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Hussein G, Al Saud AA, Siddiqi AM, Khasawinah A, Alenezi A, Mohammed RA, Alendijani YA. The Impact of Continuity of Care on Health Indicators in Patients With Type 2 Diabetes Mellitus in Family Medicine Clinics in Riyadh. Cureus 2023; 15:e43410. [PMID: 37706138 PMCID: PMC10496726 DOI: 10.7759/cureus.43410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Diabetes Mellitus Type 2 (DM2) is highly prevalent in Saudi Arabia, with many experiencing complications due to the disease. Family medicine physicians are usually the primary care providers responsible for the medical management of type 2 diabetes mellitus patients. Microvascular and macrovascular complications can occur if type 2 diabetes mellitus is poorly managed. Effective management of health indicators in patients with DM2 relating to glycated hemoglobin (HbA1c), low density lipoprotein cholesterol, blood pressure, and tobacco use is an essential part of medical care to prevent complications. Due to the projected increase in the number of patients with DM2, there is huge concern surrounding the management of this chronic illness that requires review. This study aims to evaluate the impact of continuity of care on health indicators among family medicine patients diagnosed with diabetes mellitus type 2 and to analyze the effect of continuity of care regarding the completion of age-appropriate preventive health screenings. METHODS This is a retrospective cohort study. Data collected from electronic medical records of patients 40-75 years of age that received care at the Family Medicine clinics that were diagnosed with type 2 diabetes mellitus with ≥4 clinic visits from January 1, 2017, to June 30, 2020, at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia. Data collected included demographic data, body mass index, smoking status, blood pressure, past medical history, preventive health screening completed, and laboratory results, including HbA1c and lipid profile. The continuity of care index and usual provider continuity score indices were calculated for the analysis to measure continuity of care. RESULTS Three hundred and fifty-two patients were included in the study. Most of the patients were Saudi (74.15%), female (51.99%), and married (82.67%). In addition, 90.34% accounted for a high usual provider continuity of care score (UPCS), and 64.20% of the patients had a high continuity of care index (COCi). Younger age groups were significantly more prevalent in the high UPCS group (p=0.037). Additionally, patients of non-Saudi nationalities constituted a significantly larger proportion of the high UPCS group. Single patients showed high UPCS. Comorbidities were not different between the groups, except inflammatory joint disease, which was more common in the low COCi group. Preventative screening measures were also not different between the groups; however, the type of colon cancer screening differed, where patients with high COCi more frequently underwent colonoscopies (13.3% vs. 4.4%, p=0.015) instead of fecal occult blood tests. CONCLUSION For the first time, we report the implications of the continuity of care for DM2 patients in Saudi Arabia and the Middle East. Continuity of care did not result in the improvement of health indicators or in the completion of preventive health screenings in diabetic patients. Further studies are needed in the region to confirm our findings and assess the association between continuity of care and patient health indicators impact.
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Affiliation(s)
- Ghada Hussein
- Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Aljoharah A Al Saud
- Family Medicine and Polyclinics, Alfaisal University College of Medicine, Riyadh, SAU
| | - Ahmad M Siddiqi
- Family Medicine and Polyclinics, Alfaisal University College of Medicine, Riyadh, SAU
| | - Abdallah Khasawinah
- Family Medicine and Polyclinics, Alfaisal University College of Medicine, Riyadh, SAU
| | - Ahmad Alenezi
- Family Medicine and Polyclinics, Alfaisal University College of Medicine, Riyadh, SAU
| | - Riham A Mohammed
- Family Medicine and Polyclinics, Alfaisal University College of Medicine, Riyadh, SAU
| | - Yaser A Alendijani
- Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Alenazi F, Peddle M, Bressington D, Mahzari M, Gray R. Adherence therapy for adults with type 2 diabetes: a feasibility study of a randomized controlled trial. Pilot Feasibility Stud 2023; 9:71. [PMID: 37106431 PMCID: PMC10134646 DOI: 10.1186/s40814-023-01294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Adherence Therapy is a candidate intervention to promote consistent medication taking in people with type 2 diabetes. The aim of this study was to establish the feasibility of conducting a randomized controlled trial of adherence therapy in people with type 2 diabetes who were non-adherent with medication. METHODS The design is an open-label, single-center, randomized controlled feasibility trial. Participants were randomly allocated to receive either eight sessions of telephone-delivered adherence therapy or treatment as usual. Recruitment occurred during the COVID-19 pandemic. Outcome measures-adherence, beliefs about medication, and average blood glucose (sugar) levels (HbA1c)-were administered at baseline and after 8 weeks (TAU group) or at the completion of the treatment (AT group). Feasibility outcomes included the number of people approached to participate in the trial and the numbers that consented, completed study measures, finished treatment with adherence therapy, and dropped out of the trial. Fieldwork for this trial was conducted in the National Guard Hospital, a tertiary care provider, in the Kingdom of Saudi Arabia. RESULTS Seventy-eight people were screened, of which 47 met eligibility criteria and were invited to take part in the trial. Thirty-four people were excluded for various reasons. The remaining thirteen who consented to participate were enrolled in the trial and were randomized (AT, n = 7) (TAU, n = 6). Five (71%) of the seven participants in the adherence therapy arm completed treatment. Baseline measures were completed by all participants. Week 8 (post-treatment) measures were completed by eight (62%) participants. Dropout may have been linked to a poor understanding of what was involved in taking part in the trial. CONCLUSIONS It may be feasible to conduct a full RCT of adherence therapy, but careful consideration should be given to developing effective recruitment strategies, consent procedures, rigorous field testing, and clear support materials. TRIAL REGISTRATION The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12619000827134, on the 7th of June 2019.
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Affiliation(s)
- Fatimah Alenazi
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia.
