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Carter N, Li J, Xu M, Li L, Xu S, Fan X, Zhu S, Chahal P, Chattopadhyay K. Lifestyle behaviours and associated factors among people with type 2 diabetes attending a diabetes clinic in Ningbo, China: A cross-sectional study. PLoS One 2023; 18:e0294245. [PMID: 37988393 PMCID: PMC10662728 DOI: 10.1371/journal.pone.0294245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
The burden of type 2 diabetes (T2DM) in China is significant and growing, and this is reflected in high rates of T2DM in the city of Ningbo, China. Consequent impacts on morbidity, mortality, healthcare expenditure, and health-related quality of life, make this a problem of the utmost importance to address. One way to improve T2DM outcomes is to address lifestyle behaviours that may affect prognosis and complications, such as physical activity levels, dietary habits, smoking status, and alcohol intake. A cross-sectional survey was undertaken to describe the prevalence of being physically active, having a healthy diet, currently smoking, and currently drinking alcohol among people living with T2DM attending a diabetes clinic in Ningbo, China. Regression analysis was used to determine the factors associated with these lifestyle behaviours. We found a high prevalence of a healthy diet (97.8%, 95% CI 96.5-98.7%). Prevalence of being physically active (83.4%, 95% CI 80.6-85.9%), smoking (21.6%, 95% CI 18.8-24.6%), and alcohol drinking (32.9%. 95% CI 29.6-36.2%) appeared in keeping with those of the general population. Marked associations were demonstrated between male sex and smoking (OR 41.1, 95% CI 16.2-139.0), and male sex and alcohol drinking (OR 4.00, 95% CI 2.62-6.20). Correlation between lifestyle factors was demonstrated including between alcohol drinking and smoking, and between physical activity and reduced smoking. General diabetes self-management education programmes that address multiple lifestyle risk factors simultaneously may be beneficial in this population. Specific interventions targeting smoking cessation and reduction in alcohol drinking may be of benefit to men living with T2DM attending a diabetes clinic in Ningbo.
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Affiliation(s)
- Naomi Carter
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jialin Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Miao Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Li Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Shengnan Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xuelan Fan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Shuyan Zhu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Prit Chahal
- Health Education England, Leeds, United Kingdom
| | - Kaushik Chattopadhyay
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare, A JBI Centre of Excellence, Nottingham, United Kingdom
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Nishida S, Kato T, Hayashi Y, Yamada S, Fujii H, Yamada M, Asai N, Shimizu S, Niwa T, Iihara H, Kubota S, Sakai M, Takahashi Y, Takao K, Mizuno M, Hirota T, Kobayashi R, Horikawa Y, Yabe D, Suzuki A. Effectiveness of countermeasure for polypharmacy by multidisciplinary team review in patients with diabetes mellitus. J Diabetes Investig 2023; 14:1202-1208. [PMID: 37357565 PMCID: PMC10512905 DOI: 10.1111/jdi.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023] Open
Abstract
AIMS/INTRODUCTION Polypharmacy in diabetes patients is related to worse clinical outcomes. The aim of this study was to evaluate the usefulness of our countermeasure for polypharmacy, which combines a pharmacist check followed by a multidisciplinary team review in diabetic patients with polypharmacy. METHODS A single-center, retrospective observational study was conducted at Gifu University Hospital. Study participants included diabetic patients taking six or more drugs on admission to the diabetes ward between July 2021 and June 2022. Drugs which were discontinued by the present countermeasure were examined, and the number of drugs being taken by each patient was compared between admission and discharge. RESULTS 102 of 308 patients were taking six or more drugs on admission. The drugs being taken by these patients were evaluated by pharmacists using a checklist for polypharmacy. Eighty-four drugs which were evaluated as inappropriate or potentially inappropriate medications by pharmacists were discontinued following the multidisciplinary team review. The median and mean number of drugs taken by the 102 patients significantly decreased from 9.0 (IQR: 8-12) and 9.26 ± 2.64 on admission to 9.0 (IQR: 6-10) and 8.42 ± 2.95 on discharge (P = 0.0002). We followed up with these patients after discontinuation of the drugs and confirmed that their clinical status had not deteriorated. CONCLUSION The present countermeasure for polypharmacy, which combines a pharmacist check based on a checklist for evaluating polypharmacy followed by a multidisciplinary team review, was useful for reducing the number of inappropriate or potentially inappropriate medications taken by diabetes patients with polypharmacy.
