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Teli M, Thato R, Hasan F, Rias YA. Effectiveness of Family-Based Diabetes Management Intervention on Glycated Haemoglobin Among Adults With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biol Res Nurs 2024; 26:315-333. [PMID: 38063030 DOI: 10.1177/10998004231218887] [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] [Indexed: 03/16/2024]
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) control is a crucial goal in the management of type 2 diabetes mellitus (T2DM), requiring lifelong commitment and family support. This study aimed to assess the effectiveness of family-based diabetes management intervention on HbA1c among adults with T2DM. METHODS From inception up to 2022, a comprehensive literature search was conducted across PubMed, ProQuest, Scopus, CORE, and the Cochrane Library. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Effect sizes were calculated using standard deviations (SD), while the degree of heterogeneity was evaluated using the Higgins I2 test. Subgroup analyses were performed to explore factors contributing to sources of heterogeneity among trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed, and the protocol was registered with PROSPERO CRD42022384034. RESULTS A total of 18 randomized controlled trials (RCTs) involving 2815 participants indicated that family-based diabetes management intervention had a statistically significant impact on improving HbA1c (Mean Difference [MD] = -.47; 95% Confidence Interval [CI]: -.64 to -.30, p < .001) with a moderate level of heterogeneity (I2 = 59%). Subgroup analysis indicated that family-based diabetes management intervention among adults with T2DM in developing regions was more effective in improving HbA1c levels compared to developed countries. CONCLUSION Family-based diabetes management interventions improved HbA1c. Further research is required to develop diabetes management strategies with a family focus that clearly defines the family's involvement.
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Affiliation(s)
- Margareta Teli
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Nursing School, Polytechnic of Health Ministry of Health Kupang, Kupang, Indonesia
| | - Ratsiri Thato
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Faizul Hasan
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Yohanes Andy Rias
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Faculty of Health, College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri, Indonesia
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Legese GL, Asres G, Alemu S, Yesuf T, Tesfaye YA, Amare T. Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched case-control study. Front Endocrinol (Lausanne) 2023; 14:1087437. [PMID: 36843610 PMCID: PMC9947343 DOI: 10.3389/fendo.2023.1087437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Poor glycemic control is one of the most determinant factors for type 2 diabetes-related morbidity and mortality. The proportion of type 2 diabetes mellitus patients with poor glycemic control remains high. Yet evidence on factors contributing to poor glycemic control remains scarce. The aim of this study is to identify determinants of poor glycemic control among type 2 diabetes mellitus patients at a diabetes mellitus clinic in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Determinants of Poor Glycemic Control among Type 2 Diabetes mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched Case-Control Study. METHODS A hospital-based case-control study was conducted from June to September 2020. Using convenience sampling techniques, a total of 90 cases and 90 controls with type 2 diabetes were recruited. The data were entered into Epidata version 4.6.0.2 and analyzed by Stata version 14. A multivariable logistic regression analysis was performed to assess the association between independent variables and glycemic control. Both 95% CI and p-value<0.05 were used to determine the level and significance, respectively. RESULTS The mean age ( ± standard deviations) for the cases and controls were 57.55± 10.42 and 61.03± 8.93% respectively. The determinants of poor glycemic control were age (Adjusted odd ratio (AOR)= 0.08; 95% CI= 0.02-0.33), inadequate physical exercise (AOR = 5.05; 95% CI = 1.99-11.98), presence of comorbidities (AOR = 5.50; 95% CI = 2.06-14.66), non-adherence to anti-diabetes medications (AOR= 2.76; 95% CI= 1.19-6.40), persistent proteinuria (AOR=4.95; 95% CI=1.83-13.36) and high-density lipoprotein less than 40 mg/dl (AOR=3.08; 95% CI= 1.30-7.31). CONCLUSIONS Age less than 65 years, inadequate physical exercise, presence of comorbidities, non-adherence to anti-diabetes medications, persistent proteinuria, and high-density lipoprotein less than 40 mg/dl were the determinants of poor glycemic control. Therefore, targeted educational and behavioral modification programs on adequate exercise and medication adherence should be routinely practiced. Furthermore, early guideline-based screening and treatment of comorbidities and complications is required to effectively manage diabetes mellitus.
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Affiliation(s)
- Gebrehiwot Lema Legese
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Gebrehiwot Lema Legese,
| | - Getahun Asres
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shitaye Alemu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Yesuf
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yeabsira Aklilu Tesfaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Wan KS, Hairi NN, Mustapha F, Ismail M, Mohd Yusoff MF, Moy FM. Five-year LDL-cholesterol trend and its predictors among type 2 diabetes patients in an upper-middle-income country: a retrospective open cohort study. PeerJ 2022; 10:e13816. [PMID: 36317122 PMCID: PMC9617547 DOI: 10.7717/peerj.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/08/2022] [Indexed: 01/18/2023] Open
Abstract
Background Patients with diabetes have increased risks of cardiovascular diseases (CVD), and their LDL-cholesterol (LDL-C) has to be treated to target to prevent complications. We aim to determine the LDL-C trend and its predictors among patients with type 2 diabetes (T2D) in Malaysia. Methods This was a retrospective open cohort study from 2013 to 2017 among T2D patients in public primary health care clinics in Negeri Sembilan state, Malaysia. Linear mixed-effects modelling was conducted to determine the LDL-C trend and its predictors. The LDL-C target for patients without CVD was <2.6 mmol/L, whereas <1.8 mmol/L was targeted for those with CVD. Results Among 18,312 patients, there were more females (55.9%), adults ≥60 years (49.4%), Malays (64.7%), non-smokers (93.6%), and 45.3% had diabetes for <5 years. The overall LDL-C trend reduced by 6.8% from 2.96 to 2.76 mmol/L. In 2017, 16.8% (95% CI: 13.2-21.0) of patients without CVD and 45.8% (95% CI: 44.8-46.8) of patients with CVD achieved their respective LDL-C targets. The predictors for a higher LDL-C trend were younger adults, Malay and Indian ethnicities, females, dyslipidemia, and diabetes treatment with lifestyle modification and insulin. Longer diabetes duration, obesity, hypertension, retinopathy, statin therapy, achievement of HbA1c target and achievement of BP target were independent predictors for a lower LDL-C trend. Conclusions The LDL-C trend has improved, but there are still gaps between actual results and clinical targets. Interventions should be planned and targeted at the high-risk populations to control their LDL-C.
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Affiliation(s)
- Kim Sui Wan
- Institute for Public Health, National Institutes of Health, Shah Alam, Selangor, Malaysia,Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia,Faculty of Public Health, Universitas Airlangga, Surabaya City, East Java, Indonesia
| | - Feisul Mustapha
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Federal Territory of Putrajaya, Malaysia
| | - Mastura Ismail
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Federal Territory of Putrajaya, Malaysia
| | | | - Foong Ming Moy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
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Hosseinzadeh S, Khatirnamani Z, Bakhshi E, Heidari A, Naghipour A. Assessing related factors to fasting blood sugar and glycosylated hemoglobin in patients with type 2 diabetes simultaneously by a multivariate longitudinal marginal model. Sci Rep 2022; 12:14819. [PMID: 36050425 PMCID: PMC9436939 DOI: 10.1038/s41598-022-19241-1] [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: 11/27/2021] [Accepted: 08/26/2022] [Indexed: 12/01/2022] Open
Abstract
The multivariate marginal model can be used to simultaneously examine the factors affecting both FBS and HbA1c using longitudinal data. The model fitted to multivariate longitudinal data should prevent redundant parameter estimation in order to have greater efficiency. In this study, a multivariate marginal model is used to simultaneously investigate the factors affecting both FBS and HbA1c with longitudinal data for patients with type 2 diabetes in Northern Iran. The present research is a retrospective cohort study. Overall, 500 medical records with complete information were reviewed. The multivariate marginal model is used to determine the factors associated with FBS and HbA1c using longitudinal data. Data have been analyzed in R-3.4.0 using ‘mmm2’ package. Given that the coefficients for the interactions of rtype with the intercept, time, family history of diabetes, history of hypertension, history of smoking, insulin therapy, systolic/diastolic blood pressure and duration of disease at first visit are significantly different from zero (P < 0.05), the effect of the independent variables on the two response variables is different and different coefficients should be used for each. Therefore, the interactions of these variables with rtype are kept in the final model. The coefficients for the interactions of rtype with sex, age at first visit, history of high cholesterol, and weight are not significantly different from zero (P > 0.05), indicating that their effect on the two response variables is similar and only one coefficient should be used for each. We examined the similarity of coefficients when fitting the longitudinal multivariate model for the relationship between FBS/HbA1c and sex, age, history of high blood cholesterol, and body weight. If an independent variable has similar effects on both responses, only one coefficient should be estimated, which will increase the efficiency of the model and the reliability of the results.
