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Nielsen MH, Jensen AL, Pedersen ML, Seibæk L. Living with chronic obstructive pulmonary disease or type 2 diabetes in Greenland - a qualitative interpretive description study. Int J Circumpolar Health 2024; 83:2296706. [PMID: 38127836 PMCID: PMC10763871 DOI: 10.1080/22423982.2023.2296706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Non-communicable diseases such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) represent major challenges for health systems all over the world. In an interview study, we explored patient experiences and perspectives of being diagnosed and living with COPD or T2D in Greenland. Participants (n = 24) were selected by purposeful sampling and recruited by phone. We conducted individual semi-structured interviews at the National Hospital in Nuuk and the four regional hospitals. Interviews were audio-recorded, transcribed verbatim, and analysed using interpretive description. Three themes emerged: shock and shame on receiving the diagnosis, coping with a changed life, and varying needs for care and communication. We found that being diagnosed with COPD or T2D required a rapid change in the participants' everyday lives and lifestyle behaviours. Some self-managed their disease well and were able to transfer their knowledge and integrate it into their daily lives, while others struggled to make lifestyle changes. Additionally, living with COPD or T2D could be related to silence and shame. The findings contribute to a better understanding of living with COPD or T2D in the Arctic region and the development of future, culturally-adapted patient education initiatives.
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Affiliation(s)
- Maja Hykkelbjerg Nielsen
- Queen Ingrid’s Hospital, Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annesofie Lunde Jensen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Lynge Pedersen
- Queen Ingrid’s Hospital, Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Seibæk
- Greenland Center for Health Research, Department of Health and Nature, Ilisimatusarfik/University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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Han KA, Hwang YC, Moon SJ, Cho HC, Yoo HJ, Choi SH, Chon S, Kim KA, Kim TN, Kang JG, Park CY, Won JC, Cho E, Kim J, Park KS. Dual add-on therapy of gemigliptin and dapagliflozin in patients with type 2 diabetes inadequately controlled with metformin alone: The SOLUTION 2 study. Diabetes Obes Metab 2024; 26:3743-3752. [PMID: 38978173 DOI: 10.1111/dom.15717] [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: 01/10/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 07/10/2024]
Abstract
AIM To evaluate the efficacy and safety of gemigliptin and dapagliflozin dual add-on therapy (GEMI + DAPA) to metformin in type 2 diabetes (T2D) patients who had inadequate glycaemic control on metformin alone, compared with a single add-on of either gemigliptin (GEMI) or dapagliflozin (DAPA) to metformin. MATERIALS AND METHODS In this randomized, double-blind, double-dummy, active-controlled, parallel-group, phase 3 study, 469 T2D patients treated with a stable dose of metformin for 8 weeks or longer were randomized to receive GEMI + DAPA (n = 157) and either GEMI (n = 156) or DAPA (n = 156). The primary endpoint was change in HbA1c levels from baseline at week 24. RESULTS Baseline characteristics including body mass index and T2D duration were similar among groups. At week 24, the least square mean changes in HbA1c from baseline were -1.34% with GEMI + DAPA, -0.90% with GEMI (difference between GEMI + DAPA vs. GEMI -0.44% [95% confidence interval {CI}: -0.58% to -0.31%], P < .01) and -0.78% with DAPA (difference between GEMI + DAPA vs. DAPA -0.56% [95% CI: -0.69% to -0.42%], P < .01). Both upper CIs were less than 0, demonstrating the superiority of GEMI + DAPA for lowering HbA1c. The rates of responders achieving HbA1c less than 7% and less than 6.5% were greater with GEMI + DAPA (84.9%, 56.6%) than with GEMI (55.3%, 32.2%) and DAPA (49.3%, 15.3%). The incidence rate of adverse events was similar across groups, with low incidence rates of hypoglycaemia, urinary tract infection and genital infection. CONCLUSIONS These results suggest that the addition of GEMI + DAPA to metformin as triple combination therapy was effective, safe and well-tolerated, especially for T2D patients who experienced poor glycaemic control on metformin alone.
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Affiliation(s)
- Kyung Ah Han
- Division of Endocrinology and Metabolism, Nowon Eulji Medical Centre, Eulji University, Seoul, South Korea
| | - You-Cheol Hwang
- Division of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Shin Je Moon
- Division of Endocrinology and Metabolism, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Ho Chan Cho
- Division of Endocrinology and Metabolism, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Korea University College of Medicine, Seoul, South Korea
| | - Sung Hee Choi
- Division of Endocrinology and Metabolism, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Suk Chon
- Division of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, South Korea
| | - Kyoung-Ah Kim
- Division of Endocrinology and Metabolism, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, South Korea
| | - Tae Nyun Kim
- Division of Endocrinology and Metabolism, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Seoul, South Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Jong Chul Won
- Division of Endocrinology and Metabolism, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Eunjoo Cho
- Life Sciences, LG Chem, Ltd, Seoul, South Korea
| | | | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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Kumari S, Tubaki BR, Patil RS, Laxmikant SD. Reversal of type 2 diabetes mellitus through integrated Ayurveda dietary protocol - A case report. J Ayurveda Integr Med 2024; 15:100946. [PMID: 39047599 DOI: 10.1016/j.jaim.2024.100946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 07/27/2024] Open
Abstract
Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder of hyperglycemia has close link with obesity and insulin resistance. Standard approaches in T2DM management are lifestyle management and Pharmacotherapy. Dietary management in T2DM was found to be safe and effective. In India, studies on reversal of T2DM through diet were less found. Presenting a case of female aged 31 years with T2DM (HbA1c-13.5) was successfully reversed diabetes with dietary principles of Indian traditional medicine (Ayurveda diet) and therapeutic yoga practices. Pre and post assessment of Glycaemic parameters (HbA1C, FBS, and PPBS), Lipid profiles, Insulin resistance parameter (HOMA IR) were done. Major outcome of this case is greater reduction of HbA1c from inadequate control to near normal. Marked changes observed in weight, BMI and Waist circumference. A change in Homa IR indicates improvement in insulin resistance. Ayurveda dietary management training include Therapeutic fasting [Two meal method], meals include nutrient dense wholesome food, Indian millet based diet, herbal recipes [therapeutic food/herbal drinks, smoothies and plant juices] and eat only when hungry method. Yoga include complete sequel of body loosening practices, surya namaskara, yogic postures and breathing and meditative techniques practiced for specified period [60 min].This case showed effectiveness of Ayurveda diet and Yoga practices in reversing the insulin resistance, help to maintain the glycemic parameters .In addition, patient was able to loose body weight, waist circumference & serum triglyceride levels. Patient can able to withstand her diabetic profile in normal without any pharmacotherapy intervention.