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Affiliation(s)
| | - Takehiro Kato
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Yuichi Hayashi
- Faculty of Nursing ScienceTsuruga Nursing UniversityTsurugaJapan
| | - Shoya Yamada
- Department of PharmacyGifu University HospitalGifuJapan
| | | | - Michi Yamada
- Department of PharmacyGifu University HospitalGifuJapan
| | - Nao Asai
- Department of PharmacyGifu University HospitalGifuJapan
| | | | - Takashi Niwa
- Department of PharmacyGifu University HospitalGifuJapan
| | - Hirotoshi Iihara
- Department of PharmacyGifu University HospitalGifuJapan
- Patient Safety DivisionGifu University HospitalGifuJapan
| | - Sodai Kubota
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Mayu Sakai
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Yoshihiro Takahashi
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Ken Takao
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Masami Mizuno
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Takuo Hirota
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
| | - Ryo Kobayashi
- Department of PharmacyGifu University HospitalGifuJapan
- Laboratory of Advanced Medical PharmacyGifu Pharmaceutical UniversityGifuJapan
| | - Yukio Horikawa
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
- Center for Patient Flow ManagementGifu University HospitalGifuJapan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and MetabolismGifu University Graduate School of MedicineGifuJapan
- Department of Rheumatology and Clinical ImmunologyGifu University Graduate School of MedicineGifuJapan
- Center for One Medicine Innovative Translational ResearchGifu University Institute for Advanced StudyGifuJapan
- Preemptive Food Research CenterGifu University Institute for Advanced StudyGifuJapan
- Center for Research, Education and Lifestyle DesignGifu UniversityGifuJapan
| | - Akio Suzuki
- Department of PharmacyGifu University HospitalGifuJapan
- Laboratory of Advanced Medical PharmacyGifu Pharmaceutical UniversityGifuJapan
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Zafar R, Rehman IU, Shah Y, Ming LC, Goh HP, Goh KW. Comparative analysis of potential drug-drug interactions in a public and private hospital among chronic kidney disease patients in Khyber Pakhtunkhwa: A retrospective cross-sectional study. PLoS One 2023; 18:e0291417. [PMID: 37773947 PMCID: PMC10540949 DOI: 10.1371/journal.pone.0291417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a significant public health challenge due to its rising incidence, mortality, and morbidity. Patients with kidney diseases often suffer from various comorbid conditions, making them susceptible to potential drug-drug interactions (pDDIs) due to polypharmacy and multiple prescribers. Inappropriate prescriptions for CKD patients and their consequences in the form of pDDIs are a major challenge in Pakistan. AIM This study aimed to compare the incidence and associated risk factors of pDDIs among a public and private sector hospital in Khyber Pakhtunkhwa, Pakistan. METHOD A retrospective cross-sectional study design was conducted to compare pDDIs among public and private sector hospitals from January 2023 to February 2023. Patients profile data for the full year starting from January 1 2022 to December 302022, was accessed All adult patients aged 18 years and above, of both genders, who currently have or have previously been diagnosed with end-stage renal disease (ESRD) were included. For assessing pDDIs, patient data was retrieved and checked using Lexicomp UpToDate® for severity and documentation of potential drug-drug interactions. RESULTS A total of 358 patients' data was retrieved (with n = 179 in each hospital); however, due to incomplete data, n = 4 patients were excluded from the final analysis. The prevalence of pDDIs was found to be significantly higher in private hospitals (84.7%) than in public hospitals (26.6%), with a p-value <0.001. Patients in the age category of 41-60 years (AOR = 6.2; p = 0.008) and those prescribed a higher number of drugs (AOR = 1.2; p = 0.027) were independently associated with pDDIs in private hospitals, while the higher number of prescribed drugs (AOR = 2.9; p = <0.001) was an independent risk factor for pDDIs in public hospitals. The majority of pDDIs (79.0%) were of moderate severity, and a significant number of patients (15.1%) also experienced major pDDIs, with a p-value <0.001. The majority of pDDIs had fair documentation for reliability rating in both public and private hospitals. CONCLUSION The prevalence of pDDIs was higher among CKD patients at private hospitals, and most of the pDDIs were of moderate severity. A considerable number of patients also experienced major pDDIs. The risk of experiencing pDDIs was found to be higher in older patients and among those prescribed a higher number of drugs.