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, AlBukayriyah, Kingdom of Saudi Arabia.
| | - Monica Peddle
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Daniel Bressington
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai, 50200, Thailand
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, Northern Territory, 0810, Australia
| | - Moeber Mahzari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Medicine, Division of Endocrinology, Ministry of National Guard, Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia
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Tariq MNM, Stojanovska L, Dhaheri ASA, Cheikh Ismail L, Apostolopoulos V, Ali HI. Lifestyle Interventions for Prevention and Management of Diet-Linked Non-Communicable Diseases among Adults in Arab Countries. Healthcare (Basel) 2022; 11:healthcare11010045. [PMID: 36611505 PMCID: PMC9819169 DOI: 10.3390/healthcare11010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
The increased incidences of diet-related non-communicable diseases (NCDs) such as diabetes, obesity, and cardiovascular diseases among adults are becoming the chief public health concern in most Arab countries. Economic expansion has contributed to a nutrition shift from a traditional seasonal diet to Westernized eating habits coupled with a sedentary lifestyle. Despite the rising concern for NCD mortality, public health policies are inadequately addressed. This narrative review aims to discuss the effectiveness of nutritional interventions focusing on diet and physical activity in the management of NCDs among Arab adults. A comprehensive literature search was performed using different database platforms such as Cochrane reviews, Scopus, and PubMed for articles published between 1 December 2012 and 31 December 2021. Fifteen recent research articles addressing NCDs, mainly diabetes and obesity, from different Arab countries were included in this review. Structured lifestyle interventions involving behavioral therapy approaches and personalized goals for diet and physical activity were found to improve specific health outcomes in most studies. Significant improvements in health outcomes were reported for longer-duration interventions with follow-ups. A combination of both online and face-to-face sessions was found to be effective. It is important to identify barriers to physical activity for a culturally acceptable lifestyle intervention and conduct further studies to evaluate interventions for the long-term maintenance of health outcomes.
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Affiliation(s)
- Maryam Naveed Muhammad Tariq
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Lily Stojanovska
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia
| | - Ayesha S. Al Dhaheri
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX1 2JD, UK
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia
| | - Habiba I. Ali
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Correspondence: ; Tel.: +971-03-713-6556
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Sonmez A, Sabbour H, Echtay A, Rahmah AM, Alhozali AM, al Sabaan FS, Haddad FH, Iraqi H, Elebrashy I, Assaad SN, Bayat Z, Osar Siva Z, Hassanein M. Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations. J Diabetes 2022; 14:315-333. [PMID: 35434900 PMCID: PMC9366572 DOI: 10.1111/1753-0407.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 12/11/2022] Open
Abstract
The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.
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Affiliation(s)
- Alper Sonmez
- Department of Endocrinology and MetabolismGulhane School of Medicine, University of Health SciencesAnkaraTurkey
| | - Hani Sabbour
- Heart & Vascular Institute Cleveland ClinicAbu DhabiUAE
- Brown University Warren Alpert School of MedicineProvidenceRhode IslandUSA
| | - Akram Echtay
- School of MedicineLebanese UniversityHadathLebanon
| | - Abbas Mahdi Rahmah
- National Centre for DiabetesCollege of Medicine, Al‐Mustansriya UniversityBaghdadIraq
| | | | | | - Fares H. Haddad
- Endocrine & Diabetes, Abdali Hospital/Endocrine & Diabetes ClinicAmmanJordan
| | - Hinde Iraqi
- Faculty of Medicine and PharmacyMohammed V UniversityRabatMorocco
| | | | | | - Zaheer Bayat
- Division of Endocrinology and Metabolism, Department of Internal MedicineHelen Joseph HospitalRossmore, JohannesburgSouth Africa
| | | | - Mohamed Hassanein
- Dubai Hospital, DHADubaiUAE
- Gulf Medical UniversityAjmanUAE
- Cardiff UniversityCardiffUK
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5
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Al-Ozairi E, Brown R, Hamdan Y, Alabdullah L, Voase N, Al Kandari J, Alsaeed D, Al Ozairi A, Hasan A, Al-Mulla F, Katikireddi SV, Gray SR, Gill JMR, Celis-Morales CA, Sattar N, Welsh P. Risk of mortality among inpatients with COVID-19 and type 2 diabetes: National data from Kuwait. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00287. [PMID: 34505420 PMCID: PMC8420596 DOI: 10.1002/edm2.287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 01/21/2023]
Abstract
Introduction To investigate type 2 diabetes as a risk factor for COVID‐19 death following hospital admission in Kuwait. Methods A retrospective cohort study using data from a central hospital that cared for all hospitalized COVID‐19 patients in Kuwait. We investigated the association between type 2 diabetes, with COVID‐19 mortality using multiply imputed logistic regression and calculated the population attributable fraction. Results A total of 5333 patients were admitted with COVID‐19, of whom 244 died (4.6%). Diabetes prevalence was 24.8%, but 53.7% of those who died had diabetes. After adjusting for age, sex, ethnicity and other comorbidities, diabetes was associated with death (OR 1.70 [95% CI 1.23, 2.34]) and admission to the intensive care unit more than 3 days after initial admission (OR 1.78 [95% CI 1.17, 2.70]). Assuming causality, the population attributable fraction for type 2 diabetes in COVID‐19 death was 19.6% (95% CI 10.8, 35.6). Conclusion Type 2 diabetes is a strong risk factor for COVID‐19 death in the Middle East. Given the high prevalence of type 2 diabetes in the Middle East, as well as many Western countries, the public health implications are considerable.