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Affiliation(s)
- Suketha Kumari
- Department of Kayachikitsa, KAHER's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belagavi, Karnataka, India, 590003
| | - Basavaraj R Tubaki
- Department of Kayachikitsa, KAHER's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belagavi, Karnataka, India, 590003.
| | - Rekha S Patil
- Department of Medicine, KAHER's Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India, 590003
| | - S D Laxmikant
- Department of Shalyatantra, KAHER's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belagavi, Karnataka, India, 590003
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Janez A, Muzurovic E, Bogdanski P, Czupryniak L, Fabryova L, Fras Z, Guja C, Haluzik M, Kempler P, Lalic N, Mullerova D, Stoian AP, Papanas N, Rahelic D, Silva-Nunes J, Tankova T, Yumuk V, Rizzo M. Modern Management of Cardiometabolic Continuum: From Overweight/Obesity to Prediabetes/Type 2 Diabetes Mellitus. Recommendations from the Eastern and Southern Europe Diabetes and Obesity Expert Group. Diabetes Ther 2024:10.1007/s13300-024-01615-5. [PMID: 38990471 DOI: 10.1007/s13300-024-01615-5] [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: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024] Open
Abstract
The increasing global incidence of obesity and type 2 diabetes mellitus (T2D) underscores the urgency of addressing these interconnected health challenges. Obesity enhances genetic and environmental influences on T2D, being not only a primary risk factor but also exacerbating its severity. The complex mechanisms linking obesity and T2D involve adiposity-driven changes in β-cell function, adipose tissue functioning, and multi-organ insulin resistance (IR). Early detection and tailored treatment of T2D and obesity are crucial to mitigate future complications. Moreover, personalized and early intensified therapy considering the presence of comorbidities can delay disease progression and diminish the risk of cardiorenal complications. Employing combination therapies and embracing a disease-modifying strategy are paramount. Clinical trials provide evidence confirming the efficacy and safety of glucagon-like peptide 1 receptor agonists (GLP-1 RAs). Their use is associated with substantial and durable body weight reduction, exceeding 15%, and improved glucose control which further translate into T2D prevention, possible disease remission, and improvement of cardiometabolic risk factors and associated complications. Therefore, on the basis of clinical experience and current evidence, the Eastern and Southern Europe Diabetes and Obesity Expert Group recommends a personalized, polymodal approach (comprising GLP-1 RAs) tailored to individual patient's disease phenotype to optimize diabetes and obesity therapy. We also expect that the increasing availability of dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists will significantly contribute to the modern management of the cardiometabolic continuum.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - Emir Muzurovic
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Pawel Bogdanski
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, University of Medical Sciences, Poznan, Poland
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Lubomira Fabryova
- MetabolKLINIK sro, Department for Diabetes and Metabolic Disorders, Lipid Clinic, MED PED Centre, Biomedical Research Centre of Slovak Academy of Sciences, Slovak Health University, Bratislava, Slovak Republic
| | - Zlatko Fras
- Preventive Cardiology Unit, Division of Medicine, University Medical Centre Ljubljana and Chair of Internal Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Cristian Guja
- Clinic of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21, Prague 4, Czech Republic
| | - Peter Kempler
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Nebojsa Lalic
- Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dana Mullerova
- Faculty of Medicine in Pilsen, Department of Public Health and Preventive Medicine and Faculty Hospital in Pilsen, 1st Internal Clinic, Charles University, Pilsen, Czech Republic
| | - Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dario Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Catholic University of Croatia School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer, University of Osijek School of Medicine, Osijek, Croatia
| | - José Silva-Nunes
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde São José, Lisbon, Portugal
| | - Tsvetalina Tankova
- Department of Endocrinology, Faculty of Medicine, Medical University, Sofia, Bulgaria
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Palermo, Italy
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Lin YW, Chen PC, Lin CH, Lin MH. Investigating medication adherence among Taiwanese patient with hypertension, hyperlipidemia, and diabetes: A pilot study using the Chinese version of a Two-Part Medication Nonadherence Scale and the NHI MediCloud system. PLoS One 2024; 19:e0304442. [PMID: 38985806 PMCID: PMC11236195 DOI: 10.1371/journal.pone.0304442] [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: 12/06/2023] [Accepted: 05/14/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND This pilot study aimed to investigate medication nonadherence among Taiwanese patients with diabetes, hypertension, and hyperlipidemia using the Chinese version of the Two-Part Medication Nonadherence Scale (C-TPMNS) and the National Health Insurance (NHI) Medicloud system. The study revealed insights into the factors contributing to nonadherence and the implications for improving patient adherence to medications for chronic conditions. However, the small sample size limits the generalizability of the findings. Additionally, the study identified the need for further research with larger and more diverse samples to validate the preliminary findings. METHODS The study conducted surveys individuals in central Taiwan who received three-high medications and those who returned expired medications from chain pharmacies. A structured questionnaire including the C-TPMNS was administered, and additional data on medical history and HbA1c, LDL, and blood pressure levels were collected from the NHI Medicloud system. Data analysis was performed using multiple ordered logistic regression and Wald test methods. Setting interpretation cutoff point to determine medication nonadherence. RESULTS The study found that 25.8% of participants were non-adherent to prescribed medications. Non-adherent individuals had significantly higher systolic blood pressure (SBP ≥ 140 mmHg) than adherent participants. Non-adherence was also associated with factors such as lower education, single status, living alone, abnormal glucose postprandial concentration, and triglyceride levels. The C-TPMNS demonstrated good reliability (Cronbach's alpha = 0.816) and validity (area under the ROC curve = 0.72). CONCLUSION The study highlighted the complexity of medication nonadherence with diverse determinants and emphasized the importance of tailored interventions. The findings underscored the need for region-specific research to comprehensively address medication nonadherence, especially focusing on adherence to medications for hypertension, hyperlipidemia, and diabetes. The study also identified the need for larger, more diverse studies to validate and expand upon the initial findings and emphasized the importance of pharmacist interventions and patient empowerment in managing chronic conditions and improving overall health outcomes.