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Affiliation(s)
- Samaneh Hosseinzadeh
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Khatirnamani
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgān, Iran.
| | - Enayatollah Bakhshi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alireza Heidari
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgān, Iran
| | - Arash Naghipour
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgān, Iran
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Gao Q, Tan NC, Fang HSA, Lee ML, Hsu W. Glycaemic control of Asian patients with type-2 diabetes mellitus on tiered up-titration of metformin monotherapy: A one-year real-world retrospective longitudinal study in primary care. Diabetes Res Clin Pract 2022; 187:109874. [PMID: 35436547 DOI: 10.1016/j.diabres.2022.109874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/26/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Abstract
AIMS To determine the glycaemic control and associated factors among patients with type-2 diabetes mellitus on tiered metformin monotherapy over one-year. METHODS Adult Asian patients on metformin monotherapy with tiered dosage up-titration (low < 500 mg/day; medium 500-<1000 mg/day and high ≥ 1000 mg/day) are divided into four sub-cohorts based on their baseline HbA1c < 7%(C<7); 7%-<8%(C7-<8); 8%-<9%(C8-<9) and ≥ 9%(C≥9). The HbA1c absolute reduction, time to reach glycaemic control (HbA1c < 7%), and time from glycaemic control to failure (HbA1c ≥ 7%) after the dosage up-titration were the outcomes. RESULTS Among 5503 eligible patients (mean age = 64.9 years, 45.6% males and 74.6% Chinese), the HbA1c absolute reduction after the up-titration at three months are 0%, 0.4%-0.6%, 0.8%-1.2% and 2.0%-2.1% for C<7, C7-<8, C8-<9 and C≥9 respectively. The median time (months) to attain glycaemic control for low, medium and high dosage up-titration were 4, 3, 3(C7-<8); 12, 7, 4(C8-<9); NA, 7, 7(C≥9). Within twelve months after the goal attainment, 36.2%(C<7), 48.8%(C7-<8), 52.7%(C8-<9) and 45.3%(C≥9) of patients had treatment failure. CONCLUSIONS The results show that the baseline HbA1c and tiered metformin dosage up-titration are associated with disproportionate HbA1c reduction, time to glycaemic control and time from glycaemic control to failure.
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Affiliation(s)
- Qiao Gao
- Institute of Data Science, National University of Singapore, Singapore.
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore; SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Mong Li Lee
- Institute of Data Science, National University of Singapore, Singapore; School of Computing, National University of Singapore, Singapore
| | - Wynne Hsu
- Institute of Data Science, National University of Singapore, Singapore; School of Computing, National University of Singapore, Singapore
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Bi Y, Tian Z, Yan W, Liu M, Zhao Y, Bao H, Yan T, Zhang N, Xia Y, Zhang X. Treatment and control of modifiable cardiovascular risk factors among patients with diabetes mellitus and hypertension in Inner Mongolia: A cross-sectional study. J Clin Hypertens (Greenwich) 2021; 23:2016-2025. [PMID: 34699679 PMCID: PMC8630609 DOI: 10.1111/jch.14375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 01/04/2023]
Abstract
The authors assessed treatment and control of blood glucose, blood pressure (BP), and blood lipids among patients from Inner Mongolia with diabetes mellitus (DM) and hypertension (HTN) and identified the modifiable factors associated with treatment and achievement of blood glucose, BP, and blood lipid targets. The authors used a multistage stratified cluster sampling method according to geographical location and level of economic development in Inner Mongolia. Among patients with DM and HTN, the crude rates of fasting plasma glucose (FPG) treatment and control was 30.76% and 4.73%, respectively. Crude rates of BP treatment and control were 50.81% and 8.70%, respectively. The authors found that treatment rates of HTN and DM and control rates of BP and FPG showed a gradually increasing trend with increased age. Among patients with DM and HTN, the likelihood of treatment for HTN and DM was significantly increased among participants who were older, non‐Mongolian, male, obese, smokers, and those with previous cardiovascular disease. The authors found that control of BP, FPG, and low‐density lipoprotein cholesterol was far from optimal among study participants. Medical and health departments in Inner Mongolia should take appropriate measures to reduce the burden of DM and HTN in the population, such as by promoting and improving the quality of HTN and DM treatment to achieve control goals and reduce the risk of cardiovascular disease.
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Affiliation(s)
- Yanqing Bi
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Zixuan Tian
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Wenyan Yan
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Min Liu
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Yuqian Zhao
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Han Bao
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Tao Yan
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Nan Zhang
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Yuan Xia
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Xingguang Zhang
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
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Saygili ES, Karakiliç E, Yasa S, Şen E. Evaluation of Turkey diabetes self-management education in geriatrics with type 2 diabetes. Minerva Endocrinol (Torino) 2021; 46:389-395. [PMID: 34669320 DOI: 10.23736/s2724-6507.21.03606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was conducted to evaluate the diabetes education efficiency of individuals over 65 years old in Turkey, which has the highest prevalence of diabetes in Europe. METHODS We retrospectively evaluated 320 patients who attended Turkey diabetes self-management group education program (TDSMEP) between 2016 and 2020 in a secondary hospital. Participants who have been followed up for a maximum of 9 months are grouped as over 65 years old and under. RESULTS Of the 320 patients, 114 formed the geriatric group and 206 the non-geriatric group. After the training, the number of patients who had HbA1c ≤7% increased significantly in both the geriatric (28.1%-45.6%) and non-geriatric (19.9%-42.2%) (p = 0.001) groups. After the training, similar HbA1c goals were achieved in the geriatric and non-geriatric groups. The most significant HbA1c decrease was observed at the 3rd month of follow-up and remained stable until the 9th month. In logistic regression analysis, the factors affecting HbA1c failure (HbA1c >7%) after training in the geriatric group were long diabetes duration (OR = 1.07, 95% CI = 1.02-1.13, p = 0.01), high basal HbA1c levels (OR = 1.31, 95% CI = 1.03-1.67, p = 0.03), and low education level (OR = 3.88, 95% CI = 1.54-9.76, p = 0.001). CONCLUSIONS This is the first study to evaluate the effectiveness of TDSMEP for geriatric individuals whose HbA1c ≤7% increased from 28% to 45.6% during follow-up after the training. TDSMEP is recommended for all adult age groups, regardless of age range.
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Affiliation(s)
- Emre S Saygili
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Çanakkale, Turkey - .,Division of Endocrinology and Metabolism, Department of Internal Medicine, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey -
| | - Ersen Karakiliç
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey
| | - Serap Yasa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Çanakkale, Turkey
| | - Emine Şen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Çanakkale, Turkey
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Wang TY, Lai HC, Chen HH, Wang ML, Hsieh MC, Chang CT, Chen RH, Ho CW, Hung YC, Tseng JY, Lin CL, Kao CH. Pyogenic Liver Abscess Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus: A Nationwide, Population-Based Cohort Study. Front Med (Lausanne) 2021; 8:675345. [PMID: 34055845 PMCID: PMC8149939 DOI: 10.3389/fmed.2021.675345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background: To date, no comprehensive epidemiological study exists on pyogenic liver abscess (PLA) risk in patients with newly diagnosed type 2 diabetes mellitus (T2DM) worldwide. Methods: We conducted a retrospective cohort study by using data from Taiwan National Health Insurance Research Database (NHIRD) to examine the association between newly diagnosed T2DM and PLA. The T2DM cohort included patients newly diagnosed as having T2DM (ICD-9-CM:250) from 2000 to 2009, with follow-up until December 31, 2011. The comparison cohort was then recruited through 1:4 random frequency matching with the T2DM cohort. Finally, the adjusted hazard ratios for PLA were compared between the T2DM and comparison cohorts, which included 44,728 patients with T2DM and 178,912 patients without DM respectively. Results: In T2DM cohort, 166 patients were diagnosed as having PLA (incidence rate = 5.87 per 10,000 person-years) and in comparison cohort, 238 patients were diagnosed as having PLA (incidence rate = 2.06 per 10,000 person-years). The T2DM cohort exhibited higher PLA risk than did the comparison cohort (hazard ratio = 2.83, 95% confidence interval = 2.32-3.46). Furthermore, the adjusted hazard ratio for PLA risk in T2DM cohort was the highest in those who were younger, man and with duration of DM <2 years. In the T2DM cohort, the most common PLA causative agent was Klebsiella pneumonia (KP). In addition, PLA risk was high in T2DM patients with gallstone and cholecystitis. Compared with comparison cohort, patients with T2DM prescribed acarbose has a lower PLA risk, however glyburide significantly increased PLA risk in T2DM cohort. Conclusion: In patients with newly diagnosed T2DM, PLA risk was high and acarbose might reduce PLA risk.