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Affiliation(s)
- Ebaa Al-Ozairi
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait.,Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Rosemary Brown
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Yasmine Hamdan
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait.,Ministry of Health, Kuwait City, Kuwait
| | - Lulwa Alabdullah
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nia Voase
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait
| | - Jumana Al Kandari
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait.,Ministry of Health, Kuwait City, Kuwait
| | - Dalal Alsaeed
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait
| | - Abdulla Al Ozairi
- Department of Psychiatry, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Amal Hasan
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait
| | - Fahd Al-Mulla
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman, Kuwait
| | | | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Al-Saleh Y, Sabico S, Al-Furqani A, Jayyousi A, Alromaihi D, Ba-Essa E, Alawadi F, Alkaabi J, Hassanein M, Al-Sifri S, Saleh S, Alessa T, Al-Daghri NM. Sulfonylureas in the Current Practice of Type 2 Diabetes Management: Are They All the Same? Consensus from the Gulf Cooperation Council (GCC) Countries Advisory Board on Sulfonylureas. Diabetes Ther 2021; 12:2115-2132. [PMID: 33983614 PMCID: PMC8342668 DOI: 10.1007/s13300-021-01059-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/09/2021] [Indexed: 12/22/2022] Open
Abstract
Since their inception in the commercial market in the mid-twentieth century, sulfonylureas (SUs) have remained a therapeutic option in the management of type 2 diabetes (T2D). Despite their established glucose-lowering effects, there is no consensus among global experts and modern guidelines regarding the priority of SUs in relation to other therapeutic options, given the lack of evidence that SUs are associated with a low risk of macrovascular events and excess mortality. However, findings from recent trials and real-time observations have resolved this contentious issue somewhat, albeit to varying degrees. The present consensus discusses the role of SUs in contemporary diabetes management in the Gulf Cooperation Council (GCC) countries. Regional experts from these countries gathered virtually to formulate a consensus following presentations of topics relevant to SU therapy with an emphasis on gliclazide, including long-term efficacy, cost, end-organ benefits, and side effects, based on up-to-date evidence. The present narrative review reflects the conclusions of this assembly and provides a platform upon which future guidelines for the use of SUs in the GCC can be tailored.
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Affiliation(s)
- Yousef Al-Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 22490, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia.
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh, 14611, Saudi Arabia.
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | | | - Amin Jayyousi
- Endocrine and Diabetes Section, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medical College, Doha, Qatar
| | - Dalal Alromaihi
- King Hamad University Hospital, Busaiteen, Bahrain
- Medical University of Bahrain, Busaiteen, Bahrain
- Bahrain Diabetes Society, Manama, Bahrain
| | | | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Juma Alkaabi
- Department of Internal Medicine, College of Medicine, and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Seham Saleh
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Thamer Alessa
- Division of Endocrinology, Diabetes and Metabolism, Jaber Al-Ahmad Hospital, Kuwait City, Kuwait
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
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Mohamad M, Moussally K, Lakis C, El-Hajj M, Bahous S, Peruzzo C, Reid A, Edwards JK. Self-reported medication adherence among patients with diabetes or hypertension, Médecins Sans Frontières Shatila refugee camp, Beirut, Lebanon: A mixed-methods study. PLoS One 2021; 16:e0251316. [PMID: 33970972 PMCID: PMC8109801 DOI: 10.1371/journal.pone.0251316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/25/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Low adherence to medications, specifically in patients with Diabetes (DM) and Hypertension (HTN), and more so in refugee settings, remains a major challenge to achieving optimum clinical control in these patients. We aimed at determining the self-reported medication adherence prevalence and its predictors and exploring reasons for low adherence among these patients. Methods A mixed-methods study was conducted at Médecins Sans Frontières non-communicable diseases primary care center in the Shatila refugee camp in Beirut, Lebanon in October 2018. Data were collected using the validated Arabic version of the 8-items Morisky Medication Adherence Scale (MMAS-8) concurrently followed by in-depth interviews to explore barriers to adherence in patients with DM and/or HTN. Predictors of adherence were separately assessed using logistic regression with SPSS© version 20. Manual thematic content analysis was used to analyze the qualitative data. Results Of the 361 patients included completing the MMAS, 70% (n = 251) were moderately to highly adherent (MMAS-8 score = 6 to 8), while 30% (n = 110) were low-adherent (MMAS-8 score<6). Patients with DM-1 were the most likely to be moderately to highly adherent (85%; n = 29). Logistic regression analysis showed that patients with a lower HbA1C were 75% more likely to be moderately to highly adherent [(OR = 0.75 (95%CI 0.63–0.89), p-value 0.001]. Factors influencing self-reported moderate and high adherence were related to the burden of the disease and its treatment, specifically insulin, the self-perception of the disease outcomes and the level of patient’s knowledge about the disease and other factors like supportive family and healthcare team. Conclusion Adherence to DM and HTN was good, likely due to a patient-centered approach along with educational interventions. Future studies identifying additional factors and means addressing the barriers to adherence specific to the refugee population are needed to allow reaching optimal levels of adherence and design well-informed intervention programs.
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Affiliation(s)
- Mariam Mohamad
- Field mission, Médecins Sans Frontières, Operational Center Brussels, Shatila, Beirut, Lebanon
- * E-mail:
| | - Krystel Moussally
- Lebanon branch office, Médecins Sans Frontières, Beirut, Lebanon
- Middle-East Medical Unit (MEMU), Médecins Sans Frontières, Beirut, Lebanon
| | - Chantal Lakis
- Coordination, Médecins Sans Frontières, Operational Center Brussels, Beirut, Lebanon
| | - Maya El-Hajj
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Sola Bahous
- School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Carla Peruzzo
- Coordination, Médecins Sans Frontières, Operational Center Brussels, Beirut, Lebanon
| | - Anthony Reid
- Operational Research Unit, Médecins Sans Frontières, Operational Center Brussels, Luxembourg City, Luxembourg
| | - Jeffrey K. Edwards
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Alenazi F, Peddle M, Bressington D, Mahzari M, Gray R. A study protocol for a feasibility trial of telephone-delivered Adherence Therapy for adults with type 2 diabetes. Nurs Open 2021; 8:1510-1519. [PMID: 33471963 PMCID: PMC8046149 DOI: 10.1002/nop2.735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/08/2020] [Accepted: 11/05/2020] [Indexed: 01/13/2023] Open
Abstract
AIMS Adherence therapy is a candidate intervention to improve medication adherence and clinical outcomes in patients with type 2 diabetes. The feasibility of conducting a trial of adherence therapy in this population has not been established. The objective of this study is therefore to test the feasibility of conducting a randomized controlled trial of adherence therapy in a Middle Eastern context. DESIGN A single-centre randomized controlled feasibility trial of adherence therapy in patients with type 2 diabetes. METHODS We will undertake an initial cultural adaptation of a telephone-delivered form of adherence therapy in four patients in a Middle Eastern context. Our subsequent feasibility trial will aim to recruit 40 non-adherent diabetic patients that will be randomly allocated to receive eight weekly 30-min telephone adherence therapy sessions delivered by a diabetes educator versus treatment as usual. Key outcomes of interest include the number of patients invited to take part in the trial that consent to participate and then go on to complete treatment. RESULT The findings of this study will determine the feasibility of undertaking a full randomized controlled trial of adherence therapy in patients with type 2 diabetes.