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Affiliation(s)
- Ya-Wen Lin
- School of Nursing, China Medical University, Taichung, Taiwan, R.O.C
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan, R.O.C
| | - Che-Huei Lin
- Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan, R.O.C
- Department of Business and Management, Central Taiwan University of Science and Technology, Taiwan, R.O.C
| | - Ming-Hung Lin
- Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan, R.O.C
- College of Health, Taichung University of Science and Technology, Taiwan, R.O.C
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Omotosho TOA, Senghore T. Factors Influencing Therapeutic Non-Adherence Behavior Among Patients with Type 2 Diabetes in Two Public Hospitals in the Gambia: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:2683-2692. [PMID: 39007155 PMCID: PMC11246075 DOI: 10.2147/dmso.s464761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Background Type 2 Diabetes Mellitus (DM) is a significant public health problem in The Gambia. While therapeutic non-adherence is widely recognized as a common and costly problem, very little is known about therapeutic adherence behavior among patients with diabetes in The Gambia. Purpose The objective of this study was to determine the prevalence and factors that influence diabetic therapeutic non-adherence behavior among patients with type 2 diabetes in The Gambia. Methods A cross-sectional study design was used, and participants were recruited from Edward Francis Small Teaching Hospital (EFSTH) and Kanifing General Hospital (KGH). The sample size of 145 patients with type 2 diabetes was included and data was collected using a structured questionnaire. Adherence to anti-diabetic medications was measured using the Morisky Medications Adherence Scale (MMAS-8). Logistic regression was used to determine the factors associated with diabetic therapeutic non-adherence. Results The prevalence of non-adherence to anti-diabetic treatment was 27.6%. Perceived barrier (forgetfulness, long-term medication use, and medication side effects) to diabetic treatment (OR = 0.265, 95% CI: 0.113-0.621, p = 0.041) was statistically significantly associated with non-adherence to anti-diabetic treatment. However, the frequency of doctor's visits (OR = 0.310, 95% CI: 0.046-2.111) was not significantly associated with non-adherence to anti-diabetic treatment. Conclusion The rate of non-adherence to antidiabetic treatment in this study was high. Perceived barriers to antidiabetic treatment such as forgetfulness, long-term medication use, and medication side effects influenced therapeutic non-adherence to antidiabetic treatment. While interventions should focus on how to eliminate these barriers, health education on diabetic self-care may help reinforce the importance of medication adherence to prevent complications.
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Affiliation(s)
- Tobiloba Oyejide Alex Omotosho
- Department of Nursing and Reproductive Health, The University of the Gambia, Banjul, Gambia
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Thomas Senghore
- Department of Nursing and Reproductive Health, The University of the Gambia, Banjul, Gambia
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Alfakhri A, Almadani O, Althunian T, Alrwisan A, Badreldin H, Albogami Y. Treatment modification patterns of glucose-lowering agents in Saudi Arabia: A retrospective real-world data analysis. Diabetes Res Clin Pract 2024; 214:111770. [PMID: 38971376 DOI: 10.1016/j.diabres.2024.111770] [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: 05/10/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
AIM The growing number of antidiabetics has broadened therapeutic options, leading to heterogeneity in prescribing patterns. Studies identifying antidiabetics modification patterns are lacking in Saudi Arabia. Therefore, the aim of this study is to describe modification patterns in Saudi patients. METHODS Patients ≥ 18 years old with at least one antidiabetic between 2016 and 2022 were included. Follow-up started from the earliest to the last prescription.Two modification types were evaluated: "add-on," prescribing new antidiabetics within a treatment episode, and "switching", starting a new treatment episode after the preceding ends. Descriptive statistics were used to characterize patients and estimate events proportions. RESULTS Of 122,291 patients, 47.2 % had treatment interruption or modification, totaling 303,781 events. Interruptions accounted for 54 %, add-on for 11 %, and switching for 35 %. The median time to first event was 159 days. The most add-on included dipeptidyl peptidase-4 inhibitor (DPP-4) inhibitors to biguanide and sulfonylurea (8 %), and sulfonylurea to biguanide (8 %). Among 106,405 switching events, 23 % shifted from dual to monotherapy and 17 % from monotherapy to dual therapy. CONCLUSION Nearly half of patients experienced modifications or interruptions, with notable shifts between monotherapies and dual therapies. These findings highlight the evolving landscape of treatment patterns in Saudi Arabia and guide future research and decision-making.
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Affiliation(s)
| | | | - Turki Althunian
- Saudi Food and Drug Authority, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Hisham Badreldin
- Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah Internatioanl Medical Research Center, Riyadh, Saudi Arabia; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yasser Albogami
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
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Alharbi S, Alhofaian A, Alaamri MM. Correlation between Illness Perception and Medication Adherence among Adult Patients with Type 2 Diabetes Mellitus in Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:244-251. [PMID: 39055074 PMCID: PMC11268541 DOI: 10.4103/sjmms.sjmms_511_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/13/2023] [Accepted: 03/26/2024] [Indexed: 07/27/2024]
Abstract
Objectives This study aimed to assess the level of illness perception and medication adherence among adult patients with type 2 diabetes mellitus (T2DM) in Jeddah, Saudi Arabia, with a specific focus on understanding how these two factors may be related. Materials and Methods This descriptive correlation study included all adult patients with T2DM attending the Jeddah Care Centre for Diabetes and Hypertension at King Abdulaziz Hospital between January and April 2022. Data were collected using a questionnaire that elicited sociodemographic and clinical information, and the Arabic versions of the Brief Illness Perception Questionnaire and the Morisky Medication Adherence Scale. Descriptive statistics and Pearson's correlation analysis were used for data analysis. Results A total of 365 patients were included (mean age: 50.9 ± 15.9 years), with the majority being female (53.4%). Overall, the level of medication adherence was moderate (mean score: 5.36 ± 1.73). Patients with lower medication adherence perceived the consequences of T2DM as more severe, had a stronger association with the illness identity, and experienced more intense emotional responses (for all, P < 0.001). Conversely, patients with higher adherence had a greater sense of personal control, a stronger belief in treatment effectiveness, and a better understanding of the illness (for all, P < 0.001). Conclusion The study found a correlation between illness perception and medication adherence in patients with T2DM. Addressing patients' perceptions may enhance their ability to manage the condition more effectively.
