral antidiabetic medication is low for Lebanese patients, which
leads to a poor glycemic control and increases the diabetes complications.
Intervention programs including patient education strategies are essential
to improve medication adherence.
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Affiliation(s)
- Lara Mroueh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Dana Ayoub
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Maya El-Hajj
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Sanaa Awada
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Salam Zein
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University. Beirut (Lebanon).
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10
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Fiseha T, Alemayehu E, Kassahun W, Adamu A, Gebreweld A. Factors associated with glycemic control among diabetic adult out-patients in Northeast Ethiopia. BMC Res Notes 2018; 11:316. [PMID: 29776447 PMCID: PMC5960206 DOI: 10.1186/s13104-018-3423-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/10/2018] [Indexed: 12/16/2022] Open
Abstract
Objective The aim of this study was to determine the status of glycemic control and identify factors associated with poor glycemic control among diabetic out-patients. Results A hospital based cross-sectional study was conducted among randomly selected 384 (126 type 1 and 258 type 2) diabetic adults attending a hospital in Northeast Ethiopia from January 1 to April 30, 2017. Of the total participants, 70.8% had poor status of glycemic control (defined as mean fasting blood glucose level above 130 mg/dl). In the multivariate analysis, rural residence (AOR = 2.61, 95% CI 1.37–4.96), low educational level (AOR = 7.10, 95% CI 2.94–17.17) and longer duration of diabetes (AOR = 2.20, 95% CI 1.18–4.08) were significantly associated with increased odds of poor glycemic control. Moreover, merchants (AOR = 3.39, 95% CI 1.16–9.96) were significantly more likely to have poor glycemic control compared to government employee. Diabetic patients receiving oral anti-diabetics (AOR = 5.12, 95% CI 2.10–12.52) or insulin (AOR = 3.26, 95% CI 1.26–8.48) were more likely to be poorly controlled. These results highlight the needed for appropriate management of patients focusing on associated factors identified for poor glycemic control to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Science, College of Health & Medical Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wongelawit Kassahun
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aderaw Adamu
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Al Mansari A, Obeid Y, Islam N, Fariduddin M, Hassoun A, Djaballah K, Malek M, Dicker D, Chaudhury T. GOAL study: clinical and non-clinical predictive factors for achieving glycemic control in people with type 2 diabetes in real clinical practice. BMJ Open Diabetes Res Care 2018; 6:e000519. [PMID: 30023075 PMCID: PMC6045741 DOI: 10.1136/bmjdrc-2018-000519] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/23/2018] [Accepted: 06/13/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The American Diabetes Association and the European Association for the Study of Diabetes guidelines recommend to individualize treatment targets/strategies in inadequately controlled patients by lifestyle management and glucose-lowering drugs to decrease the burden of diabetes-related complications. This real-world practice study aimed to assess predictive factors for achieving the glycemic hemoglobin A1c (HbA1c) at 6 months as targeted by the treating physician in adults with type 2 diabetes who required initiation of basal insulin, initiation of bolus insulin, or modification from basal or premixed insulin to new insulin regimen containing insulin glargine and/or insulin glulisine. RESEARCH DESIGN AND METHODS This was an international, multicenter, observational survey with 12-month follow-up time in adults with type 2 diabetes inadequately controlled conducted in 10 developing countries. RESULTS Overall, 2704 patients (mean age: 54.6 years, body mass index: 28.7 kg/m2; Caucasian: 46.1%, type 2 diabetes duration: 10.1 years) with poor glycemic control (mean HbA1c: 9.7% (83 mmol/mol), fasting blood glucose: 196.8 mg/dL) were eligible. At 6 months, advanced age, Caucasian ethnicity, shorter type 2 diabetes duration (>10 vs 1 year, p<0.0001), lower baseline HbA1c (≥ 8.5% vs <7%, p<0.0001) and no intake of oral antidiabetic drug (OAD) (none vs 2, p=0.02) were predictive factors for achieving glycemic goal as targeted by the treating physician. Absolute changes in the mean HbA1c of -1.7% and -2% were observed from baseline to 6 and 12 months, respectively. CONCLUSIONS Along with some well-known predictive factors, this study suggested that early insulin regimen treatment initiation and/or intensification allowed patients to promote glycemic control.