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Affiliation(s)
- Fatimah Alenazi
- College of Science Health and EngineeringLa Trobe UniversityBundooraVICAustralia
- Department of Public HealthCollege of Public Health and Health InformaticsQassim UniversityAlBukayriyahSaudi Arabia
| | - Monica Peddle
- Lecturer in NursingSchool of Nursing and MidwiferyCollege of Science Health and EngineeringLa Trobe UniversityMelbourneAustralia
| | - Daniel Bressington
- Associate ProfessorSchool of NursingHong Kong Polytechnic UniversityKowloonHong Kong
- Adjunct Professor‐College of Nursing & MidwiferyCharles Darwin UniversityBundooraAustralia
| | - Moeber Mahzari
- Assistant professor of Medicine‐EndocrinologyKing Saud Bin Abdulaziz University for Health SciencesCollege of MedicineRiyadhKSASaudi Arabia
- Department of MedicineDivision of Endocrinology – Ministry of National Guard – Health AffairsRiyadhKSASaudi Arabia
- King Abdullah International Medical Research CenterRiyadhKSASaudi Arabia
| | - Richard Gray
- Professor of Clinical Nursing PracticeLa Trobe UniversityMelbourneAustralia
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Al-Sofiani ME, Batais MA, Aldhafiri E, Alzaid A. Pharmacological treatment of type 2 diabetes in Saudi Arabia: A consensus statement from the Saudi Society of Endocrinology and Metabolism (SSEM). Diabetes Metab Syndr 2021; 15:891-899. [PMID: 33895710 DOI: 10.1016/j.dsx.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/14/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS The list of available treatment options for managing blood glucose in patients with type 2 diabetes (T2D) has grown over recent years making the task of choosing between traditional and newer glucose-lowering agents a difficult one for healthcare providers. METHODS We summarize treatment algorithms developed by popular professional societies and propose a patient-centered and culture-driven recommendations for selecting diabetes medications for people with T2D in Saudi Arabia. RESULTS Though most professional societies recognize patient's adherence to medications as an important factor in achieving glycemic targets, published algorithms schemes do not formally enlist adherence to medication as a deciding factor in the choice of glucose-lowering agents. Medication appeal to patients, an important determinant of medication adherence, is influenced by several factors including lifestyle, common beliefs, customs and traditions, health literacy, perception of health and disease, socioeconomic and cultural backgrounds, and religious commitments and obligations. In Saudi Arabia, poor adherence to therapy is a major obstacle to effective management of local people with T2D. CONCLUSIONS The Saudi population has a unique socioeconomic and cultural background that widely respect adherence to religion and culture; and the applicability of international guidelines for the management of T2D to the Saudi population has been called into question. In this consensus statement, we propose patient-centered and culture-driven recommendations that integrate medication-adherence and medication-cost into overall selection of diabetes medications for people with T2D in Saudi Arabia.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Endocrinology, Diabetes & Metabolism, the Johns Hopkins University, Baltimore, MD, USA; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Aus Alzaid
- Diabetes Consultant, Riyadh, Saudi Arabia
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Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence. Nutrients 2021; 13:nu13041060. [PMID: 33805161 PMCID: PMC8064070 DOI: 10.3390/nu13041060] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022] Open
Abstract
The alarmingly rising trend of type 2 diabetes constitutes a major global public health challenge particularly in the Middle Eastern and North African (MENA) region where the prevalence is among the highest in the world with a projection to increase by 96% by 2045. The economic boom in the MENA region over the past decades has brought exceptionally rapid shifts in eating habits characterized by divergence from the traditional Mediterranean diet towards a more westernized unhealthy dietary pattern, thought to be leading to the dramatic rises in obesity and non-communicable diseases. Research efforts have brought a greater understanding of the different pathways through which diet and obesity may affect diabetes clinical outcomes, emphasizing the crucial role of dietary interventions and weight loss in the prevention and management of diabetes. The purpose of this review is to explore the mechanistic pathways linking obesity with diabetes and to summarize the most recent evidence on the association of the intake of different macronutrients and food groups with the risk of type 2 diabetes. We also summarize the most recent evidence on the effectiveness of different macronutrient manipulations in the prevention and management of diabetes while highlighting the possible underlying mechanisms of action and latest evidence-based recommendations. We finally discuss the need to adequately integrate dietetic services in diabetes care specific to the MENA region and conclude with recommendations to improve dietetic care for diabetes in the region.
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11
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Tirfie M, Tadesse S, Woldie H, Weldegiorgis T, Birhanu M, Shibabaw T. Dietary non-adherence and associated factors among individuals with diabetes who are on treatment follow up at Felege-Hiwot Referral Hospital, Northwest Ethiopia. Heliyon 2020; 6:e04544. [PMID: 32904193 PMCID: PMC7452454 DOI: 10.1016/j.heliyon.2020.e04544] [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: 06/03/2019] [Revised: 01/06/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
Difficulty in adhering to the recommended diet is a common problem in individuals with diabetes mellitus (DM). Dietary non-adherence among diabetic individuals leads to diabetes related complication and death. As far as our search established, there is a scarcity of scientific evidence of dietary non-adherence of individuals with diabetes to the recommended diet in Ethiopia, specifically in the Northwest part of the country. Hence, this study aims to assess the dietary non-adherence and associated factors among individuals with diabetes at Felege-Hiwot Referral Hospital, Bahir Dar city, Northwest Ethiopia. An institution-based cross-sectional study was conducted on 385 systematically selected individuals with diabetes following their treatment from March to April 2017. Quantitative data were collected using a pre-tested and structured questionnaire. The dependent variable association with explanatory variables was determined using logistic regression. Statistical significance was considered at p-value <0.05 with 95% CI. The overall proportion of dietary non-adherence among participants was 46.8% (95% CI: 41.1-52.0). Living rurally (AOR = 3. 75; 95% CI: 2.12-6.63), duration of diabetes less than 5 years (AOR = 2. 81; 95% CI: 1.22-6.50), did not receive nutritional education (AOR = 5. 88; 95% CI: 3.30-10.48), poor social support (AOR = 3. 84; 95% CI: 1.74-8.46) and did not make choices when eating out (AOR = 3. 49; 95% CI: 2.09-5.81) were significantly associated with dietary non-adherence. Nearly half of the individuals with diabetes involved in this study did not adhere to the recommended diet. This problem could be addressed through the provision of nutritional education and strengthening social support to adhere to diabetes dietary recommendations. Therefore, health professional and nutritional educators should take appropriate action to increase the proportion of dietary adherence of individuals with diabetes.