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Affiliation(s)
- Samaher Alharbi
- Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aisha Alhofaian
- Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marym M. Alaamri
- Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
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Moon JS, Kang S, Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Seo JA, Kim MK, Lim JH, Song YJ, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Bae J, Jeon E, Kim JM, Kang SM, Park JH, Yun JS, Cha BS, Moon MK, Lee BW. 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association. Diabetes Metab J 2024; 48:546-708. [PMID: 39091005 DOI: 10.4093/dmj.2024.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Jun Sung Moon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Shinae Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Yoon Ju Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Ye Seul Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Suk Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hae Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo-Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehyun Bae
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Eonju Jeon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Mee Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Hwan Park
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Tripathi P, Kadam N, Tiwari D, Kathrikolly T, Vyawahare A, Sharma B, Ganla M, Saboo B. The Diabetes Remission in India (DiRemI) study: Protocol for a prospective matched-control trial. PLoS One 2024; 19:e0306394. [PMID: 38941311 PMCID: PMC11213318 DOI: 10.1371/journal.pone.0306394] [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: 04/18/2024] [Accepted: 06/12/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The global rise in diabetes, particularly in India, poses a significant public health challenge, with factors such as limited awareness, financial strain, and cultural considerations hindering its effective management. Although lifestyle changes have shown promising results, their consistent implementation and maintenance continue to pose challenges. Most studies have focused primarily on dietary modifications, overlooking other essential aspects of lifestyle intervention. The DiRemI study aims to address these gaps by evaluating the efficacy of a comprehensive one-year program that combines diet, exercise, psychological support, and medical management to achieve weight loss, diabetes remission, and improved glycemic control among patients with type 2 diabetes (T2D) in India, while also considering the unique needs of the Indian population. METHODS The DiRemI study is a prospective, open-label, matched-group trial aimed at assessing the impact of a one-year online integrated intensive lifestyle intervention (ILI) comprising dietary modifications, physical activity, psychological support, and medical management on weight loss and remission in adult T2D patients (aged 30-70 years), with a body mass index (BMI) between 25 and 35 kg/m2, and disease duration of <15 years. ILI will be compared with routine medical care (RMC). Participants will be recruited from three clinics: one providing ILI and two others providing RMC. The co-primary outcome will be weight loss and remission at 12 months, with a follow-up at 18 months. The proposed sample size is 360 participants (180 each in intervention and control group). DISCUSSION The DiRemI study represents the first large-scale remission study in India to show the effectiveness of an integrated approach in the remission and management of T2D and its complications. The findings of this study hold the potential to report evidence-based strategies for managing T2D both in India and globally, thus alleviating the substantial burden of diabetes on public health systems. TRIAL REGISTRATION Clinical Trials Registry, India (Registered Number: CTRI/2023/06/053885).
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Affiliation(s)
- Pramod Tripathi
- Department of Research, Freedom From Diabetes Research Foundation, Pune, Maharashtra, India
- Department of Management & Exercise Science, Freedom from Diabetes Clinic, Pune, Maharashtra, India
| | - Nidhi Kadam
- Department of Research, Freedom From Diabetes Research Foundation, Pune, Maharashtra, India
| | - Diptika Tiwari
- Department of Research, Freedom From Diabetes Research Foundation, Pune, Maharashtra, India
| | - Thejas Kathrikolly
- Department of Research, Freedom From Diabetes Research Foundation, Pune, Maharashtra, India
| | - Anagha Vyawahare
- Department of Research, Freedom From Diabetes Research Foundation, Pune, Maharashtra, India
| | - Baby Sharma
- Department of Research, Freedom From Diabetes Research Foundation, Pune, Maharashtra, India
| | - Malhar Ganla
- Department of Management & Exercise Science, Freedom from Diabetes Clinic, Pune, Maharashtra, India
| | - Banshi Saboo
- Department of Medicine, Dia Care- Diabetes Care and Hormone Clinic, Diabetology, Ahmedabad, Gujarat, India
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11
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Chan JC, Mbanya JC, Chantelot JM, Shestakova M, Ramachandran A, Ilkova H, Deplante L, Rollot M, Melas-Melt L, Gagliardino JJ, Aschner P. Patient-reported outcomes and treatment adherence in type 2 diabetes using natural language processing: Wave 8 of the Observational International Diabetes Management Practices Study. J Diabetes Investig 2024. [PMID: 38840439 DOI: 10.1111/jdi.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024] Open
Abstract
AIMS/INTRODUCTION We analyzed patient-reported outcomes of people with type 2 diabetes to better understand perceptions and experiences contributing to treatment adherence. MATERIALS AND METHODS In the ongoing International Diabetes Management Practices Study, we collected patient-reported outcomes data from structured questionnaires (chronic treatment acceptance questionnaire and Diabetes Self-Management Questionnaire) and free-text answers to open-ended questions to assess perceptions of treatment value and side-effects, as well as barriers to, and enablers for, adherence and self-management. Free-text answers were analyzed by natural language processing. RESULTS In 2018-2020, we recruited 2,475 patients with type 2 diabetes (43.3% insulin-treated, glycated hemoglobin (HbA1c) 8.0 ± 1.8%; 30.9% with HbA1c <7%) from 13 countries across Africa, the Middle East, Europe, Latin America and Asia. Mean ± standard deviation scores of chronic treatment acceptance questionnaire (acceptance of medication, rated out of 100) and Diabetes Self-Management Questionnaire (self-management, rated out of 10) were 87.8 ± 24.5 and 3.3 ± 0.9, respectively. Based on free-text analysis and coded responses, one in three patients reported treatment non-adherence. Overall, although most patients accepted treatment values and side-effects, self-management was suboptimal. Treatment duration, regimen complexity and disruption of daily routines were major barriers to adherence, whereas habit formation was a key enabler. Treatment-adherent patients were older (60 ± 11.6 vs 55 ± 11.7 years, P < 0.001), and more likely to have longer disease duration (12 ± 8.6 vs 10 ± 7.7 years, P < 0.001), exposure to diabetes education (73.1% vs 67.8%, P < 0.05), lower HbA1c (7.9 ± 1.8% vs 8.3 ± 1.9%, P < 0.001) and attainment of HbA1c <7% (29.7% vs 23.3%, P < 0.01). CONCLUSIONS Patient perceptions/experiences influence treatment adherence and self-management. Patient-centered education and support programs that consider patient-reported outcomes aimed at promoting empowerment and developing new routines might improve glycemic control.