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Affiliation(s)
- Roheena Zafar
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
- Department of Pharmacy, North West General Hospital and Research Center, Hayatabad Peshawar, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Yasar Shah
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Hui Poh Goh
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
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Zong Q, Feng Z, Wang J, Zheng Z, Chen C, Feng D. Is shared decision-making a determinant of polypharmacy in older patients with chronic disease? A cross-sectional study in Hubei Province, China. BMC Geriatr 2023; 23:258. [PMID: 37118790 PMCID: PMC10148389 DOI: 10.1186/s12877-023-03968-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/13/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Shared decision-making(SDM) is recognized as an important means of managing polypharmacy among older people with chronic diseases. However, no studies have quantitatively measured the effect of SDM on polypharmacy. The objective of this study was to compare the impact of SDM and other factors on polypharmacy in inpatients and community patients. Additionally, the study aimed to compare the impact of different decision types on polypharmacy in community patients. METHODS This is a population-based multicenter retrospective study conducted in Hubei Province, China. A cluster sampling approach was used to recruit 536 chronic disease inpatients from March to April 2019, and 849 community patients were recruited from April to June 2021. Propensity score weighting was used to control the confounding variables and determine the net effect of SDM on polypharmacy. RESULTS Among the 536 hospitalized patients, the prevalence of polypharmacy was 56.3%. A high level of SDM was significantly associated with a lower risk of polypharmacy. Patients with chronic illnesses aged 76 years and older and with an annual family income of 24,001-36,000 yuan were associated with a lower likelihood of polypharmacy (p < 0.05). Multimorbidity was often accompanied by the occurrence of multiple medication use. Among 849 community patients, the prevalence of polypharmacy was 21.8%. Among types of decision-making, informed and paternalistic decision-making showed a higher likelihood of polypharmacy compared with shared decision-making (P < 0.05). Male, older patients over 76 years of age, urban residents, annual household income of 12,001-24,000 yuan, and multimorbidity were associated with higher likelihood of polypharmacy (P < 0.05). Patients with an annual household income of 24,001-36,000 yuan, 36,001 yuan or more, and good medication compliance showed a lower likelihood of polypharmacy (P < 0.05). CONCLUSIONS The prevalence of polypharmacy is high among China's older population with chronic disease who should be paid more atthention by the healthcare providers. Additionaly, encouraging the patients' attendance in SDM, reducing paternalistic and informed decision-making during prescribing, improving patient medication compliance, and increasing the promotion and guidance of rational medication use for patients are essential to reduce polypharmacy in Chinese chronic disease patients.
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Affiliation(s)
- Qiao Zong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jia Wang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zehao Zheng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chaoyi Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Iqbal A, Richardson C, Iqbal Z, O’Keefe H, Hanratty B, Matthews FE, Todd A. Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis. BMC Geriatr 2023; 23:149. [PMID: 36934249 PMCID: PMC10024437 DOI: 10.1186/s12877-023-03835-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status. METHODS A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. RESULTS Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. CONCLUSIONS There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.