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Affiliation(s)
- Mulat Tirfie
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Sebsibe Tadesse
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Haile Woldie
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Teshager Weldegiorgis
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Minyichil Birhanu
- Department of Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Tebkew Shibabaw
- Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
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12
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Abdullah A, Alkandari A, Longenecker JC, Devarajan S, Alkhatib A, Al-Wotayan R, Al-Duwairi Q, Tuomilehto J. Glycemic control in Kuwaiti diabetes patients treated with glucose-lowering medication. Prim Care Diabetes 2020; 14:311-316. [PMID: 31911041 DOI: 10.1016/j.pcd.2019.12.001] [Citation(s) in RCA: 8] [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: 10/14/2019] [Revised: 11/24/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes is prevalent in Kuwait. We aimed to assess the level of glycemic control in Kuwaiti adults with diabetes. METHODS The World Health Organization's STEPS non-communicable disease risk factor survey was conducted in Kuwait in 2014. Participants' demographics, medical history, physical measurements and blood biochemistry were assessed. A total of 2561 Kuwaiti men and women aged 18-69 years completed all three survey steps. Glycemic control in 278 individuals with diabetes who were on glucose-lowering medication was determined using the US National Institutes of Health guidelines of fasting plasma glucose (FPG) ≤7.2mmol/l and the American Diabetes Association guidelines of glycated hemoglobin (HbA1c) <7% (53mmol/mol). RESULTS Adequate glycemic control in people with drug-treated diabetes was 34.5% when determined by HbA1c, 37.8% when determined by FPG level, and 24.5% when both criteria were met. Mean body-mass index and fasting serum triglycerides were significantly higher and serum high-density lipoprotein-cholesterol significantly lower in individuals with an inadequate glycemic control than in those with adequate control. Women with diabetes were almost twice as likely to have inadequate HbA1c levels as men with diabetes (OR, 1.9, [95% CI, 1.03, 3.5]). CONCLUSIONS Glycemic control in Kuwaiti adults with treated diabetes is low. A systemic, multi-disciplinary public health approach is needed to improve diabetes education and adherence to treatment.
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Affiliation(s)
| | | | | | | | - Ahmad Alkhatib
- Dasman Diabetes Institute, Kuwait City, Kuwait; School of Health and Life Sciences, Teesside University, United Kingdom
| | | | | | - Jaakko Tuomilehto
- Dasman Diabetes Institute, Kuwait City, Kuwait; Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
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13
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Beliefs about medicines among type 2 diabetes mellitus patients in Quetta city, Pakistan: a cross-sectional assessment. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01046-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Ibrahim M, Davies MJ, Ahmad E, Annabi FA, Eckel RH, Ba-Essa EM, El Sayed NA, Hess Fischl A, Houeiss P, Iraqi H, Khochtali I, Khunti K, Masood SN, Mimouni-Zerguini S, Shera S, Tuomilehto J, Umpierrez GE. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD consensus. BMJ Open Diabetes Res Care 2020; 8:e001248. [PMID: 32366501 PMCID: PMC7223028 DOI: 10.1136/bmjdrc-2020-001248] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
Fasting the Holy month of Ramadan constitutes one of the five pillars of the Muslim faith. Although there is some evidence that intermittent fasting during Ramadan may be of benefit in losing weight and cardiometabolic risk factors, there is no strong evidence these benefits apply to people with diabetes. The American Diabetes Association/European Association for the Study of Diabetes consensus recommendations emphasize the importance of patient factors and comorbidities when choosing diabetes medications including the presence of comorbidities, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, hypoglycemia risk, weight issues and costs. Structured education and pre-Ramadan counseing are key components to successful management of patients with diabetes. These should cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity including Taraweeh prayers, medication and dose adjustment, side effects and when to break the fast. The decision cycle adapted for the specific situation of Ramadan provides an aid for such an assessment. Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA), although there is very little evidence that DKA is increased in Ramadan. Pregnant women with diabetes or gestational diabetes should be advised to avoid fasting because of possible negative maternal and fetal outcomes. Hypoglycemia is a common concern during Ramadan fasting. To prevent hypoglycemic and hyperglycemic events, we recommend the adoption of diabetes self-management education and support principles. The use of the emerging technology and continuous glucose monitoring during Ramadan could help to recognize hypoglycemic and hyperglycemic complications related to omission and/or medication adjustment during fasting; however, the cost represents a significant barrier.