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Affiliation(s)
- Tzu-Yuan Wang
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsueh-Chou Lai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Hung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Chung Sheng Clinic, Nantou, Taiwan
| | - Mei-Lin Wang
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Ming-Chia Hsieh
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chwen-Tzuei Chang
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Rong-Hsing Chen
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Wei Ho
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Chin Hung
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Juei-Yu Tseng
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and Positron Emission Tomography (PET) Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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Haymana C, Sonmez A, Demirci I, Fidan Yaylalı G, Nuhoglu I, Sancak S, Yilmaz M, Altuntas Y, Dinccag N, Sabuncu T, Bayram F, Satman I. Patterns and preferences of antidiabetic drug use in Turkish patients with type 2 diabetes - A nationwide cross-sectional study (TEMD treatment study). Diabetes Res Clin Pract 2021; 171:108556. [PMID: 33242516 DOI: 10.1016/j.diabres.2020.108556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 10/07/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
AIMS The treatment preferences in type 2 diabetes (T2DM) are affected by multiple factors. This survey aims to find out the profiles of the utilization of antidiabetics and their determinants. METHODS The nationwide, multicenter TEMD survey consecutively enrolled patients with T2DM (n = 4678). Medications including oral antidiabetics (OAD) and injectable regimens were recorded. Multiple injectable regimens with or without OADs were defined as complex treatments. RESULTS A total of 4678 patients with T2DM (mean age: 58.5 ± 10.4 years, 59% female) were enrolled. More than half of patients (n = 2372; 50.7%) were using injectable regimens with or without OADs, and others (n = 2306, 49.3%) were using only OADs. The most common OADs were metformin (93.5%), secretagogues (40.1%), and DPP-4 inhibitors (37.2%). The rates of the use of basal, basal-bolus and premix insulin were 26.5%, 39.5% and 22.4%, respectively. Patients using OADs achieved better glycemia, blood pressure and weight control (p < 0.001 for all) but poorer LDL-C control (p < 0.001). The independent associates of complex treatments were diabetes duration, obesity, eGFR, glycated haemoglobin, macro and microvascular complications, education level, and self-reported hypoglycemia. CONCLUSION This study is the first nationwide report to show that almost half of the patients with T2DM are using injectable regimens in Turkey.
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Affiliation(s)
- Cem Haymana
- University of Health Sciences, Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey.
| | - Alper Sonmez
- University of Health Sciences, Gulhane School of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ibrahim Demirci
- University of Health Sciences, Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Guzin Fidan Yaylalı
- Pamukkale University, School of Medicine, Department of Endocrinology and Metabolism, Denizli, Turkey
| | - Irfan Nuhoglu
- Karadeniz Technical University, School of Medicine, Department of Endocrinology and Metabolism, Trabzon, Turkey
| | - Seda Sancak
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Murat Yilmaz
- Çorlu REYAP Private Hospital, Department of Endocrinology and Metabolism, Tekirdag, Turkey
| | - Yuksel Altuntas
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Nevin Dinccag
- Istanbul University, School of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Tevfik Sabuncu
- Harran University, School of Medicine, Department of Endocrinology and Metabolism, Sanlıurfa, Turkey
| | - Fahri Bayram
- Erciyes University, School of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey
| | - Ilhan Satman
- Istanbul University, School of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
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Khatirnamani Z, Bakhshi E, Naghipour A, Teymouri R, Hosseinzadeh S. Longitudinal Trend of Fasting Blood Glucose and Related Factors in Patients with Type 2 Diabetes. Int J Prev Med 2020; 11:177. [PMID: 33456733 PMCID: PMC7804876 DOI: 10.4103/ijpvm.ijpvm_195_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 03/14/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Control of diabetes plays an important role in improving complications and disabilities and quality of life. This study aimed to evaluate the 3-year changes in fasting blood glucose (FBG) values and its related factors in patients with type 2 diabetes. METHODS In this retrospective cohort study, 500 patients with type 2 diabetes covered by the National Diabetic Prevention and Care Plan during 2013-2016 were selected based on random cluster systematic sampling. A linear mixed model was used to study changes in FBG levels and their related factors. The data were analyzed using the R3.2.0 software. RESULTS The patients' mean age was 47.7 years. Among these patients, 58.6% were female, 19.8% had a history of smoking. High FBG was associated with high disease duration, high body mass index (BMI), low age, normal BMI at baseline, insulin therapy, smoking, and family history of diabetes. Trend of FBG in follow-up was decreasing. CONCLUSIONS Given that patients who received insulin therapy had higher mean FBG, it is recommended to examine their insulin dose and modifications should be made in terms of the patients' needs during their continuous follow-up. Weight loss during follow-up and cessation of smoking indicate a favorable prognosis of disease. More attention should be paid to younger patients in care. Patients are encouraged to start treatment and care at the same time diagnose.
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Affiliation(s)
- Zahra Khatirnamani
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arash Naghipour
- Health Center Complex, Prevention and Control of Diseases Unit, Gorgan, Iran
| | - Robab Teymouri
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Wulandari N, Maifitrianti M, Hasanah F, Atika S, Dini Putri R. Medication Adherence Assessment Among Patients with Type 2 Diabetes Mellitus Treated Polytherapy in Indonesian Community Health Center: A Cross Sectional-Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:S758-S762. [PMID: 33828374 PMCID: PMC8021045 DOI: 10.4103/jpbs.jpbs_257_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/16/2020] [Accepted: 04/01/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic disease where most of the patients usually need polytherapy. This could affect their medication adherence (MA). However, other complex factors may also associate with MA, which are important to identify. AIM The purpose of this study was to evaluate the MA of patients with T2DM who received polytherapy and to identify other factors that can affect the MA. MATERIALS AND METHODS This was a cross-sectional study conducted in seven community health centers in Jakarta with HbA1C representing their MA level. Poor controlled blood glucose with Hemoglobin A1C (HbA1C) of ≥7% is indicated to have low MA. All characteristics were collected to identify factors that are potentially associated with low MA. The univariate analysis tests were used to analyze factors that potentially associate with low MA. Multiple logistic regression analysis was performed in the factors to find their relationship with low MA. RESULTS The study obtained 143 patients with a female dominance (67.8%) and mean ± standard deviation (SD) age of 59.53 ± 9.251 years. Approximately 75.5% of the patients had low MA (HbA1C ≥ 7). Univariate analysis found that duration of T2DM significantly (P = 0.047) related to MA, where patients with T2DM of less than or equal to 5 years tended to have low MA. Logistic regression showed that patients with T2DM less than or equal to 5 years (P = 0.015, odds ratio = 1.206, 95% confidence interval = 1.216-8.014) were associated with low MA. CONCLUSION Patients with the duration of T2DM less than or equal to 5 years surprisingly were susceptible to have low MA. Low MA was not affected by polytherapy.
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Affiliation(s)
- Nora Wulandari
- Faculty of Pharmacy and Science, University of Muhammadiyah Prof. DR. HAMKA Jl Delima II/IV Islamic Center, Malakasari, Duren Sawit, East Jakarta, Indonesia
| | - Maifitrianti Maifitrianti
- Faculty of Pharmacy and Science, University of Muhammadiyah Prof. DR. HAMKA Jl Delima II/IV Islamic Center, Malakasari, Duren Sawit, East Jakarta, Indonesia
| | - Faridlatul Hasanah
- Faculty of Pharmacy and Science, University of Muhammadiyah Prof. DR. HAMKA Jl Delima II/IV Islamic Center, Malakasari, Duren Sawit, East Jakarta, Indonesia
| | - Sri Atika
- Faculty of Pharmacy and Science, University of Muhammadiyah Prof. DR. HAMKA Jl Delima II/IV Islamic Center, Malakasari, Duren Sawit, East Jakarta, Indonesia
| | - Risa Dini Putri
- Faculty of Pharmacy and Science, University of Muhammadiyah Prof. DR. HAMKA Jl Delima II/IV Islamic Center, Malakasari, Duren Sawit, East Jakarta, Indonesia
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Association of Health Literacy and Nutritional Status Assessment with Glycemic Control in Adults with Type 2 Diabetes Mellitus. Nutrients 2020; 12:nu12103152. [PMID: 33076406 PMCID: PMC7602618 DOI: 10.3390/nu12103152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 01/26/2023] Open
Abstract
While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg/m2) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R2 = 0.21; p < 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.
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Xi Y, Bao H, Han K, Qiao L, Xu X, Zhu H, Yan T, Niu L, Hang G, Wang W, Zhang X. Evaluating the treatment and control of modifiable cardiovascular disease risk factors among patients with diabetes in the Inner Mongolia, China: A cross-sectional study. Prev Med 2020; 139:106174. [PMID: 32592794 DOI: 10.1016/j.ypmed.2020.106174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 05/24/2020] [Accepted: 06/06/2020] [Indexed: 01/19/2023]
Abstract
Reducing the risk of diabetes has been a great public health challenge in China. In this study, we aimed to estimate the treatment and control of FPG (fasting blood plasma glucose) as well as the other main modifiable cardiovascular disease (CVD) risk factors in patients with diabetes and to identify those characteristics associated with the treatment and control of diabetes, hypertension, and low-density lipoprotein cholesterol (LDL-C). Between 2015 and 2017, participants aged 35 to 75 years from Inner Mongolia in northern China were recruited. A total 13,644 participants with diabetes were enrolled in this study. We calculated rates and 95% confidence intervals for treatment and control of FPG, blood pressure, and LDL-C. We performed multivariate logistic regression to identify characteristics associated with the treatment and control of diabetes as well as hypertension and LDL-C. Overall, the treatment rates of diabetes, hypertension, and dyslipidemia were 30.76%, 50.75%, and 9.17%, respectively. Control rates of FPG, blood pressure, and LDL-C were 4.73%, 4.86%, and 57.83%, respectively. Patients who were younger, Mongol ethnicity and rural residents were less likely to be treated and controlled for diabetes and hypertension. Patients insured by NCMS (new rural cooperative medical scheme) were less likely to be treated and achieve the treatment target of blood pressure. Patients having prior CVD were more likely to be treated and have controlled FPG and blood pressure. Substantial efforts are urgently needed to improve the treatment and control of these modifiable CVD risk factors among patients with diabetes in Inner Mongolia.