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Affiliation(s)
- Anum Iqbal
- grid.1006.70000 0001 0462 7212School of Pharmacy, Population Health Sciences Institute, Newcastle University, King George VI Building, King’s Road, Newcastle Upon Tyne, NE1 7RU England
| | - Charlotte Richardson
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
| | - Zain Iqbal
- grid.419481.10000 0001 1515 9979Novartis International, Basel, Switzerland
| | - Hannah O’Keefe
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Barbara Hanratty
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Fiona E. Matthews
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Adam Todd
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
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Yu J, Li J, Xu M, Li L, Chattopadhyay K. Dissatisfaction of people with type 2 diabetes with the care received at a diabetes clinic in Ningbo, China: A cross-sectional study. Health Sci Rep 2022; 5:e927. [PMID: 36324426 PMCID: PMC9621465 DOI: 10.1002/hsr2.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
Aim The study aimed to assess the dissatisfaction of people with type 2 diabetes mellitus (T2DM) with the care that they received at a diabetes outpatient clinic in Ningbo, China and to determine the associated factors. Methods A cross‐sectional study was conducted among 406 adults with T2DM in 2020–2021. Those who were treated at the diabetes outpatient clinic for at least six consecutive months before the survey date were eligible. The Short Assessment of Patient Satisfaction scale was used to assess participants' dissatisfaction with the care that they received. Results Of the participants, 25.1% were not satisfied with the care that they received at the diabetes outpatient clinic in Ningbo. The odds of dissatisfaction were higher in physically active people compared to those who were not (odds ratio [OR]: 3.41; 95% confidence interval [CI]: 1.56–7.45) and those with >1–5 years of T2DM compared to ≤1 year (OR: 2.18; 95% CI: 1.05–4.53). Conclusion A quarter of people with T2DM were dissatisfied with the care that they received at the diabetes outpatient clinic in Ningbo, China, and the factors associated with dissatisfaction were identified.
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Affiliation(s)
- Jingjia Yu
- Department of Endocrinology and MetabolismNingbo First HospitalNingboPeople's Republic of China
| | - Jialin Li
- Department of Endocrinology and MetabolismNingbo First HospitalNingboPeople's Republic of China
| | - Miao Xu
- Department of Endocrinology and MetabolismNingbo First HospitalNingboPeople's Republic of China
| | - Li Li
- Department of Endocrinology and MetabolismNingbo First HospitalNingboPeople's Republic of China
| | - Kaushik Chattopadhyay
- Lifespan and Population Health Academic Unit, School of MedicineUniversity of NottinghamNottinghamUK
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Bradley MD, Arnold ME, Biskup BG, Campbell TM, Fuhrman J, Guthrie GE, Kelly JH, Lacagnina S, Loomis JF, McMacken MM, Trapp C, Karlsen MC. Medication Deprescribing Among Patients With Type 2 Diabetes: A Qualitative Case Series of Lifestyle Medicine Practitioner Protocols. Clin Diabetes 2022; 41:163-176. [PMID: 37092156 PMCID: PMC10115617 DOI: 10.2337/cd22-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study is a qualitative case series of lifestyle medicine practitioners' protocols for medication de-escalation in the context of reduced need for glucose-lowering medications due to lifestyle modifications. Increasing numbers of lifestyle medicine practitioners report achieving reductions in medications among patients with type 2 diabetes, and in some cases remission, but limited data exist on the clinical decision-making process used to determine when and how medications are deprescribed. Practitioners interviewed here provide accounts of their deprescribing protocols. This information can serve as pilot data for other practitioners seeking examples of how deprescribing in the context of lifestyle medicine treatment is conducted.