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Affiliation(s)
- Juliana Cn Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jean Claude Mbanya
- Doctoral School of Life Sciences, Health and Environment, and Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | | | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | | | | | | | | | | | - Pablo Aschner
- Javeriana University School of Medicine and San Ignacio University Hospital, Bogotá, Colombia
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12
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Wahab M, Janaswamy S. Porous corn starch granules as effective host matrices for encapsulation and sustained release of curcumin and resveratrol. Carbohydr Polym 2024; 333:121967. [PMID: 38494222 DOI: 10.1016/j.carbpol.2024.121967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Type 2 Diabetes Mellitus (T2DM) is a carbohydrate-rich diet-regulated ailment with carbohydrates digested and absorbed rapidly. Hence, modulating carbohydrate digestion is warranted; to this end, polyphenols from plant sources are handy. However, polyphenols' instability and low bioavailability limit their wholesome use, and thus, encapsulating them into an inexpensive and suitable wall material would be the best strategy. Herein, the potential of porous starch granules is demonstrated. Curcumin and resveratrol were chosen as the test polyphenols due to their proven health benefits, and porous corn starch granules were chosen as the wall material. Porous corn starch granules were prepared through enzymatic modification with 11, 22, and 33 units of amyloglucosidase at three reaction times of 2, 4, and 6 h. The polyphenols were loaded at 100, 200, and 500 mg concentrations in 1 g of starch for 21 days and were characterized through Scanning Electron Microscope (SEM) and Fourier Transform Infrared spectroscopy (FTIR) analyses. The encapsulation efficiency was determined, the rate of starch digestion was calculated through the Englyst test, and polyphenols' in vitro release behavior in gastric and intestinal fluids was measured. Results suggest that 33 enzyme units for a 2 h reaction time were optimal for forming spherical-oval pores on corn starch granules with the maximum encapsulation efficiency of 80.16 % and 88.33 % for curcumin and resveratrol, respectively. The FTIR results suggest the entrapment of polyphenols inside the starch matrix. The inclusion significantly reduced starch digestion and increased the percentage of resistant starch up to 41.11 % and 66.36 % with curcumin and resveratrol, respectively. The in vitro release behavior demonstrated good stability in the simulated gastric fluids and sustained release in simulated intestinal fluids. The encapsulated polyphenols showed a complex Fickian type of diffusion mechanism. Overall, the results suggest that porous corn starch granules could be a potential delivery system for curcumin and resveratrol and will aid in developing novel functional foods to address the T2DM concerns.
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Affiliation(s)
- Maryam Wahab
- Department of Dairy and Food Science, South Dakota State University, Brookings, SD 57007, USA
| | - Srinivas Janaswamy
- Department of Dairy and Food Science, South Dakota State University, Brookings, SD 57007, USA.
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13
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McClintock HF, Imel BE. Food insecurity and medication restricting behavior among persons with diabetes in the United States. Nutr Health 2024; 30:341-347. [PMID: 35876349 DOI: 10.1177/02601060221115588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medication restricting behaviours are common among persons with diabetes increasing risk for poor health outcomes. Persons with diabetes are more likely to experience food insecurity than persons without diabetes. AIM This study aimed to assess the relationship between food insecurity and medication restricting behaviour among persons with diabetes in the United States. METHODS Data from the 2019 National Health Interview Survey (NHIS) data conducted in the United States was used for this analysis. Medication restricting behaviour was assessed by questions asking whether four restricting behaviours were present (skipped medication, took less medication, delayed filling a prescription and/or took less medication due to cost). Food insecurity status was obtained through a 10-item scale and participants were categorized as either food secure, low food security, or very low food security. Poisson regression evaluated the relationship between medication restricting behaviour and food insecurity controlling for confounders. RESULTS Participants with very low food security had a significantly higher mean number of medication restricting behaviours than participants who were food secure (adjusted mean ratio (AMR) = 4.01; 95% confidence interval (CI) = (3.09, 5.21)). Similarly, participants with low food security had a significantly higher mean ratio than participants who were food secure (AMR = 3.76; 95% CI = (2.86. 4.94). CONCLUSION Persons with diabetes who have low or very low food security are at an increased risk for engaging in medication restricting behaviours.
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Affiliation(s)
- Heather F McClintock
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA, USA
| | - Brittany E Imel
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA, USA
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Mason S, Lewis J, Wren J. Tackling the burden of chronic ill health in emergency medicine. CAN J EMERG MED 2024; 26:369-370. [PMID: 38856940 DOI: 10.1007/s43678-024-00721-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Suzanne Mason
- Centre for Urgent and Emergency Care Research (CURE) Group, Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK.