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Affiliation(s)
- Yunfeng Xi
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Han Bao
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Ke Han
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Liying Qiao
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Xiaoqian Xu
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Hao Zhu
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Tao Yan
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Liwei Niu
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Gai Hang
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Wenrui Wang
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China.
| | - Xingguang Zhang
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China..
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Afaya RA, Bam V, Azongo TB, Afaya A, Kusi-Amponsah A, Ajusiyine JM, Abdul Hamid T. Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana. PLoS One 2020; 15:e0237710. [PMID: 32822381 PMCID: PMC7446850 DOI: 10.1371/journal.pone.0237710] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes often coexists with other medical conditions and is a contributing cause of death in 88% of people who have it. The study aimed at evaluating medication adherence, self-care behaviours and diabetes knowledge among patients with type 2 diabetes mellitus in Ghana. METHODS A total of 330 participants were recruited into the study from three public hospitals in the Tamale metropolis. A validated medication adherence questionnaire and the Summary of Diabetes Self-care Activities tool were used to assess medication adherence and self-care activities respectively. Logistic and linear regressions were used to determine factors positively associated with non-adherence to medication and self-care behaviours respectively. RESULTS Of the 330 participants whose data were analysed, the mean (SD) age was 57.5 (11.8) years. The majority (84.5%) were adherent to anti-diabetes medication. Participant's age, educational level, and practice of self-care behaviours influenced adherence to anti-diabetes medication. Participants aged 70 years and above were 79% less likely to be non-adherent to medication as compared to those below 50 years [OR = 0.21 (95%CI: 0.06-0.74), p = 0.016]. Participants with senior high school education were 3.7 times more likely to be non-adherent to medication than those with tertiary education [OR = 3.68 (95%CI: 1.01-13.44), p = 0.049]. Participants with tertiary education had an increase in the level of practice of self-management by 1.14 (p = 0.041). A unit increase in knowledge score also increased the level of practice of self-management by 3.02 (p<0.001). CONCLUSION The majority of participants were adherent to anti-diabetes medication. Non-adherence to medication was associated with younger age and low level of education. Interventions to improve adherence should target younger and newly diagnosed patients through aggressive counselling to address healthy self-management behaviours.
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Affiliation(s)
- Richard Adongo Afaya
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Victoria Bam
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas Bavo Azongo
- Department of Public Health, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Abigail Kusi-Amponsah
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - James Mbangbe Ajusiyine
- Department of Maternal and Child Health, School of Nursing, University of Ghana, Accra, Ghana
| | - Tahiru Abdul Hamid
- Department of Trauma and Orthopaedics, Tamale Teaching Hospital, Tamale, Ghana
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Tan YZ, Cheen MHH, Goh SY, Bee YM, Lim PS, Khee GY, Thumboo J. Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017. J Diabetes 2019; 11:573-581. [PMID: 30556375 DOI: 10.1111/1753-0407.12886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/08/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore. METHODS We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex- and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbA1c of less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, or 9% or more were estimated using logistic regression. Poisson regression was used to estimate standardized rate of severe hypoglycemia. RESULTS From 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P < 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P < 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P < 0.001). The proportion of patients with HbA1c of 8% or more increased (33.7% to 36.0%, P < 0.001). Rates of severe hypoglycemia (5.0 to 8.4 per 100 patient-years, P < 0.001) also rose. CONCLUSION Medication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.
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Affiliation(s)
- Yan Zhi Tan
- Department of Pharmacy, Singapore General Hospital, Singapore
| | | | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Paik Shia Lim
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Giat Yeng Khee
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
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16
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Luo M, Tan CS, Lim WY, Chia KS, Tang WE, Tai ES, Venkataraman K. Association of diabetes treatment with long-term glycemic patterns in patients with type 2 diabetes mellitus: A prospective cohort study. Diabetes Metab Res Rev 2019; 35:e3122. [PMID: 30600922 PMCID: PMC6590368 DOI: 10.1002/dmrr.3122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 01/06/2023]
Abstract
AIM This study aimed to analyze diabetes treatment and treatment changes in association with long-term glycemic patterns in an Asian population with diabetes. MATERIALS AND METHODS This was a prospective cohort study of 6218 patients with type 2 diabetes managed in public primary care clinics in Singapore. Clinical data from 2011 to 2016 were extracted from electronic medical records, including serial HbA1c measurements and dispensed antidiabetic medication records. Patterns of longitudinal HbA1c trajectories were identified using latent class growth analysis, and patients' annual treatment plans were compared between subgroups with different HbA1c patterns. RESULTS We identified four distinct HbA1c patterns. Eighty-one percent of patients were classified in the low-stable group, where monotherapy and dual therapy with oral agents were the most common treatments. We also identified three groups with poorer control, with moderate-stable (14%), moderate-increase (3%), and high-decrease (2%) HbA1c patterns. Insulin treatment was most prevalent in these groups, with 61% to 72% of subjects receiving insulin treatment in 2016. More than 60% of subjects in poorer control groups had experienced treatment intensification during follow-up. Addition of multiple insulin injections was the most common intensification in moderate-increase and high-decrease groups. CONCLUSIONS Treatment reflected and was appropriate to the extent of dysglycemia in this population. A small group of patients had deteriorating glycemic control, in spite of being treated with multiple insulin injections, suggesting non-response or non-adherence to treatment. Further investigation is needed to identify reasons for the deteriorating control observed and design effective interventions for these patients.
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Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | | | - Kee Seng Chia
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - E. Shyong Tai
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
- Division of EndocrinologyNational University HospitalSingapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
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Amer FA, Mohamed MS, Elbur AI, Abdelaziz SI, Elrayah ZA. Influence of self-efficacy management on adherence to self-care activities and treatment outcome among diabetes mellitus type 2. Pharm Pract (Granada) 2018; 16:1274. [PMID: 30637026 PMCID: PMC6322981 DOI: 10.18549/pharmpract.2018.04.1274] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background: High level of self-efficacy and adherence to self-care activities have a positive impact on the achievement of glycemic goal among diabetic patients. In Sudan, there is a gap in knowledge related to self-efficacy management and its influence on adherence to self-care activities and overall disease control. Objective: To identify the influence of management self-efficacy on adherence to self-care activities and treatment outcome among Sudanese patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted at two health care facilities in Sudan from April to May 2016. Patients with type 2 diabetes mellitus were included. Convenience sampling method was adopted. Diabetes Management Self-Efficacy Scale and the Revised Summary of Diabetes Self-care Activities were used to collect data through a face-to-face interview. Logistic regression analysis was performed. A p value <0.05 was considered to be significant. Data were processed using the software SPPS v 21.0. Results: A total of 392 patients were included. Respondents classified with high level of self- efficacy across all domains were 191 (48.7%). Moreover, high level of education [adjusted OR 0.5 (0.3-0.7), (p=0.001)] and formal health education on diabetes [adjusted OR 2.4 (1.6-3.7), (p<0.001)], were found to be significantly associated with high level of diabetes management self-efficacy. Patients who had high level of self-efficacy to manage nutrition, physical exercise activity and medication were found more adherent to general diet, exercise activity, and medication taking, respectively. Patients with controlled disease were 87(22.2%). The only predictor of diabetes control was diabetes management self-efficacy [OR 2.1(1.3- 3.5), (p=0.002)]. Conclusions: Diabetes management self-efficacy was associated with high level of education and receiving health education. Self-efficacy was significantly associated with adherence to self-care activities and glycemic control. Substantial efforts are still needed to empower the patients with self-efficacy and improving adherence to self-care activities through appropriate interventions.
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Affiliation(s)
- Fathi A Amer
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, (Sudan).
| | - Malik S Mohamed
- Department of Pharmaceutics, Faculty of Pharmacy, University of Khartoum, Khartoum, (Sudan).
| | - Abubaker I Elbur
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University. Dammam (Saudi Arabia).
| | - Sulafa I Abdelaziz
- Department of medicine, Faculty of Medicine, University of Khartoum. Khartoum (Sudan).
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Sonmez A, Haymana C, Bayram F, Salman S, Dizdar OS, Gurkan E, Kargili Carlıoglu A, Barcin C, Sabuncu T, Satman I. Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study). Diabetes Res Clin Pract 2018; 146:138-147. [PMID: 30244051 DOI: 10.1016/j.diabres.2018.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/04/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022]
Abstract
AIMS Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus. METHODS A nationwide, multicenter survey consecutively enrolled patients who were under follow up for at least a year. Optimal control was defined as HbA1c < 7%, home arterial blood pressure (ABP) < 135/85 mmHg, or LDL-C < 100 mg/dL. Achieving all parameters indicated triple metabolic control. RESULTS HbA1c levels of patients (n = 5211) were 8.6 ± 1.9% (71 ± 22 mmol/mol) and 7.7 ± 1.7% (61 ± 19 mmol/mol), in Type 1 and Type 2 diabetes, respectively. Glycemic control was achieved in 15.3% and 40.2%, and triple metabolic control was achieved in 5.5% and 10.1%, respectively. Only 1.5% of patients met all the criteria of being non-obese, non-smoker, exercising, and under triple metabolic control. Low education level was a significant predictor of poor glycemic control in both groups. CONCLUSIONS Few patients with Type 2, and even fewer with Type 1 diabetes have optimal metabolic control in Turkey. TEMD study will provide evidence-based information to policy makers to focus more on the quality and sustainability of diabetes care in order to reduce the national burden of the disease.