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Affiliation(s)
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester and Leicester General Hospital, Leicester, UK
| | | | - Robert H Eckel
- Division of Endocrinology, Metabolism & Diabetes Division of Cardiology, University of Colorado Denver Anschutz Medical Campus Official Bookstore, Denver, Colorado, USA
| | | | | | - Amy Hess Fischl
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, Illinois, USA
| | - Pamela Houeiss
- Division of Endocrinology, American University, Beirut, Lebanon
| | - Hinde Iraqi
- Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Ines Khochtali
- Department of Endocrinolgy and Internal Medicine, University of Tunisia, Monstair, Tunisia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Shabeen Naz Masood
- Obstetrics & Gynecology, ISRA Medical University, Karachi, Sindh, Pakistan
| | | | - Samad Shera
- Diabetic Association of Pakistan, Karachi, Pakistan
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Kuwait City, Kuwait
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15
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Abduo H, Curtain C, Othman N. Use of Smartphone Applications for Diabetes Management in Kuwait: A Pilot Study. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1750827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Heba Abduo
- Pharmacy Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Colin Curtain
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Nashwa Othman
- Education & Training Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
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16
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AlQarni K, AlQarni EA, Naqvi AA, AlShayban DM, Ghori SA, Haseeb A, Raafat M, Jamshed S. Assessment of Medication Adherence in Saudi Patients With Type II Diabetes Mellitus in Khobar City, Saudi Arabia. Front Pharmacol 2019; 10:1306. [PMID: 31787894 PMCID: PMC6856211 DOI: 10.3389/fphar.2019.01306] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/15/2019] [Indexed: 01/19/2023] Open
Abstract
Objective: Medication adherence is defined as taking medications as advised and prescribed by health care professionals for stated duration. Diabetes mellitus (DM) is one of the most common chronic illnesses in Saudi Arabia. This study aimed to document medication adherence in Saudi patients with type 2 diabetes. Methods: A quantitative cross-sectional study was conducted in Saudi out-patients with type 2 DM in the city of Khobar, Saudi Arabia. The study used the General Medication Adherence Scale (GMAS) to document medication adherence in this population. Data was analyzed through SPSS version 23. Study was ethically approved. Results: Data was collected from 212 patients. Few patients (35.8%) had high adherence to anti diabetic medications. The correlation between HbA1c level and adherence score was negative and significantly strong (ρ = -0.413, p < 0.0001). Most patients (N = 126, 59.4%) modified their medication therapy during month of Ramadan and on Eid occassion. Education level was not a determinant of adherence in this population. Conclusion: This study highlighted that medication adherence is influenced by religious and social factors. Patient counseling is required to improve patient beliefs and increase awareness of adhering to prescribed anti diabetic pharmacotherapy. A pharmacist can play constructive role of a disease educator and patient counselor.
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Affiliation(s)
- Khaled AlQarni
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Elham A AlQarni
- Obstetrics and Gynecology, King Fahd Military Medical Complex, Dammam, Saudi Arabia
| | - Atta Abbas Naqvi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dhfer Mahdi AlShayban
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Syed Azizullah Ghori
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Mohamed Raafat
- Department of Pharmacology & Toxicology, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Shazia Jamshed
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia.,Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
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17
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Azizi F, Hadaegh F, Hosseinpanah F, Mirmiran P, Amouzegar A, Abdi H, Asghari G, Parizadeh D, Montazeri SA, Lotfaliany M, Takyar F, Khalili D. Metabolic health in the Middle East and north Africa. Lancet Diabetes Endocrinol 2019; 7:866-879. [PMID: 31422063 DOI: 10.1016/s2213-8587(19)30179-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/09/2023]
Abstract
The Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa.
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Affiliation(s)
- Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Donna Parizadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Montazeri
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzin Takyar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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18
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Naser AY, Wong ICK, Whittlesea C, Alwafi H, Abuirmeileh A, Alsairafi ZK, Turkistani FM, Bokhari NS, Beykloo MY, Al-Taweel D, Almane MB, Wei L. Attitudes and perceptions towards hypoglycaemia in patients with diabetes mellitus: A multinational cross-sectional study. PLoS One 2019; 14:e0222275. [PMID: 31647820 PMCID: PMC6812873 DOI: 10.1371/journal.pone.0222275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background Preventing hypoglycaemia is an essential component of diabetes self-management that is affected by patients’ attitudes and perceptions. This study aimed to explore the hypoglycaemia problem-solving ability of patients who have diabetes mellitus and factors that determine their attitudes and perceptions towards their previous events. Methodology A cross-sectional study was conducted between October 2017 and May 2018 in three Arab countries (Jordan, Saudi Arabia and Kuwait) in patients with diabetes mellitus, who were prescribed antidiabetic therapy and had experienced hypoglycaemic events in the past six months. The Hypoglycaemia Problem-Solving Scale was used in this study. This scale contains two subscales, problem orientation (six questions) and problem-solving skills (eighteen questions), using a five-point Likert scale (range 0–4). Multiple linear regression analysis was used to identify predictors of hypoglycaemia problem-solving abilities. Results A total of 895 patients participated in this study from the three countries (300 in Jordan, 302 in Saudi Arabia, and 293 in Kuwait). The average age of the patients was 53.5 years (standard deviation = 13.7) and 52.4% (n = 469) were males. Patients had moderate overall problem-solving ability with a median score of 63.00 (interquartile range = 13.00). Patients’ problem-solving skills score (68.1%) was better than their problem-orientation skills score (58.3%). The highest sub-scale scores were for detection control, setting problem-solving goals, and evaluating strategies, 75.0%. The lowest sub-scale score was for problem-solving perception and immediate management, 50.0%. Older age, being educated, being married, having T2DM, prescribed insulin therapy, and not having been admitted to hospital for hypoglycaemia were important predictors of patients’ problem-solving ability (p < 0.05). Conclusions Healthcare professionals are advised to provide more education to patients on how to self-manage hypoglycaemic events. Specifically, they should focus on the overall problem-solving perception of hypoglycaemia and its immediate management.