| | - Jen Lewis
- Medical Statistics Group, Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Joshua Wren
- Centre for Urgent and Emergency Care Research (CURE) Group, Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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15
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Shumye AF, Tegegne MM, Eticha BL, Bekele MM, Woredekal AT, Asmare L. Prevalence and associated factors of proliferative diabetic retinopathy among adult diabetic patients in Northwest Ethiopia, 2023: A cross-sectional multicenter study. PLoS One 2024; 19:e0303267. [PMID: 38728350 PMCID: PMC11086827 DOI: 10.1371/journal.pone.0303267] [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: 11/15/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Proliferative diabetic retinopathy is one of the advanced complications of diabetic retinopathy. If left untreated, almost all eyes could lose a significant portion of their vision within four months. There is limited evidence regarding the magnitude of proliferative diabetic retinopathy and associated factors in the study setting and also in Ethiopia. PURPOSE To determine the magnitude and associated factors of proliferative diabetic retinopathy among adult diabetic patients attending Specialized Comprehensive Hospital-Diabetic Care Clinics in Northwest Ethiopia, 2023. METHODS A multicenter, hospital-based, cross-sectional study was conducted on 1219 adult diabetic patients selected by systematic random sampling technique. Data were collected through an in-person interview and physical examination. The Statistical Package for Social Science Version 20 was used to analyze the data. Logistic regression methods were used to test the association between predisposing factors and proliferative diabetic retinopathy. The adjusted odds ratio with a 95% confidence interval was used to determine the strength of association. RESULTS The prevalence of proliferative diabetic retinopathy was 3.1% (95% CI: 2.10%-4.10%). Hypertension (AOR = 4.35 (95% CI: 1.87-10.12)), peripheral neuropathy (AOR = 3.87 (95% CI: 1.57-9.54)), nephropathy (AOR = 2.58 (95% CI: 1.13-5.87)), ≥10 years duration of diabetes mellitus (AOR = 5.30 (95% CI: 2.32-12.14)), insulin use (AOR = 3.07 (95% CI: 1.08-8.68)), and poor adherence to diabetes mellitus medications (AOR = 3.77 (95% CI: 1.64-8.64)) were confirmed to have statistically significant association with proliferative diabetic retinopathy. CONCLUSION The prevalence of proliferative diabetic retinopathy among adult diabetic patients in the diabetes clinic was higher than the global study. Hypertension, peripheral neuropathy, nephropathy, ≥10 year's duration of diabetic mellitus, insulin use and poor adherence to diabetes mellitus medications were among the factors significantly associated with proliferative diabetic retinopathy.
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Affiliation(s)
- Abebech Fikade Shumye
- Department of Optometry, College of Medicine and Health Sciences, Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Mebratu Mulusew Tegegne
- Department of Optometry, College of Medicine and Health Sciences, Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Biruk Lelisa Eticha
- Department of Optometry, College of Medicine and Health Sciences, Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Matiyas Mamo Bekele
- Department of Optometry, College of Medicine and Health Sciences, Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Asamere Tsegaw Woredekal
- Department of Ophthalmology, College of Medicine and Health Sciences, Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Lakew Asmare
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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16
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Kronborg T, Hangaard S, Hejlesen O, Vestergaard P, Jensen MH. Bedtime Prediction of Nocturnal Hypoglycemia in Insulin-Treated Type 2 Diabetes Patients. J Diabetes Sci Technol 2024; 18:592-597. [PMID: 36514195 PMCID: PMC11089861 DOI: 10.1177/19322968221141736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Hypoglycemia may lead to anxiety, poor adherence, and hypoglycemia unawareness and is especially a threat during the night in patients with insulin-treated type 2 diabetes (T2D). It would therefore be beneficial to warn patients at risk of hypoglycemia at bedtime so they can react accordingly and avoid the episode. Hence, the aim of the present study was to develop a model for predicting nocturnal hypoglycemia. METHODS Continuous glucose monitoring (CGM), mealtime, and insulin data were collected from 67 insulin-treated patients with T2D (NCT01819129). Data were structured into 24-hour periods and labeled as nocturnal hypoglycemia or not depending on whether 15 consecutive minutes were spent below 3.0 mmol/L (54 mg/dL) during the following night. Each period was divided into "last night," "morning," "day," and "evening" for feature extraction purposes, and 72 potential features were extracted for every period. A five-fold cross-validation was used to select features by forward selection and for training and validating a model based on logistic regression. RESULTS The prediction model was based on 30 patients with 60/496 periods resulting in nocturnal hypoglycemia. Forward selection revealed that the best features were based on CGM and involved the last value and mean value during the evening, as well as the relative difference in maximum value during the day between the present period and previous periods. The model obtained a mean area under the receiver operating characteristics curve (AUC) of 0.82 with an accuracy of 0.79. CONCLUSIONS The model was able to predict nocturnal hypoglycemia with an acceptable accuracy and could therefore prevent such cases.
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Affiliation(s)
- Thomas Kronborg
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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17
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Jain SN, Choi JY, Cooper B, Renwick B, Mohamed MM, Makris SA. Long-Term Impact of COVID-19 Related Disruption of National Health Service Elective Services on Emergency Major Lower Limb Amputations. Ann Vasc Surg 2024; 102:84-91. [PMID: 38280485 DOI: 10.1016/j.avsg.2023.11.035] [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: 09/11/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND The COVID-19 pandemic has affected the healthcare systems worldwide since the dawn of 2020. In March 2020, the United Kingdom government announced the first national lockdown which severely disturbed all National Health Service (NHS) healthcare elective services. Our aim is to assess the long-term impact of COVID-19 related disruption of NHS elective services on emergency major lower limb amputations (MLLAs). METHODS Patients' data for emergency MLLA for critical limb-threatening ischemia and diabetic foot infections performed at Aberdeen Royal Infirmary was collected through Trakcare and divided into the control prepandemic group (April 2018-March 2020) and the pandemic group (April 2020-March 2022). The statistical analysis was conducted using the IBM SPSS software (v28.0.1.1 [14]). RESULTS A total of 358 patients underwent MLLA and 206 (57.5%) of these had diabetes mellitus. There was a 17% increase in the number of urgent referrals and every 1 in 5 of these finally underwent an amputation. There was an increase in the absolute number of Above- and Below-Knee amputations. There was a statistically significant increase by 33% in emergency MLLAs during the pandemic period (P < 0.05). A total of 165 postoperative deaths up to December 2022 were recorded with 30-day mortality rate of 7.26% (n = 26). CONCLUSIONS NHS vascular management groups should update themselves with evolving technologies to optimize the care provided during future unprecedented times. Furthermore, more effective measures should also be implemented to avoid delayed presentations, which can potentially lead to higher rates of major limb amputations.