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Affiliation(s)
- Alper Sonmez
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Cem Haymana
- Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey.
| | - Fahri Bayram
- Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey
| | - Serpil Salman
- Istinye University, Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Oguzhan Sitki Dizdar
- Kayseri Training and Research Hospital, Department of Endocrinology and Metabolism, Kayseri, Turkey
| | - Eren Gurkan
- Mustafa Kemal University, Faculty of Medicine, Department of Endocrinology and Metabolism, Hatay, Turkey
| | - Ayse Kargili Carlıoglu
- Erzurum Training and Research Hospital, Department of Endocrinology and Metabolism, Erzurum, Turkey
| | - Cem Barcin
- Health Sciences University, Gulhane Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Tevfik Sabuncu
- Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Ilhan Satman
- Istanbul University, Faculty of Medicine, Istanbul, Turkey
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Luo M, Poh Z, Koh G, Tham TY, Lau W, Toh SA, Chong CK, Low LL, Venkataraman K. Diabetes management in a Primary Care Network (PCN) of private general practitioners in Singapore: An observational study. Medicine (Baltimore) 2018; 97:e12929. [PMID: 30412099 PMCID: PMC6221669 DOI: 10.1097/md.0000000000012929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A Primary Care Network (PCN) is a virtual network of general practitioners (GPs), sharing common resources and common clinical governance framework for effective chronic disease management. In this study, we analyzed the frequency of assessment as well as control of HbA1c, blood pressure (BP), and low-density lipoprotein (LDL) over time among adult patients with diabetes managed by a group of private GPs under PCN.Data, including clinical measurements of HbA1c, BP, and LDL from 2012 to 2015, of 943 subjects at 9 GP clinics that piloted PCN in Singapore in 2012 was obtained from the chronic disease register for this analysis.The total number of PCN patients increased from 371 in 2012 to 911 in 2015. The average HbA1c decreased from 7.5% in 2012 to 7.3% in 2015, with a significant yearly improving trend of -0.11% (P < .001). The trends in change for systolic BP and LDL were not statistically significant during the same follow-up period. Regular assessment of HbA1c decreased from 80% in 2012 to 55% in 2015. Such decreases were also found in BP and LDL assessments. We also found that receiving government subsidies under a national scheme was a major determinant for maintaining regular assessment, with patients so covered 3 to 20 times more likely to have regular assessments.The PCN model can help improve care and clinical outcomes in adult patients with diabetes in the private primary care sector. Investing greater financial and human resources to augment service capacity and expanding subsidy coverage may be important to ensure the effectiveness, scalability, and sustainability of such a model of care.
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Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public Health, National University of Singapore
| | | | - Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Tat Yean Tham
- Frontier Healthcare Group
- Yong Loo Lin School of Medicine, National University of Singapore
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Goh CC, Koh KH, Goh S, Koh Y, Tan NC. Achieving triple treatment goals in multi-ethnic Asian patients with type 2 diabetes mellitus in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2018; 13:10-18. [PMID: 30302178 PMCID: PMC6173958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDL-Cholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines. METHODS A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore. The demographic and clinical data for this sub-population with both T2DM and dyslipidemia were collated with laboratory and treatment information retrieved from their electronic health records. The combined data was then analyzed to determine the proportion of patients who attained triple treatment goals, and logistic regression analysis was used to identify factors associated with this outcome. RESULTS 665 eligible patients [60.5% female, 30.5% Chinese, 35% Malays, and 34.4% Indians] with a mean age of 60.6 years were recruited. Of these patients, 71% achieved LDL-C ≤2.6 mmol/L, 70.4% had BP CONCLUSION Eight in ten patients with T2DM failed to achieve concurrent glycemic, BP, and LDL-C treatment goals, subjecting them to risks of vascular complications. Primary healthcare professionals can mitigate these risks by optimizing therapeutic treatment to maximize glycemia, dyslipidemia, and BP control.
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Affiliation(s)
- C C Goh
- B Pharm, SingHealth Polyclinics 167, Jalan Bukit Merah, Tower 5 #15-10, Singapore 150167
| | - K H Koh
- M.Med (Fam Med), MRCS., SingHealth Polyclinics
| | - Scp Goh
- M.Med (Fam Med), FCFPS, SingHealth Polyclinics 167, Jalan Bukit Merah, Tower 5 #15-10, Singapore 150167
| | - Yle Koh
- BSc, SingHealth Polyclinics 167, Jalan Bukit Merah, Tower 5 #15-10, Singapore 150167
| | - N C Tan
- M.Med (Fam Med), FCFPS, SingHealth Polyclinics, Duke NUS Medical School, Singapore
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Relevant patient characteristics for guiding tailored integrated diabetes primary care: a systematic review. Prim Health Care Res Dev 2018; 19:424-447. [PMID: 29405097 PMCID: PMC6452927 DOI: 10.1017/s146342361800004x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim To identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care. Background Integrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients’ needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach. Methods PubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines. Findings In total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.
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22
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Griffiths FE, Armoiry X, Atherton H, Bryce C, Buckle A, Cave JAK, Court R, Hamilton K, Dliwayo TR, Dritsaki M, Elder P, Forjaz V, Fraser J, Goodwin R, Huxley C, Ignatowicz A, Karasouli E, Kim SW, Kimani P, Madan JJ, Matharu H, May M, Musumadi L, Paul M, Raut G, Sankaranarayanan S, Slowther AM, Sujan MA, Sutcliffe PA, Svahnstrom I, Taggart F, Uddin A, Verran A, Walker L, Sturt J. The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundYoung people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely.ObjectivesTo explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation.DesignObservational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups.SettingTwenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions.ParticipantsOne hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists.InterventionsClinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol.Main outcome measuresEmpirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility.Data sourcesObservation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications.ResultsDigital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health.LimitationsQualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available.ConclusionsTimely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.Future workFuture development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes.Study registrationTwo of the reviews in this study are registered as PROSPERO CRD42016035467 and CRD42016038792.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Abigail Buckle
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kathryn Hamilton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Thandiwe R Dliwayo
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | - Patrick Elder
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Vera Forjaz
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Joe Fraser
- Patient and public involvement representative, London, UK
| | - Richard Goodwin
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | | | | | - Sung Wook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason J Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Harjit Matharu
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mike May
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Moli Paul
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Gyanu Raut
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | | | - Mark A Sujan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | | | - Ayesha Uddin
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice Verran
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Leigh Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
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Gouda M, Matsukawa M, Iijima H. Associations between eating habits and glycemic control and obesity in Japanese workers with type 2 diabetes mellitus. Diabetes Metab Syndr Obes 2018; 11:647-658. [PMID: 30410377 PMCID: PMC6199223 DOI: 10.2147/dmso.s176749] [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] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To investigate the impact of poor eating habits on glycemic and metabolic control, we analyzed the associations between eating behaviors and HbA1c and body mass index (BMI) in Japanese workers with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS The Japan Medical Data Center database of workers' medical health insurance claims was used to identify individuals with T2DM who were receiving antidiabetic medication between April 2012 and March 2015 (the primary analysis population). The database included routine medical check-up results and responses to questions on lifestyle and eating habits. Using these, we retrospectively analyzed the associations between the individuals' eating habits and their HbA1c levels and BMIs. RESULTS In total, 31,722 individuals were included in the primary analysis. The mean values of HbA1c and BMI were 7.27% and 26.29 kg/m2, respectively; these tended to be higher among the younger population. Approximately 36% of the individuals regularly ate supper within 2 hours of bedtime, 14.5% regularly consumed late-night snacks, and 13.4% regularly skipped breakfast. Each of these eating habits correlated significantly with higher HbA1c and BMI. In addition, the population with two or all three of these poor dietary habits showed the highest association with HbA1c ≥7.0% and BMI ≥25 kg/m2. Approximately 38% of workers ate fast. Fast eating was significantly associated with BMI ≥25 kg/m2 but not with HbA1c ≥7.0%. CONCLUSION Poor eating habits were significantly associated with poor glycemic and body weight control in Japanese workers with T2DM. Improved eating habits may help with glycemic and body weight management.