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Affiliation(s)
| | - Youssef Obeid
- Department of Endocrinology, Zalka, Haroun Hospital, Beirut, Lebanon
| | - Najmul Islam
- Section of Diabetes, Endocrinology & Metabolism, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammed Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ahmed Hassoun
- Department of Endocrinology, Dubai Diabetes Center, Dubai, UAE
| | | | - Mojtaba Malek
- Department of Endocrinology, Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Dror Dicker
- Department of Endocrinology, Internal Medicine D, Hasharon Hospital Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tirthankar Chaudhury
- Department of Endocrinology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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12
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Bukhsh A, Khan TM, Nawaz MS, Ahmed HS, Chan KG, Lee LH, Goh BH. Association of diabetes-related self-care activities with glycemic control of patients with type 2 diabetes in Pakistan. Patient Prefer Adherence 2018; 12:2377-2385. [PMID: 30519003 PMCID: PMC6235006 DOI: 10.2147/ppa.s177314] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Association of various self-care activities on glycemic control of people with diabetes (PWD) in Pakistan is yet to be explored. The current study aimed to evaluate the association of various diabetes-related self-care activities with glycated hemoglobin (HbA1c) levels and to examine the predictive relationship of patients' demographic variables with their self-care activities. PATIENTS AND METHODS A cross-sectional study was conducted on adult PWD (N=218) who were diagnosed with type 2 diabetes mellitus of at least 1 year duration. Self-care activities were examined by using the Urdu version of Diabetes Self-management Questionnaire. Linear regression analysis was conducted to examine the significant predictors for diabetes-related self-care activities and glycemic control. RESULTS Mean age of the patients was 50.77±13.3 years. Poor glycemic control (HbA1c $7%) was observed in majority of the patients (83%). Linear regression analysis revealed that glucose management (β=-0.44; 95% CI -0.438, -0.209; P<0.001) was the strongest predictor for low levels of patients' HbA1c, followed by dietary control (β=-0.19; 95% CI -0.248, -0.018; P=0.024) and physical activity (β=-0.17; 95% CI -0.165, -0.023; P=0.010), respectively. Linear regression analysis showed that use of oral hypoglycemic agents only (β=-0.218; 95% CI -0.956, -0.200; P=0.003) and higher education level (β=0.204; 95% CI 0.138, 0.777; P=0.005) were significant predictors for higher scores of patients' self-care activities. CONCLUSION The findings support that PWD having better self-reported self-care activities achieve better glycemic control. Patients' self-care activities should be monitored on a regular basis, especially for those who are at risk of poor glycemic control.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
| | | | | | - Kok Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, China,
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia,
| | - Learn-Han Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Center of Health Outcomes Research and Therapeutic, Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Center of Health Outcomes Research and Therapeutic, Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand
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Ashur ST, Shah SA, Bosseri S, Fah TS, Shamsuddin K. Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya. Libyan J Med 2016; 11:31086. [PMID: 27005896 PMCID: PMC4803895 DOI: 10.3402/ljm.v11.31086] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. METHODS A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8(©)), while glycaemic control status was based on the HbA1c level. RESULTS Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). CONCLUSION The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.
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Affiliation(s)
- Sana Taher Ashur
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Soad Bosseri
- National Centre for Diabetes and Endocrinology, Tripoli, Libya
| | - Tong Seng Fah
- Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Khadijah Shamsuddin
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia;
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Al-Rasheedi AA. Glycemic Control among Patients with Type 2 Diabetes Mellitus in Countries of Arabic Gulf. Int J Health Sci (Qassim) 2015; 9:345-350. [PMID: 26609299 PMCID: PMC4633198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Type 2 diabetes mellitus is a growing, worldwide public health concern. The countries of Arabic Gulf appear to have a higher prevalence of diabetes than the global average. The recent and rapid socio-economic development of these countries has been associated with this rising prevalence. Although the rate of type 2 diabetes management based on glycosylated hemoglobin level in the countries of Arabic Gulf is labeled as poor, the outcomes are almost similar to those reported from elsewhere. Unfortunately, overweight and obesity are driving the global diabetes epidemic. A minority of patients with type 2 diabetes had a normal body weight which might make the control of diabetes difficult. Anyhow, Greater efforts are urgently needed to properly manage diabetes early in order to prevent short and long-term complications. Practical strategies aimed at more effective management of type 2 diabetes patients are strongly needed.
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Affiliation(s)
- Ahmad Ali Al-Rasheedi
- Correspondence: Dr. Ahmad Ali S. Al-Rasheedi, Family and Community Medicine, College of Medicine, Qassim University, Qassim, Saudi Arabia, Mobile: 0502400066,
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