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Affiliation(s)
- Shubham N Jain
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Jean Y Choi
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Benjamin Cooper
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Bryce Renwick
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Mirghani M Mohamed
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Sotirios A Makris
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.
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18
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Kalyani RR, Allende-Vigo MZ, Antinori-Lent KJ, Close KL, Das SR, Deroze P, Edelman SV, El Sayed NA, Kerr D, Neumiller JJ, Norton A. Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement. J Clin Endocrinol Metab 2024; 109:1155-1178. [PMID: 38381587 DOI: 10.1210/clinem/dgad745] [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: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.
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Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | - Sandeep R Das
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Phyllisa Deroze
- dQ&A, The Diabetes Research Company, San Francisco, CA 94117, USA
| | - Steven V Edelman
- Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego, San Diego, CA 92103, USA
| | - Nuha A El Sayed
- American Diabetes Association, Harvard Medical School, Boston, MA 02215, USA
| | - David Kerr
- Director of Digital Health, Diabetes Technology Society, Santa Barbara, CA 94010, USA
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Anna Norton
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL 60440, USA
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19
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Argano C, Priola L, Manno F, Corrao S. What Is the Role of Basal Weekly Insulin in Clinical Practice? The State of the Art. Biomedicines 2024; 12:900. [PMID: 38672255 PMCID: PMC11048618 DOI: 10.3390/biomedicines12040900] [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: 03/11/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the advent of innovative therapies in the treatment of diabetes, ever-increasing awareness is still directed to the role of insulin since it has continued to be at the centre of diabetes therapy for decades, as a therapeutic integration of innovative agents in type 2 diabetes mellitus (T2DM), as the only replacement therapy in type 1 diabetes mellitus (T1DM) and also in gestational diabetes. In this context, the study of molecules such as weekly basal insulins, both for their technological and pharmacodynamic innovation and their manageability and undoubted benefits in compliance with drug therapy, can only be a turning point in diabetes and for all its phenotypes. This review aims to provide insight into the knowledge of basal weekly insulins and their use in type 1 and 2 diabetes mellitus by examining their safety, efficacy, manageability and increased therapeutic compliance.
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Affiliation(s)
- Christiano Argano
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127 Palermo, Italy; (L.P.); (F.M.); (S.C.)
| | - Laura Priola
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127 Palermo, Italy; (L.P.); (F.M.); (S.C.)
| | - Francesco Manno
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127 Palermo, Italy; (L.P.); (F.M.); (S.C.)
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127 Palermo, Italy; (L.P.); (F.M.); (S.C.)
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
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20
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Zhang Z, Du C, Zhong X, Wang R, Tang L, Liu X. The secondary prevention of coronary heart disease in US adults 75 Years and older in daily practice: Results from the National Health and Nutrition Examination Survey 1999-2018 survey. Heliyon 2024; 10:e28239. [PMID: 38571641 PMCID: PMC10987917 DOI: 10.1016/j.heliyon.2024.e28239] [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: 11/11/2022] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Background Pharmacologic therapies, risk factor control, and lifestyle alterations were independently proven to reduce long-term cardiovascular events. However, comprehensive research examining the extent to which individuals aged 75 and above in the United States adhere to national guidelines for the secondary prevention of coronary heart disease is limited. Therefore, the primary objective of this study was to examine the current state of secondary prevention of coronary heart disease in persons 75 years of age and older in the United States and to examine the factors that contribute to inadequate drug utilization and poor control of numerous risk factors. Methods We identified patients over 75 years of age with coronary heart disease based on the National Health and Nutrition Examination Survey from 1999 to 2018 and analyzed the adequacy of risk factor control and adherence to lifestyle and medication recommendations to assess the effectiveness of coronary heart disease management. Logistic regression analysis was used to identify factors associated with uncontrolled risk factors or noncompliance with recommended medications. Results We collected information from 1566 known coronary heart disease patients aged ≥75 years of age. The majority were at target goals for blood pressure (58.88%), low-density lipoprotein cholesterol (66.85%), and glycated hemoglobin (76.12%). Only 27.8% and 36.06% were at targets for body mass index and waist circumference, respectively. 91.95% reported smoking cessation, 85.98% followed recommended alcohol consumption, whereas only 10.34% reported sufficient physical activity. For β blockers, angiotensin -converting enzyme inhibitors/angiotensin receptor blockers, statins, and antiplatelet drugs, the utilization of indicated therapy was 54.41%, 49.36%, 54.79%, and 19.03%, respectively (6.26% for all 4 medications). The results of the logistic regression analysis demonstrated that diabetes mellitus and metabolic syndrome were critical markers of numerous uncontrolled risk variables as well as noncompliance with medication regimens. Conclusions A vast majority of coronary heart disease patients ≥75 years in the USA exhibited suboptimal overall control of critical coronary heart disease risk factors. For this patient population, more knowledge is necessary to enable patients to receive continuous support, guidance, and counseling.