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Affiliation(s)
- Maki Gouda
- Medical Intelligence Department, Ikuyaku. Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan,
| | - Miyuki Matsukawa
- Data Science Department, Ikuyaku. Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation,Osaka, Japan
| | - Hiroaki Iijima
- Medical Affairs Department, Ikuyaku. Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
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Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ Open 2017; 7:e016317. [PMID: 28912194 PMCID: PMC5640112 DOI: 10.1136/bmjopen-2017-016317] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The disease burden of type 2 diabetes mellitus (T2DM) is rising due to suboptimal glycaemic control leading to vascular complications. Medication adherence (MA) directly influences glycaemic control and clinical consequences. This study aimed to assess the MA of patients with T2DM and identify associated factors. DESIGN Analysis of data from a cross-sectional survey and electronic medical records. SETTING Primary care outpatient clinic in Singapore. PARTICIPANTS Adult patients with T2DM. MAIN OUTCOME MEASURES MA to each prescribed oral hypoglycaemic agent (OHA) was measured using the five-question Medication Adherence Report Scale (MARS-5). Low MA is defined as a MARS-R score of <25. Demographic data, clinical characteristics and investigation results were collected to identify factors that are associated with low MA. RESULTS The study population comprised 382 patients with a slight female predominance (53.4%) and a mean±SD age of 62.0±10.4 years. 57.1% of the patients had low MA to at least one OHA. Univariate analysis showed that patients who were younger, of Chinese ethnicity, married or widowed, self-administering their medications or taking fewer (four or less) daily medications tended to have low MA to OHA. Logistic regression revealed that younger age (OR 0.97; 95% CI 0.95 to0.99), Chinese ethnicity (OR 2.80; 95% CI 1.53 to5.15) and poorer glycaemic control (HbA1c level) (OR 1.27; 95% CI 1.06 to1.51) were associated with low MA to OHA. CONCLUSIONS Younger patients with T2DM and of Chinese ethnicity were susceptible to low MA to OHA, which was associated with poorer glycaemic control. Polytherapy was not associated with low MA.
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Affiliation(s)
- Cia Sin Lee
- SingHealth Polyclinics, Singapore, Singapore
| | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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25
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Unnikrishnan R, Anjana RM, Amutha A, Ranjani H, Jebarani S, Ali MK, Narayan K, Mohan V. Younger-onset versus older-onset type 2 diabetes: Clinical profile and complications. J Diabetes Complications 2017; 31:971-975. [PMID: 28410927 DOI: 10.1016/j.jdiacomp.2017.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/28/2017] [Accepted: 03/18/2017] [Indexed: 12/22/2022]
Abstract
AIMS To compare the clinical profile and complications between younger and older onset type 2 diabetes (T2DM) patients at a tertiary care diabetes center in south India. METHODS We compared individuals with T2DM detected at age ≤25years (n=267) and at age≥50years (n=267), matched for gender and duration of diabetes. We reviewed electronic patient charts and extracted data on biochemical parameters (plasma glucose, serum lipids and glycated hemoglobin). We estimated prevalence of complications (retinopathy, nephropathy, neuropathy, and peripheral vascular disease). We examined odds of having each complication, after adjusting for clinical differences between younger- and older-onset T2DM. RESULTS Individuals with younger-onset T2DM had significantly greater glycated hemoglobin (8.7 vs. 7.5%), serum cholesterol (160 vs. 148mg/dl), serum triglycerides (147 vs. 128mg/dl), LDL cholesterol (92 vs. 82mg/dl) and lower HDL cholesterol levels (39 vs. 42mg/dl). However, waist circumference (90.4 vs. 92.6cm) and systolic blood pressure (125 vs. 133mmHg) were significantly higher in older onset T2DM. Prevalence of retinopathy (47.6 vs. 31.0%) was higher in younger onset T2DM while neuropathy (41.8 vs. 9.2%) and peripheral vascular disease (6.2 vs. 1.2%) were higher in older onset T2DM. In multiple logistic regression analysis, after adjusting for glycated hemoglobin, hypertension, and hypercholesterolemia, younger onset T2DM had a higher odds of developing retinopathy [Odds Ratio: 2.19; Confidence Intervals: 1.42-3.38] when compared to older onset T2DM. CONCLUSIONS Younger onset T2DM patients have worse glycemic and lipid control, and higher prevalence of retinopathy compared to older onset T2DM patients. This underscores the need for more aggressive metabolic control in young-onset T2DM.
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Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Anandakumar Amutha
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Harish Ranjani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Saravanan Jebarani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kmv Narayan
- Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India.
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Trikkalinou A, Papazafiropoulou AK, Melidonis A. Type 2 diabetes and quality of life. World J Diabetes 2017; 8:120-129. [PMID: 28465788 PMCID: PMC5394731 DOI: 10.4239/wjd.v8.i4.120] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/24/2016] [Accepted: 01/18/2017] [Indexed: 02/05/2023] Open
Abstract
It is true that a primary goal of diabetes early diagnosis and treatment is quality of life (QoL). The term QoL is still confusing but it is agreed that it composes of four components: The physical component, mental, cogitative component, psychological and social component. Many articles have been written addressing those four components. During the last five years 15500 articles and reviews have been written addressing diabetes and coronary arterial disease, 16100 addressing diabetes and renal function, 28900 addressing diabetes and retinopathy, 16800 addressing diabetic foot ulcers and other 26300 addressing diabetic neuropathy. Moreover 17200 articles are dealing with diabetic sexual dysfunction, 24500 with the correlation of diabetes and depression 17500 about diabetes and dementia, only 1 about diabetes and family functioning and 1950000 about diabetes and QoL, indicating the worldwide interest. In order to confront this metabolic anomaly and its consequences, researchers developed numerous generic and disease specific psychometric tools. With the aid of those psychometric tools the scientific community has started to realize the gruesome effect of diabetes on patients’ lives. Diabetic’s QoL becomes worse when complications start to develop or comorbidities coexist. Dominant amongst complications, in health-related quality of life (HRQoL) lowering, but not related to risk factors (genetic, the weight of birth, or others) is coronary arterial disease followed by renal failure, blindness, and the combination of micro- and macro-vascular complications and in some studies by sexual dysfunction. Moreover many are the comorbidities which deteriorate further the effect of diabetes in a patient life. Among them obesity, hypertension, dyslipidemia, depression, arthritis are the most common. Most intriguing field for research is the interaction of diabetes and depression and in some cases the progression to dementia. Many aspects and combinations of actions are under researchers’ microscope regarding the improvement of HRQoL scores. Until now, the studies performed, have demonstrated little to moderate benefit. More of them are needed to draw safe conclusions on the topic of the best combination of actions to optimize the HRQoL scores.
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27
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Sim SYT, Chin SL, Tan JLK, Brown SJ, Cussons AJ, Stuckey BGA. Polycystic ovary syndrome in type 2 diabetes: does it predict a more severe phenotype? Fertil Steril 2016; 106:1258-1263. [PMID: 27456547 DOI: 10.1016/j.fertnstert.2016.06.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the prevalence of a history of polycystic ovary syndrome (PCOS) in women with type 2 diabetes (DM2) and to compare metabolic and reproductive outcomes between women with and without PCOS. DESIGN Cross-sectional study. SETTING Tertiary hospital. PATIENT(S) Female inpatients age 18-75 years with DM2. INTERVENTION(S) A face-to-face questionnaire was administered. MAIN OUTCOME MEASURE(S) Age at diagnosis of diabetes, history of gestational diabetes, family history of diabetes, and reproductive history, fertility history, number of miscarriages, and morbidity in pregnancy. RESULT(S) One hundred seventy-one inpatients with DM2 participated. The prevalence of a history of PCOS was 37%. Women with PCOS had an earlier mean age of diagnosis of DM2 (44.2 vs. 48.8 years), higher recalled peak body mass index (BMI; 43.1 kg/m2 vs. 36.8 kg/m2), higher rate of gestational diabetes (28% vs. 18%), and higher rate of hypertension in pregnancy (40% vs. 22%). Women with PCOS were less likely to have a family history of DM2 than those without PCOS (45% vs. 67%). CONCLUSION(S) A history of PCOS in women with DM2 is associated with earlier onset of DM2, higher BMI, and a more severe phenotype. Since PCOS subjects were less likely to have a family history of DM2, lack of a family history of DM2 in women with PCOS is not reassuring for DM2 risk. We recommend identifying PCOS in early life and intervening to reduce the risk of diabetes and its comorbidities and suboptimal reproductive outcomes.
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Affiliation(s)
- Stephanie Y T Sim
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
| | - Sian L Chin
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
| | - Jocelyn L K Tan
- Keogh Institute for Medical Research, Nedlands, Western Australia, Australia
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Andrea J Cussons
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Bronwyn G A Stuckey
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia; Keogh Institute for Medical Research, Nedlands, Western Australia, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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28
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Hu H, Hori A, Nishiura C, Sasaki N, Okazaki H, Nakagawa T, Honda T, Yamamoto S, Tomita K, Miyamoto T, Nagahama S, Uehara A, Yamamoto M, Murakami T, Shimizu C, Shimizu M, Eguchi M, Kochi T, Imai T, Okino A, Kuwahara K, Kashino I, Akter S, Kurotani K, Nanri A, Kabe I, Mizoue T, Kunugita N, Dohi S. Hba1c, Blood Pressure, and Lipid Control in People with Diabetes: Japan Epidemiology Collaboration on Occupational Health Study. PLoS One 2016; 11:e0159071. [PMID: 27437997 PMCID: PMC4954688 DOI: 10.1371/journal.pone.0159071] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/27/2016] [Indexed: 01/19/2023] Open
Abstract
Aims The control of blood glucose levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of diabetes complications; however, data are scarce on control status of these factors among workers with diabetes. The present study aimed to estimate the prevalence of participants with diabetes who meet glycated hemoglobin (HbA1c), BP, and LDL-C recommendations, and to investigate correlates of poor glycemic control in a large working population in Japan. Methods The Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study is an ongoing cohort investigation, consisting mainly of employees in large manufacturing companies. We conducted a cross-sectional analysis of 3,070 employees with diabetes (2,854 men and 216 women) aged 20–69 years who attended periodic health examinations. BP was measured and recorded using different company protocols. Risk factor targets were defined using both American Diabetes Association (ADA) guidelines (HbA1c < 7.0%, BP < 140/90 mmHg, and LDL-C < 100 mg/dL) and Japan Diabetes Society (JDS) guidelines (HbA1c < 7.0%, BP < 130/80 mmHg, and LDL-C < 120 mg/dL). Logistic regression models were used to explore correlates of poor glycemic control (defined as HbA1c ≥ 8.0%). Results The percentages of participants who met ADA (and JDS) targets were 44.9% (44.9%) for HbA1c, 76.6% (36.3%) for BP, 27.1% (56.2%) for LDL-C, and 11.2% (10.8%) for simultaneous control of all three risk factors. Younger age, obesity, smoking, and uncontrolled dyslipidemia were associated with poor glycemic control. The adjusted odds ratio of poor glycemic control was 0.58 (95% confidence interval, 0.46–0.73) for participants with treated but uncontrolled hypertension, and 0.47 (0.33–0.66) for participants with treated and controlled hypertension, as compared with participants without hypertension. There was no significant difference in HbA1c levels between participants with treated but uncontrolled hypertension and those with treated and controlled hypertension. Conclusion Data from a large working population, predominantly composed of men, suggest that achievement of HbA1c, BP, and LDL-C targets was less than optimal, especially in younger participants. Uncontrolled dyslipidemia was associated with poor glycemic control. Participants not receiving antihypertensive treatment had higher HbA1c levels.