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Affiliation(s)
- Abdallah Y. Naser
- Research Department of Practice and Policy, UCL School of Pharmacy, London, the UK
- Isra University, Faculty of Pharmacy, Amman, Jordan
| | - Ian C. K. Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, the UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, London, the UK
| | - Hassan Alwafi
- Research Department of Practice and Policy, UCL School of Pharmacy, London, the UK
| | | | | | | | | | - Maedeh Y. Beykloo
- Research Department of Practice and Policy, UCL School of Pharmacy, London, the UK
| | - Dalal Al-Taweel
- Department of Pharmacy Practice, Kuwait University, Kuwait, Kuwait
| | - Mai B. Almane
- Sabah Al-Ahmad Cardiology Center Pharmacy, Al Amiri Hospital, Kuwait, Kuwait
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, the UK
- * E-mail:
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19
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Sousa Pinto G, Bader L, Billberg K, Criddle D, Duggan C, El Bizri L, Gharat M, Hogue MD, Jacinto I, Oyeneyin Y, Zhou Y, Laven A. Beating non-communicable diseases in primary health care: The contribution of pharmacists and guidance from FIP to support WHO goals. Res Social Adm Pharm 2019; 16:974-977. [PMID: 31668903 DOI: 10.1016/j.sapharm.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 11/27/2022]
Abstract
According to the World Health Organization (WHO), more than 36 million people die annually from non-communicable diseases (NCDs), representing over 60% of deaths worldwide, 15 million of which occur before the age of 70 years. Prevention and control of NCDs and their risk factors require interventions that are therapeutically cost-effective, affordable by the patient and/or health systems and feasible, based upon local resources. This commentary paper sets a basis of global evidence to advocate, nationally and internationally, for an expanded role for pharmacists in NCD management by compiling best practices and examples. It encourages pharmacists around the world to act upon NCDs, from prevention and screening activities, to patient referral when appropriate, and to pharmacist-led, patient-centred NCD management to improve outcomes and quality of life. Priority NCDs fall into four areas: cardiovascular diseases, diabetes, asthma/chronic obstructive pulmonary disease and cancer. Building on the key roles they already play as primary healthcare professionals in the community, pharmacists can provide focused interventions, specialised counselling and care coordination, improving patient engagement to achieve better outcomes in the global fight against NCDs.
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Affiliation(s)
| | - Lina Bader
- International Pharmaceutical Federation (FIP), The Hague, the Netherlands
| | | | - Deirdre Criddle
- South Metropolitan Health Service and Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Catherine Duggan
- International Pharmaceutical Federation (FIP), The Hague, the Netherlands
| | - Luna El Bizri
- School of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Manjiri Gharat
- Indian Pharmaceutical Association, Mumbai, and KM Kundnani Pharmacy Polytechnic, Ulhasnagar, India
| | - Michael D Hogue
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Isabel Jacinto
- National Association of Pharmacies of Portugal, Lisbon, Portugal
| | - Yetunde Oyeneyin
- Association of Industrial Pharmacists of Nigeria/ Pharmaceutical Society of Nigeria, Lagos, Nigeria
| | - Ying Zhou
- Chinese Pharmaceutical Association, Beijing, China
| | - Anna Laven
- Pharmabrain GmbH, Research and Training Centre, Berlin, Germany
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20
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Al-Sahouri A, Merrell J, Snelgrove S. Barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a literature review. Patient Prefer Adherence 2019; 13:675-693. [PMID: 31118591 PMCID: PMC6507072 DOI: 10.2147/ppa.s198828] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/03/2019] [Indexed: 12/17/2022] Open
Abstract
Poorly controlled Type-2 diabetes is considered a significant public health problem and associated with adverse outcomes in Jordan. This review focuses on barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan. The aim was to identify the extent of Type-2 diabetes and the influence of knowledge, perceptions and sociocultural factors on adherence to the diabetes management plan. Thirty-two studies were included in the literature review. The high prevalence rate of poorly controlled Type-2 diabetes is associated with many negative consequences among patients in Jordan. Despite the publication of research findings that have shown the importance of adherence to diet, physical activity, medications, monitoring blood glucose and foot care, the level of adherence is still unsatisfactory among patients in Jordan. This review also identified that social, cultural and religious factors influence diabetes management. These factors highlighted the overwhelming influence of socio-cultural factors and lifestyles as determinants of patients' health and health behaviors. For example, the influence of family, friends and culture on herbal use and food preferences that patients make on a daily basis and during social gatherings. A holistic approach incorporating patient-centered care could usefully be incorporated into educational programs to improve the understanding of patients' health and information needs. The importance of factors beyond the individual level in terms of social, cultural, organizational and policy influences such as food habits, religious beliefs and lack of continuity of care were identified as key factors which influence adherence to the diabetes management plan. Recognition of multiple determinants of patients' health among health care professionals may expand the scope of interventions to seek to modify social norms and values and improve patient outcomes.
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Affiliation(s)
- Amer Al-Sahouri
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK
| | - Joy Merrell
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK
| | - Sherrill Snelgrove
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK
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21
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Zarrin A, Tourchian N, Heckman GA. Chronic Disease Self-Management Among Iranian Older Adults: A Scoping Review. J Appl Gerontol 2019; 39:922-930. [PMID: 30819025 DOI: 10.1177/0733464819832198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Implementing care models that emphasize chronic disease self-management (CDSM) strategies may be an effective approach to the growing prevalence of chronic conditions in Iran. We, therefore, conducted a scoping review on CDSM among older Iranians to identify existing gaps and opportunities to improve chronic disease care. Method: We conducted a search in CINAHL, EMBASE, MEDLINE/PubMed, and Cochrane library. Selected articles were charted based on year of publication, language, objectives, methods, target chronic disease(s), sample demographics, self-management type, and key findings. Results: We selected 73 articles. The main components of CDSM addressed were social support, education, physical activity, nutrition, self-monitoring, spirituality, and financial support. Older Iranians reported low levels of physical activity. Conclusion: Enhancing the quality of CDSM research and provision of coaching to enhance older adults' social and mental health are among the main strategies to enhance CDSM among the Iranian older population.
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Affiliation(s)
- Aein Zarrin
- University of Waterloo, Waterloo, Ontario, Canada
| | | | - George A Heckman
- University of Waterloo, Waterloo, Ontario, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Channanath AM, AlWotayan R, Alkandari H, Davidsson L, Tuomilehto J, Thanaraj TA. Glycaemic control in native Kuwaiti Arab patients with type 2 diabetes. Prim Care Diabetes 2018; 12:526-532. [PMID: 30115526 DOI: 10.1016/j.pcd.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the influence of age at diabetes diagnosis, diabetes duration, BMI, comorbidity with hypertension and medication regimen on glycaemic control in native Kuwaiti Arab patients with T2D. METHODS This cross-sectional study considered 7657 patients from Kuwait Diabetes Registry and analysed data from their laboratory and hospital records. RESULTS HbA1c and prevalence of hypertension increased significantly with diabetes duration. Duration of diabetes (β=0.034; P<0.001) and age at diagnosis (β=-0.03; P<0.001) were independently associated with HbA1c. Inadequate glycaemic control was more likely in patients diagnosed at <60 than in those ≥60 years of age (OR:1.80, 95%-CI:1.39-2.31). Increasing duration of diabetes witnessed decrease in metformin prescription and increase in sulfonylureas prescription; proportion of patients treated with insulin increased from 5.6% to 44.4% in 9 years of diagnosis. Patients with 9-years duration of diabetes or with combination therapy of insulin-metformin-sulfonylureas differed in mean BMI for adequate or inadequate glycaemic control (29.5 versus 31.2kg/m2; P<0.001 and 29.8 versus 33.2; P<0.01, respectively). CONCLUSIONS Only 25.6% of the T2D patients in this ethnic cohort exhibited adequate glycaemic control. The delineated relationship of inadequate glycaemic control with diabetes duration, onset age, obesity and hypertension prevalence has a bearing on diabetes management programs for Arabs.