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Affiliation(s)
- Michael D. Bradley
- University of North Texas Health Science Center School of Public Health, Fort Worth, TX
| | - Matthew E. Arnold
- Genesis Quad Cities Family Medicine Residency Program, Genesis Health System, Davenport, IA
| | | | | | | | - George E. Guthrie
- Advent Health Allopathic Family Medicine Residency, Winter Park, FL
- Loma Linda University School of Medicine, Loma Linda, CA
| | - John H. Kelly
- Loma Linda University School of Medicine, Loma Linda, CA
| | | | | | - Michelle M. McMacken
- New York University Grossman School of Medicine, New York, NY
- NYC Health + Hospitals/Bellevue, New York
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Cheng C, Bai J. Association Between Polypharmacy, Anxiety, and Depression Among Chinese Older Adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey. Clin Interv Aging 2022; 17:235-244. [PMID: 35283629 PMCID: PMC8909463 DOI: 10.2147/cia.s351731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate the association between polypharmacy, anxiety, and depression among Chinese older adults. Patients and Methods The data used in this study were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the 2018 wave. Polypharmacy status was measured by the accumulation of self-reported medications. Anxiety and depression were assessed by the Generalized Anxiety Disorder (GAD-7) scale and the Center for Epidemiologic Studies Depression Scale (CES-D-10), respectively. Logistic regression models were performed. Results A total of 2484 Chinese older adults (female: 1321, 53.2%) aged from 60 to 117 years old were included in the analysis. Regression analysis showed that polypharmacy was associated with depression after controlling for the covariates. No association was observed between polypharmacy and anxiety. Conclusion There was a suggestive link between polypharmacy and depression among Chinese older adults. Having polypharmacy might be an indicator for the possible depression among this population, but a comprehensive assessment of polypharmacy is necessary.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Cheng Cheng, Tel/Fax +86-21-64431003, Email
| | - Jie Bai
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
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Al Shidhani A, Al Salmani A, Al Saidi Y, Al Shehhi M, Al Khanjari H, Al Aamri M, Al Hadabi F. Polypharmacy and Medication Compliance among Patients with Type 2 Diabetes in Oman: A Cross-Sectional Study. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/zimw7hb8od] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Zhang XM, Jiao J, Guo N, Bo HX, Xu T, Wu XJ. Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study. Geriatr Gerontol Int 2021; 21:810-817. [PMID: 34318576 DOI: 10.1111/ggi.14245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
AIM Polypharmacy is prevalent among older adults and has been mainly reported to be associated with falls among community-dwelling or nursing home residents. Our study aimed to investigate the relationship between polypharmacy and falls among older Chinese hospitalized patients. METHODS A nationwide prospective cohort study included 9062 participants in six hospitals from China aged ≥65 years, with a 1-year follow-up period. Baseline polypharmacy and other health-related variables were collected when older inpatients were recruited on hospital admission. Polypharmacy was defined as patients who have taken five medications or more. Well-trained nurses assessed falls by telephone at follow up. We used multivariate logistic regression analysis to examine the association between polypharmacy and the risk of falls based on cross-sectional analyses and longitudinal analyses. RESULTS Of 9062 participants, the mean age was 72.42 years (SD= 5.69), and 5228 (57.69%) were men. After fully adjusted for age, sex, education, depression, cognitive impairment, low handgrip strength, frailty, various hospitals, and nutritional status, the cross-sectional and longitudinal analyses showed that inpatients with polypharmacy had an increased risk of falls (OR 1.37, 95%CI 1.17-1.56 for the cross-sectional association; OR 1.43, 95% CI 1.01-2.03 for the longitudinal association, respectively), compared with those without polypharmacy. In addition, subgroup analyses of the association between polypharmacy and 1-year falls, or history of falls was unchanged. CONCLUSIONS Polypharmacy was prevalent among older Chinese hospitalized patients and was an independent risk factor of 1-year falls, suggesting that clinicians should make a comprehensive assessment of medications, and deprescribing strategies should be implemented to reduce unnecessary medications for decreasing the rate of falls. Geriatr Gerontol Int 2021; 21: 810-817.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Na Guo