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Affiliation(s)
- Huanhuan Hu
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | - Ai Hori
- Tokyo Gas Co., Ltd., Tokyo, Japan
| | | | - Naoko Sasaki
- Mitsubishi Fuso Truck and Bus Corporation, Kanagawa, Japan
| | | | | | | | | | | | - Toshiaki Miyamoto
- Nippon Steel & Sumitomo Metal Corporation Kimitsu Works, Chiba, Japan
| | | | | | | | - Taizo Murakami
- Mizue Medical Clinic, Keihin Occupational Health Center, Kanagawa, Japan
| | - Chii Shimizu
- Mizue Medical Clinic, Keihin Occupational Health Center, Kanagawa, Japan
| | - Makiko Shimizu
- Mizue Medical Clinic, Keihin Occupational Health Center, Kanagawa, Japan
| | | | | | | | | | - Keisuke Kuwahara
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Ikuko Kashino
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shamima Akter
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kayo Kurotani
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akiko Nanri
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Isamu Kabe
- Furukawa Electric Co., Ltd., Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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Musenge EM, Michelo C, Mudenda B, Manankov A. Glycaemic Control and Associated Self-Management Behaviours in Diabetic Outpatients: A Hospital Based Observation Study in Lusaka, Zambia. J Diabetes Res 2015; 2016:7934654. [PMID: 26798654 PMCID: PMC4699008 DOI: 10.1155/2016/7934654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The control of diabetes mellitus depends on several factors that also include individual lifestyles. We assessed glycaemic control status and self-management behaviours that may influence glycaemic control among diabetic outpatients. METHODS This cross-sectional study among 198 consenting randomly selected patients was conducted at the University Teaching Hospital diabetic clinic between September and December 2013 in Lusaka, Zambia. A structured interview schedule was used to collect data on demographic characteristics, self-management behaviours, and laboratory measurements. Binary logistic regression analysis using IBM SPSS for Windows version 20.0 was carried out to predict behaviours that were associated with glycaemic control status. RESULTS The proportion of patients that had good glycaemic control status (HbA1c≤ 48 mmol/mol) was 38.7% compared to 61.3% that had poor glycaemic control status (HbA1c≥ 49 mmol/mol). Adherence to antidiabetic treatment and fasting plasma glucose predicted glycaemic control status of the patients. However, self-blood glucose monitoring, self-blood glucose monitoring means and exercise did not predict glycaemic control status of the patients. CONCLUSION We find evidence of poor glycaemic control status among most diabetic patients suggesting that health promotion messages need to take into account both individual and community factors to promote behaviours likely to reduce nonadherence.
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Affiliation(s)
- Emmanuel Mwila Musenge
- Department of Physiological Sciences, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
| | - Charles Michelo
- Department of Public Health, Section for Epidemiology and Biostatistics, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
| | - Boyd Mudenda
- Department of Public Health, Section for Epidemiology and Biostatistics, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
| | - Alexey Manankov
- Department of Physiological Sciences, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
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Tan NC, Barbier S, Lim WY, Chia KS. 5-Year longitudinal study of determinants of glycemic control for multi-ethnic Asian patients with type 2 diabetes mellitus managed in primary care. Diabetes Res Clin Pract 2015; 110:218-23. [PMID: 26385596 DOI: 10.1016/j.diabres.2015.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/15/2015] [Accepted: 07/27/2015] [Indexed: 11/30/2022]
Abstract
AIM This study aims to determine the risk factors associated with glycaemic control of ambulatory patients with type 2 diabetes mellitus (T2DM) who are managed in primary care. METHOD The data was retrieved from a primary care site within the Singapore Consortium of Cohort Studies-Diabetes Cohort (SCCS-DC). Demographic and clinical variables were described, in association with the risk of having a deteriorating glycaemic control (defined as an absolute increase of at least 1% HbA1c from one year to a subsequent year). Next, multivariate model was performed to define the independent effect of each factor. The longitudinal analysis of the HbA1c was performed using Generalised Estimating Equation (GEE). RESULTS The 5 year longitudinal data of 1256 patients (54% Chinese, 25% Malays, 12% Indians, 9% others) were analysed. Their mean HbA1c decreased by <0.1% in the initial 3 years, but increased thereafter. 12% of them had absolute HbA1c increment of ≥1% in the first year, and 22% over 5 years. Based on GEE analysis, insulin, was associated with an increase of HbA1c (≥1%) from one year to another (all p<0.05). Compared with Chinese patients, Malays had higher HbA1c (+0.3%), Indians (+0.3%), and others (+0.2%), (all p<0.01). Patients with retinopathy had higher HbA1c (+0.2%) and those with cataract had lower mean HbA1c (-0.2%) (p<0.01). CONCLUSION Most cohort patients achieved glycaemic control within the initial 3 years. Patients of Malay and Indian ethnicity and those with retinopathy were associated with subsequent risk of glycaemic control deterioration. Those with cataract were associated with trend towards improved glycaemic control.
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Affiliation(s)
- Ngiap Chuan Tan
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Tower 5, #15-10, Connection One, Singapore 150167, Singapore; Duke NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore.
| | - Sylvaine Barbier
- Center for Quantitative Medicine, Duke NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore.
| | - Wei Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
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Huri HZ, Ling DYH, Ahmad WAW. Association between glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with cardiovascular complications. Drug Des Devel Ther 2015; 9:4735-49. [PMID: 26316711 PMCID: PMC4547657 DOI: 10.2147/dddt.s87294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Cardiovascular disease (CVD) is a macrovascular complication in patients with type 2 diabetes mellitus (T2DM). To date, glycemic control profiles of antidiabetic drugs in cardiovascular (CV) complications have not been clearly elucidated. Therefore, this study was conducted retrospectively to assess the association of antidiabetic drugs and glycemic control with CV profiles in T2DM patients. The association of concurrent medications and comorbidities with glycemic control was also investigated. METHODS A total of 220 T2DM patients from the University of Malaya Medical Centre, Malaysia, who had at least one CV complication and who had been taking at least one antidiabetic drug for at least 3 months, were included. The associations of antidiabetics, cardiovascular diseases, laboratory parameters, concurrent medications, comorbidities, demographics, and clinical characteristics with glycemic control were investigated. RESULTS Sulfonylureas in combination (P=0.002) and sulfonylurea monotherapy (P<0.001) were found to be associated with good glycemic control, whereas insulin in combination (P=0.051), and combination biguanides and insulin therapy (P=0.012) were found to be associated with poor glycemic control. Stroke (P=0.044) was the only type of CVD that seemed to be significantly associated with good glycemic control. Other factors such as benign prostatic hyperplasia (P=0.026), elderly patients (P=0.018), low-density lipoprotein cholesterol levels (P=0.021), and fasting plasma glucose (P<0.001) were found to be significantly correlated with good glycemic control. CONCLUSION Individualized treatment in T2DM patients with CVDs can be supported through a better understanding of the association between glycemic control and CV profiles in T2DM patients.