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Affiliation(s)
- Arshad M Channanath
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Rihab AlWotayan
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Primary Health Care, Ministry of Health, Kuwait
| | - Hessa Alkandari
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Pediatrics, Farwaniya Hospital, Farwaniya, Kuwait
| | - Lena Davidsson
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Jaakko Tuomilehto
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
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Alsairafi ZK, Smith FJ, Taylor KMG, Alsaleh F, Alattar AT. A qualitative study exploring patients' experiences regarding insulin pump use. Saudi Pharm J 2018; 26:487-495. [PMID: 29844719 PMCID: PMC5962644 DOI: 10.1016/j.jsps.2018.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/05/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diabetes is a threat to peoples' lives around the world, particularly in the Middle East. Medicine misuse and poor glycaemic control are prevalent among patients with type 2 diabetes, especially insulin-dependent patients (Alsairafi et al., 2016). With advances in medical technology, insulin pumps became a treatment option for patients with type 1 diabetes and those with insulin-dependent type 2 diabetes. However, use of these devices is still lacking in Kuwait, particularly in patients with type 2 diabetes. Information on how patients manage these devices and their efficacy and safety from the perspectives of patients is also lacking (Alsaleh et al., 2016). OBJECTIVE To examine the views and experiences of adults with type 2 diabetes regarding the use of insulin pumps compared to their previous insulin delivery methods, in terms of glycaemic control, quality of life, preference, convenience and adherence to doses. SETTING The main five secondary-care hospitals in Kuwait: Mobarak Al-Kabeer, Al Amiri, Al Adan, Al Farwaniya and Al Jahra. METHOD All adults with type 2 diabetes who used an insulin pump were invited to participate. Data were collected through semi-structured interviews. Data analysis was performed using MAXQDA-11. RESULTS A total of eight patients were interviewed. Interviews with patients revealed that using an insulin pump improved patients' glycaemic control and quality of life as a consequence of improved satisfaction and adherence to doses. CONCLUSION From the perspective of adults with type 2 diabetes, there are lots of benefits of using insulin pumps over other insulin delivery methods, mainly seen by the improvement of quality of life and patients' adherence to doses. Policy-makers and healthcare professionals (HCPs) must be aware of such benefits and should support the wider implementation of this technology in the country by including patients with type 2 diabetes. Results of this study will help to inform healthcare provision and guideline modifications and to provide guidance for new patients using this therapy.
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Affiliation(s)
| | - Felicity J. Smith
- Ministry of Health, Hawalli, Kuwait
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Kevin Michael Geoffrey Taylor
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Department of Pharmaceutics, School of Pharmacy, University College of London, London, UK
| | - Fatemah Alsaleh
- Department of Pharmaceutics, School of Pharmacy, University College of London, London, UK
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Abdulnabi T. Alattar
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
- Diabetes Unit, Al-Amiri Hospital, Ministry of Health, Safat, Kuwait
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24
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Al-Khamees NA. Factors Associated with Type 1 and Type 2 Diabetes in Infants in Kuwait. Health (London) 2018. [DOI: 10.4236/health.2018.1011113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Waheedi M, Jeragh-Alhaddad FB, Awad AI, Enlund H. "Patients' understanding is the problem": physicians' views of nonadherence among Arabs with type 2 diabetes. Patient Prefer Adherence 2017; 11:1413-1421. [PMID: 28860724 PMCID: PMC5566892 DOI: 10.2147/ppa.s138468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Nonadherence to diabetes medication is a significant barrier toward achieving positive treatment outcomes. There is an abundance of research looking at the problem from the patient perspective, but less from the provider perspective. The Middle East region has one of the highest prevalences of type 2 diabetes in the world, with special cultural characteristics, which require research attention. The aim of this study was to explore the views of primary-care physicians on medication nonadherence among type 2 diabetes patients. MATERIALS AND METHODS A descriptive qualitative study was performed using one-on-one semistructured interviews of 21 primary-care physicians who were selected using stratified and random sampling from polyclinics in the five health districts in Kuwait. The interviews elicited the participants' views about barriers and facilitators of medication adherence in type 2 diabetes patients. The interviews were audio-recorded and transcribed verbatim. Thematic content analysis with constant comparison was used to generate the codes and themes to arrive at a core category. RESULTS Patient understanding, including knowledge, beliefs, and attitudes, was identified by respondents as the core determinant of medication nonadherence in type 2 diabetes. This was composed of six major themes: four against understanding and two for understanding. The ones against were "Patients do not understand diabetes", "Patients do not understand the importance of medications", "What the patient hears from friends is more important than what the doctor says", "Patients are in denial (or difficult)". Themes for understanding were "I need to educate more" and "Patients must hear it from other sources". CONCLUSION That lack of understanding among patients results in medication nonadherence is the dominant view of primary-care physicians. This finding has implications in relation to the evolution of diabetes care toward more patient-centeredness within the cultural context.
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Affiliation(s)
- Mohammad Waheedi
- Faculty of Pharmacy, Kuwait University, Kuwait
- Correspondence: Mohammad Waheedi, Faculty of Pharmacy, Kuwait University, PO Box 24923, Safat 13110, Kuwait, Tel +965 6622 3629, Fax +965 2534 7918, Email
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