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Hai-Xin Bo
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xin-Juan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
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Guo L, Zheng J, Pan Q, Zhang Q, Zhou Y, Wang W, Zhang L, Tesfaye S, Zhang J. Changes in Direct Medical Cost and Medications for Managing Diabetes in Beijing, China, 2016 to 2018: Electronic Insurance Data Analysis. Ann Fam Med 2021; 19:332-341. [PMID: 34264834 PMCID: PMC8282298 DOI: 10.1370/afm.2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although the cost and complexity of managing diabetes is increasing around the world, placing greater burden on patients and their families, the cost of drug regimens prescribed to Chinese patients has not been evaluated. This study was conducted to evaluate the temporal changes in the costs and drugs used for people with diabetes. METHODS Patients enrolled in Beijing Medical Insurance with outpatient medical records from 2016 through 2018 were included in this study. The outcomes of interest were: (1) the number of outpatient medications, (2) the number of comorbidities diagnosed, (3) the estimated annual cost of the outpatient drug regimen, (4) the drug therapy strategies used for diabetic patients, and (5) the most commonly prescribed classes of drugs. RESULTS Over the 3-year period, there was a significant decrease (9.0%, P <.001) in the average number of diabetes medications used. Both antiglycemic and non-antiglycemic drug use decreased by 3.6% and 12.9%, respectively. Similarly, for estimated annual costs of medication, an 18.4% (P <.05) decrease was observed, with a gradual decreased from ¥6,868 ($1,059) in 2016 to ¥5,605 ($865) in 2018. CONCLUSION This is the first large-scale cost analysis of the medical management of diabetes since the implementation of medical insurance in China. Despite the increasing availability of newer, more expensive diabetes drugs, there was a significant reduction in the number of diabetes medications used, that may be due to a more rational approach to optimizing metabolic targets.
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Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jie Zheng
- Beijing Municipal Medical Insurance Bureau, Beijing, PR China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Qun Zhang
- Department of Medical Insurance, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yan Zhou
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Jie Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
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Min HK, Sung SA, Chung W, Kim YH, Chae DW, Ahn C, Oh KH, Park SK, Lee SW. Polypharmacy and the Progression of Chronic Kidney Disease: Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease. Kidney Blood Press Res 2021; 46:460-468. [PMID: 34091449 DOI: 10.1159/000516029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The renal hazard of polypharmacy has never been evaluated in predialysis chronic kidney disease (CKD) patients. OBJECTIVE We aimed to analyze the renal hazard of polypharmacy in predialysis CKD patients with stage 1-5. METHOD The data of 2,238 patients from a large-scale multicenter prospective Korean study (2011-2016), excluding 325 patients with various missing data, were reviewed. Polypharmacy was defined as taking 6 or more medications at the time of enrollment; renal events were defined as a ≥50% decrease in kidney function from baseline values, doubling of the serum creatinine levels, or initiation of renal replacement treatment. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox proportional-hazard regression analysis. RESULTS Of the 1,913 patients, the mean estimated glomerular filtration rate was 53.6 mL/min/1.73 m2. The mean medication count was 4.1, and the prevalence of polypharmacy was 27.1%. During the average period of 3.6 years, 520 patients developed renal events (27.2%). Although increased medication counts were associated with increased renal hazard with HR (95% CI) of 1.056 (1.007-1.107, p = 0.025), even after adjusting for various confounders, adding comorbidity score and kidney function nullified the statistical significance. In mediation analysis, 55.6% (p = 0.016) of renal hazard in increased medication counts was mediated by the kidney function, and there was no direct effect of medication counts on renal event development. In subgroup analysis, the renal hazard of the medication counts was evident only in stage 1-3 of CKD patients (p for interaction = 0.014). CONCLUSIONS We cannot identify the direct renal hazard of multiple medications, and most of the potential renal hazard was derived from intimate relationship with disease burden and kidney function.