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Affiliation(s)
- Hasniza Zaman Huri
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Clinical Investigation Centre, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Doris Yew Hui Ling
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Clinical Investigation Centre, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
- Cardiology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Gao F, Lam CSP, Sim LL, Koh TH, Foo D, Ong HY, Tong KL, Tan HC, Machin D, Wong KS, Chan MYY, Chua TSJ. Impact of the joint association between sex, age and diabetes on long-term mortality after acute myocardial infarction. BMC Public Health 2015; 15:308. [PMID: 25885528 PMCID: PMC4423520 DOI: 10.1186/s12889-015-1612-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of sex, and its joint effect with age and diabetes mellitus, on mortality subsequent to surviving an acute myocardial infarction (AMI) beyond 30 days are unclear. The high prevalence of diabetes mellitus in an ethnically diverse Asian population motivates this study. METHODS The study population comprised of a nationwide cohort of Asian patients with AMI, hospitalized between 2000 to 2005, who survived the first 30 days post-admission and were followed prospectively until death or 12 years. RESULTS Among the 13,389 survivors, there were fewer women (25.5%) who were older than men (median 70 vs. 58 years) and a larger proportion had diabetes mellitus at admission (51.4% vs. 31.4%). During follow-up 4,707 deaths (women 13.2%; men 22.0%) occurred, with women experiencing higher mortality than men with an averaged hazard ratio (HR): 2.08; 95% confidence interval : 1.96-2.20. However the actual adverse outcome, although always greater, reduced over time with an estimated HR: 2.23 (2.04-2.45) at 30 days to HR: 1.75; (1.47-2.09) 12 years later. The difference in mortality also declined with increasing age: HR 1.80 (1.52-2.13) for those aged 22-59, 1.26 (1.11-1.42) for 60-69, 1.06 (0.96-1.17) and 0.96 (0.85-1.09) for those 70-79 and 80-101 years. Significant two-factor interactions were observed between sex, age and diabetes (P < 0.001). Diabetic women <60 years of age had greater mortality than diabetic men of the same age (adjusted HR: 1.44; 1.14-1.84; P = 0.003), while diabetic women and men ≥60 years of age had a less pronounced mortality difference (adjusted HR: 1.12; 0.99-1.26). CONCLUSIONS One in two women hospitalized for AMI in this Asian cohort had diabetes and the sex disparity in post-MI mortality was most pronounced among these who were <60 years of age. This underscores the need for better secondary prevention in this high-risk group.
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Affiliation(s)
- Fei Gao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Carolyn Su Ping Lam
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - Ling Ling Sim
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - Tian Hai Koh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - David Foo
- Cardiac Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Hean Yee Ong
- Khoo Teck Puat Hospital, 378 Alexandra Road, Singapore, 159964, Singapore.
| | - Khim Leng Tong
- Changi General Hospital, Simei Street 3, Singapore, 529889, Singapore.
| | - Huay Cheem Tan
- National University Heart Centre Singapore, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - David Machin
- Medical Statistics Group, School of Health and Related Sciences, University of Sheffield, Regents Court, 30 Regent Street, Sheffield, S1 4DA, UK. .,Department of Cancer Studies and Molecular Medicine, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
| | - Kok Seng Wong
- Singapore General Hospital, 1 Hospital Drive, Singapore, 169608, Singapore.
| | - Mark Yan Yee Chan
- National University Heart Centre Singapore, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Browne JL, Nefs G, Pouwer F, Speight J. Depression, anxiety and self-care behaviours of young adults with Type 2 diabetes: results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Study. Diabet Med 2015; 32:133-40. [PMID: 25131861 DOI: 10.1111/dme.12566] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/08/2014] [Accepted: 08/11/2014] [Indexed: 01/21/2023]
Abstract
AIM Young adults with Type 2 diabetes have higher physical morbidity and mortality than other diabetes sub-groups, but differences in psychosocial outcomes have not yet been investigated. We sought to compare depression and anxiety symptoms and self-care behaviours of young adults with Type 2 diabetes with two matched control groups. METHODS Using cross-sectional survey data from the Australian and Dutch Diabetes Management and Impact for Long-term Empowerment and Success (MILES) studies, we matched 93 young adults (aged 18-39 years) with Type 2 diabetes (case group) with: (i) 93 older adults ( ≥ 40 years) with Type 2 diabetes (Type 2 diabetes control group; matched on country, gender, education, diabetes duration and insulin use) and (ii) 93 young adults with Type 1 diabetes (Type 1 diabetes control group; matched on country, gender, age and education). Groups were compared with regard to depression symptoms (nine-item Patient Health Questionnaire), anxiety symptoms (seven-item Generalised Anxiety Disorder questionnaire) and frequency of selected self-care behaviours (single item per behaviour). RESULTS Participants in the case group had higher depression scores (Cohen's d = 0.40) and were more likely to have clinically meaningful depressive symptoms (Cramer's V = 0.23) than those in the Type 2 diabetes control group. Participants in the case group had statistically equivalent depression scores to the Type 1 diabetes control group. The groups did not differ in anxiety scores. Those in the case group were less likely than both control groups to take insulin as recommended (Cramer's V = 0.24-0.34), but there were no significant differences between the groups in oral medication-taking. The case group were less likely than the Type 2 diabetes control group to eat healthily (Cramer's V = 0.16), and less likely than the Type 1 diabetes control group to be physically active (Cramer's V = 0.15). CONCLUSIONS Our results suggest that Type 2 diabetes is as challenging as Type 1 diabetes for young adults and more so than for older adults. Young adults with Type 2 diabetes may require more intensive psychological and self-care support than their older counterparts.
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Affiliation(s)
- J L Browne
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia - Vic, Melbourne, VIC, Australia; Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood VIC, Australia
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Noureddine H, Nakhoul N, Galal A, Soubra L, Saleh M. Level of A1C control and its predictors among Lebanese type 2 diabetic patients. Ther Adv Endocrinol Metab 2014; 5:43-52. [PMID: 25126407 PMCID: PMC4132378 DOI: 10.1177/2042018814544890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM Lebanon is among the top 10 countries with the highest prevalence of diabetes in the Middle East region with estimates reaching as high as 16.6% in adults aged 20-79 years. The objective of this study was to assess the level of A1C control among a cohort of type 2 diabetic patients and factors associated with uncontrolled A1C. METHODS We carried out a retrospective observational study among type 2 diabetes mellitus patients attending an outpatient endocrinologist's clinic between June 2008 and July 2012 in Beirut, Lebanon. Two groups were compared, based on their diabetic control (A1C < 7% and A1C ≥ 7%). RESULTS A total of 551 patients were included in this study, where 31.8% attained A1C control. Crude analyses showed that some factors were significantly associated with uncontrolled A1C, and these were long-standing diabetes, diabetes-related complications, uncontrolled blood pressure, lipid profile, as well as the use of metformin, sulfonylurea, or insulin. When multivariate analysis was carried out, the chances of having uncontrolled A1C were significantly higher among patients who developed neuropathy (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11-3.90), had uncontrolled triglycerides (OR 1.98, 95% CI 1.33-2.94), used insulin (OR 4.52, 95% CI 2.32-8.83), and sulfonylureas (OR 2.88, 95% CI 1.88-4.40). CONCLUSION Uncontrolled diabetes is more likely to exist in patients with neuropathy, uncontrolled triglycerides and those using insulin or sulfonylurea. Further research is needed to confirm the findings.
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Affiliation(s)
- Hanan Noureddine
- Department of Pharmacy Practice, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Nancy Nakhoul
- American University of Beirut, School of Medicine, Beirut, Lebanon
| | - Amal Galal
- Beirut Arab University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics, Beirut, Lebanon
| | - Lama Soubra
- Department of Pharmacy Practice, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Mounzer Saleh
- American University of Beirut, School of Medicine, Beirut, Lebanon
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Pihau-Tulo ST, Parsons RW, Hughes JD. An evaluation of patients' adherence with hypoglycemic medications among Papua New Guineans with type 2 diabetes: influencing factors. Patient Prefer Adherence 2014; 8:1229-37. [PMID: 25258517 PMCID: PMC4172082 DOI: 10.2147/ppa.s66655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aims of this study were to evaluate the extent of adherence to hypoglycemic medications, assess the relationship between adherence and glycemic control, and evaluate factors affecting adherence. RESEARCH DESIGN AND METHODS This was a cross-sectional study of patients with established type 2 diabetes attending the Port Moresby General Hospital Diabetes Clinic. Face-to-face interviews were conducted using a questionnaire designed for the study and data were collected concerning the 3 months prior to interview. The questionnaire covered demographic details, lifestyle, biochemical and physical measurements, and medication management. Glycemic control was investigated among patients adhering to their medications (not missing doses) to different degrees (100%, 95%, 90%, and 80%). RESULTS Of a total of 356 participants who were prescribed hypoglycemic medications, 59.6% omitted some of their doses. Age appeared to have a significant impact on adherence at some levels of adherence, with those aged >60 years being more likely to be adherent (logistic regression). Those who were 95%-99% and those who were <80% adherent had a statistically significant risk of a high glycated hemoglobin of >10% (85.5 mmol/mol). Multiple factors were identified as contributors to nonadherence, with patient-based issues (86.0%) and the health care system (21.7%) being the most common. CONCLUSION This study showed a significant level of nonadherence among patients with type 2 diabetes in Papua New Guinea. Nonadherence to medication appeared to be associated with poor glycemic control and was due to a variety of reasons. Future interventions aimed at improving adherence will need to take these into account.
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Affiliation(s)
| | - Richard W Parsons
- CHIRI and School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Jeffery D Hughes
- CHIRI and School of Pharmacy, Curtin University, Perth, WA, Australia
- Correspondence: Jeffery D Hughes, School of Pharmacy, Curtin University, GPO Box U1987, Perth, WA 6845, Australia, Tel +61 8 9266 7367, Fax +61 8 9266 2769, Email
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