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Affiliation(s)
- Hyang Ki Min
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Su Ah Sung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Uijeongbu, Republic of Korea
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13
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Polypharmacy among people living with type 2 diabetes mellitus in rural communes in Vietnam. PLoS One 2021; 16:e0249849. [PMID: 33831073 PMCID: PMC8031303 DOI: 10.1371/journal.pone.0249849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives People with diabetes are at high risk of polypharmacy owing to complex treatment of diabetes and comorbidities. Polypharmacy is associated with increased risk of adverse reactions and decreased compliance. Therefore, the objectives of this study were to assess polypharmacy in people with type 2 diabetes (T2D) and associated diabetes-related factors in rural areas in Vietnam. Method People with T2D (n = 806) who had received treatment for diabetes at a district hospital were invited to participate in a questionnaire-based cross-sectional survey. Polypharmacy was defined as ≥5 types of medicine and assessed as a) prescription medicine and non-prescription/over the counter (OTC) medicine and b) prescription medicine and non-prescription/OTC, herbal and traditional medicine, and dietary supplement. Multiple logistic regression was used to investigate the association between polypharmacy and diabetes specific factors: duration, comorbidities and diabetes-related distress. Results Of the people with T2D, 7.8% had a medicine use corresponding to polypharmacy (prescription medicine and non-prescription/OTC), and 40.8% when herbal and traditional medicine, and dietary supplement were included. Mean number of medicine intake (all types of medicines and supplements) were 3.8±1.5. The odd ratios (ORs) of polypharmacy (medicine and supplements) increased with diabetes duration (<1–5 years OR = 1.66; 95%CI: 1.09–2.53 and >5 years OR = 1.74; 95%CI: 1.14–2.64 as compared to ≤1-year duration of diabetes), number of comorbidities (1–2 comorbidities: OR = 2.0; 95%CI: 1.18–3.42; ≥3 comorbidities: OR = 2.63;95%CI: 1.50–4.61 as compared to no comorbidities), and suffering from diabetes-related distress (OR = 1.49; 95%CI: 1.11–2.01) as compared to those without distress. Conclusions In rural northern Vietnam, persons with longer duration of T2D, higher number of comorbidities and diabetes-related stress have higher odds of having a medicine use corresponding to polypharmacy. A high proportion of people with T2D supplement their prescription, non-prescription/OTC medicine with herbal and traditional medicine and dietary supplements.
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14
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Lorber M, Kmetec S, Mlinar Reljić N, Fekonja Z. Diabetes management of older adults in nursing homes: A retrospective study. J Nurs Manag 2021; 29:1293-1301. [PMID: 33482053 DOI: 10.1111/jonm.13268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023]
Abstract
AIM To examine the diabetes management of older adults in nursing homes. BACKGROUND Diabetes is an increasing problem in nursing homes, and diabetes care is defined as a neglected clinical area. METHODS A retrospective collected data review of 166 older adults with known diabetes from four nursing homes. RESULTS 65% older than 75 years had HbA1c levels lower than 7.5% (58 mmol/mol), 74% older than 85 years had HbA1c levels lower than 8% (64 mmol/mol). The HbA1c levels were 7.3% (56 mmol/mol) for those who had three and more chronic disorders and 6.8% (51 mmol/mol) for those who had less than three chronic disorders. Individuals treated with insulin had higher HbA1c levels (p < .001) and glycaemia (p = .002). Age was associated with a number of chronic disorders (p = .031), a number of regularly prescribed medications (p = .038) and a number of medications as needed (p = .009). CONCLUSIONS More than half to three quarters have diabetes well-managed. Nevertheless, there is still some potential for improving diabetes care, and these findings warrant further research for improving diabetes management of older adults in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT Interventions designed to promote a healthy lifestyle, documenting individuals' target level and regular monitoring of glycaemia and HbA1c levels may help to improve diabetes management, which may result in better well-being and quality of life for older adults with diabetes in nursing homes.
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Affiliation(s)
- Mateja Lorber
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | | | - Zvonka Fekonja
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Li X, Chattopadhyay K, Xu S, Chen Y, Xu M, Li L, Li J. Prevalence of comorbidities and their associated factors in patients with type 2 diabetes at a tertiary care department in Ningbo, China: a cross-sectional study. BMJ Open 2021; 11:e040532. [PMID: 33414143 PMCID: PMC7797259 DOI: 10.1136/bmjopen-2020-040532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To determine the prevalence of comorbidities in patients with type 2 diabetes mellitus (T2DM) and identify the factors independently associated with comorbidities in a tertiary care department in Ningbo, China. DESIGN A computerised medical records database was used to conduct a cross-sectional study. SETTING The study was conducted in a tertiary care department in Ningbo, China. PARTICIPANTS The study was conducted on adult patients with T2DM, and it included 8 years of data, from 1 January 2012 to 31 December 2019. THE PRIMARY OUTCOME MEASURE Comorbidity was defined as the coexistence of at least one other chronic condition, that is, either a physical non-communicable disease (duration ≥3 months), a mental health condition (duration ≥3 months) or an infectious disease (duration ≥3 months). RESULTS In total, 4777 patients with T2DM satisfied the eligibility criteria. Over 8 years, the prevalence of comorbidities was 93.7%. The odds of comorbidities increased with the age of patients (18 to 39 years: 1; 40 to 59 years: OR 2.80, 95% CI 1.98 to 3.96; 60 to 69 years: OR 4.43, 95% CI 3.04 to 6.44; and ≥70 years: OR 10.97, 95% CI 7.17 to 16.77). The odds were lower in female patients (OR 0.66, 95% CI 0.51 to 0.84), patients residing in rural areas (OR 0.75, 95% CI 0.59 to 0.95) and patients without health insurance (OR 0.62, 95% CI 0.46 to 0.83). The odds were higher in single/divorced/widowed patients compared with those in married patients (OR 1.95, 95% CI 1.21 to 3.12). CONCLUSIONS A large percentage of patients with T2DM in the tertiary care department in Ningbo, China, had comorbidities, and the factors associated with comorbidities were identified. The findings could be used in developing, evaluating and implementing interventions aimed at improving outcomes in patients with T2DM with comorbidities.
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Affiliation(s)
- Xueyu Li
- School of Medicine, Ningbo University, Ningbo, China
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shengnan Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Yanshu Chen
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
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16
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Wang T, Zhang F, Wang X, Li X, Ling H, Lv D, Yin X, Lu Q. Predictive factors associated with glycaemic response to exenatide in Chinese patients with type 2 diabetes mellitus. J Clin Pharm Ther 2020; 45:1050-1057. [PMID: 32176827 DOI: 10.1111/jcpt.13134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/06/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Exenatide is widely used in the treatment of type 2 diabetes mellitus (T2DM) because of its established effect on lowering glucose and promotion of weight loss. However, therapeutic response to exenatide varies considerably among patients with T2DM. The purpose of this study was to determine which variables can predict the response to exenatide and to individualize specific therapies for patients with T2DM who need treatment with exenatide. METHODS This is a retrospective cohort study of patients with T2DM who were treated with exenatide twice daily as a part of their diabetes care for at least 12 months. Patients were categorized into two cohorts based on glycaemic response to exenatide use: responders and non-responders. RESULTS AND DISCUSSION One hundred forty-eight patients met the inclusion criteria; among them, 92 responded with an HbA1C reduction ≥1.0% from baseline HbA1C and 56 did not respond to exenatide after 6 months of exenatide treatment. Binary logistic regression analysis revealed that baseline HbA1C and duration of diabetes were identified as predictors of HbA1C reduction ≥1% at 6 months (P < .05). Linear regression analysis further identified that patients with a higher baseline HbA1C (≥7.4%) and shorter duration of diabetes (≤15.0 years) were likely to respond to exenatide, whereas those with a lower baseline HbA1C (<7.4%) and longer duration of diabetes (>15.0 years) were not likely to respond to exenatide. WHAT IS NEW AND CONCLUSION Our data indicate that T2DM patients with a higher baseline HbA1C and a shorter duration of diabetes are more likely to have a glycaemic response to exenatide than those with a lower baseline HbA1C and a longer duration of diabetes. The identification of predictors of therapeutic response to exenatide can provide clinically useful information for characterizing the patients who could receive the greatest benefit from exenatide.
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Affiliation(s)
- Tao Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China.,Department of Pharmacy, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Fan Zhang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Xiaotong Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Xizhi Li
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Hongwei Ling
- Department of Endocrinology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dongmei Lv
- Department of Pharmacy, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaoxing Yin
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Qian Lu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
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