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Affiliation(s)
- Zhi Zhang
- Department of Cardiology, First People's Hospital of Linping District, Hangzhou, Zhejiang 311199, PR China
| | - Changqing Du
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Xin Zhong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Ruilin Wang
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, 310013, PR China
| | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Xiaowei Liu
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
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21
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Saleem SZ, Fareed A, Akhtar SMM, Farhat S, Taha AM, Akilimali A. Efficacy and safety of once-weekly insulin icodec compared to once-daily insulin g U-100 in patients with type II diabetes: a systematic review and meta-analysis. Diabetol Metab Syndr 2024; 16:80. [PMID: 38566252 PMCID: PMC10988795 DOI: 10.1186/s13098-024-01305-z] [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: 01/05/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND//OBJECTIVE Diabetes affects millions of people globally, despite treatment options, adherence and other factors pose obstacles. Once-weekly Insulin Icodec, a novel basal Insulin analog with a week-long half-life, offers potential benefits, enhancing convenience, adherence, and quality of life for improved glycemic control. This systematic review and meta-analysis aimed to assess the efficacy and safety of once-weekly Insulin Icodec compared to once-daily Insulin Glargine U-100 in individuals with type II diabetes (T2D). METHODS A comprehensive literature search was conducted using PubMed, and Cochrane Library databases before September 2023 to identify relevant Randomized control trials (RCTs) with no language restrictions following PRISMA guidelines. The Cochrane risk-of-bias tool was used for quality assessment. All statistical analyses were conducted using RevMan (version 5.4; Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULT Four RCTs published from 2020 to 2023 with a cumulative sample size of 1035 were included. The pooled mean difference (MD) revealed a 4.68% longer TIR (%) with Insulin Icodec compared to Insulin Glargine U-100 [{95% CI (0.69, 8.68), p = 0.02}], the estimated mean changes in HbA1c (%) and FPG (mg%) were found to be insignificant between the two groups [MD = - 0.12 {95% CI (- 0.26, 0.01), p = 0.07}] and [MD = - 2.59 {95% CI (- 6.95, 1.78), p = 0.25}], respectively. The overall OR for hypoglycemia was also nonsignificant between the two regimens 1.04 [{95% CI (0.71, 1.52), p = 0.84}]. Other safety parameters were similar between the two groups. CONCLUSIONS Switching from daily Insulin Glargine U-100 to weekly Insulin Icodec showed longer TIR (%) as well as similar blood glycemic control and safety profile. Hence, it may be a good alternate option for management of longstanding T2D.
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Affiliation(s)
- Syed Zia Saleem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | | | - Solay Farhat
- Faculty of Science, Lebanese University, Beirut, Lebanon
| | | | - Aymar Akilimali
- Department of Research, Medical Research Circle, Bukavu, DR, Congo.
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22
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Holdt‐Caspersen NS, Dethlefsen C, Vestergaard P, Hejlesen O, Hangaard S, Jensen MH. Adherence to newer second-line oral antidiabetic drugs among people with type 2 diabetes-A systematic review. Pharmacol Res Perspect 2024; 12:e1185. [PMID: 38450950 PMCID: PMC10918987 DOI: 10.1002/prp2.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
The adherence to oral antidiabetic drugs (OADs) among people with type 2 diabetes (T2D) is suboptimal. However, new OADs have been marketed within the last 10 years. As these new drugs differ in mechanism of action, treatment complexity, and side effects, they may influence adherence. Thus, the aim of this study was to assess the adherence to newer second-line OADs, defined as drugs marketed in 2012-2022, among people with T2D. A systematic review was performed in CINAHL, Cochrane Trials, Embase, PubMed, PsycINFO, and Scopus. Articles were included if they were original research of adherence to newer second-line OADs and reported objective adherence quantification. The quality of the articles was assessed using JBI's critical appraisal tools. The overall findings were reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and summarized in a narrative synthesis. All seven included articles were European retrospective cohort studies investigating alogliptin, canagliflozin, dapagliflozin, empagliflozin, and unspecified types of SGLT2i. Treatment discontinuation and medication possession ratio (MPR) were the most frequently reported adherence quantification measures. Within the first 12 months of treatment, 29%-44% of subjects on SGLT2i discontinued the treatment. In terms of MPR, 61.7%-94.9% of subjects on either alogliptin, canagliflozin, dapagliflozin, empagliflozin or an unspecified SGLT2i were adherent. The two investigated adherence quantification measures, treatment discontinuation and MPR, suggest that adherence to the newer second-line OADs may be better than that of older OADs. However, a study directly comparing older and newer OADs should be done to verify this.
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Affiliation(s)
- Nynne Sophie Holdt‐Caspersen
- Department of BiostatisticsNovo NordiskAalborgDenmark
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Claus Dethlefsen
- Department of BiostatisticsNovo NordiskAalborgDenmark
- Department of Mathematical SciencesAalborg UniversityAalborgDenmark
| | - Peter Vestergaard
- Steno Diabetes Center North DenmarkAalborg University HospitalAalborgDenmark
- Department of EndocrinologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Ole Hejlesen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Stine Hangaard
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
- Steno Diabetes Center North DenmarkAalborg University HospitalAalborgDenmark
| | - Morten Hasselstrøm Jensen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
- Department of Data OrchestrationNovo NordiskSøborgDenmark
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23
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Kulzer B, Aberle J, Haak T, Kaltheuner M, Kröger J, Landgraf R, Kellerer M. Fundamentals of Diabetes Management. Exp Clin Endocrinol Diabetes 2024; 132:171-180. [PMID: 38378015 DOI: 10.1055/a-2166-6566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Bernhard Kulzer
- Diabetes Centre Mergentheim, Research Institute of the Diabetes Academy Bad Mergentheim, University of Bamberg, Germany
| | - Jens Aberle
- Section Endocrinology and Diabetology, University Obesity Centre Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Haak
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
| | - Matthias Kaltheuner
- dialev, Diabetes Centre for Internal and General Medicine, Leverkusen, Germany
| | - Jens Kröger
- diabetesDE-German Diabetes Aid, Berlin, Germany
| | | | - Monika Kellerer
- Department of Internal Medicine, Marienhospital, Stuttgart, Germany
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24
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Yildirim D, Çiriş Yildiz C, Ergin E, Özbay İ. Hypoglycaemia fear, treatment adherence, and the quality of life in patients with type 2 diabetes and its determinants. Int J Nurs Pract 2024; 30:e13248. [PMID: 38385845 DOI: 10.1111/ijn.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/03/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
AIM This work aims to evaluate the relationship between the fear of hypoglycaemia, treatment adherence, and the quality of life in patients with type 2 diabetes mellitus (T2DM) and its determinants. METHODS This descriptive and cross-sectional study sample recruited 1060 T2DM outpatients in a health centre between January and July 2022. The Hypoglycemia Fear Survey (HFS), Type 2 DM Treatment Patient Compliance Scale, and the 5-Level EuroQol 5-Dimension (EQ-5D-5L) were used for data collection. RESULTS There was a positive correlation between age, duration of T2DM, and the scores obtained from the HFS and its subscales (p < 0.001). There was a positive, moderate correlation between the total HFS score and the TCS (p < 0.001). There was a negative correlation between the scores obtained from the HFS and the EQ-5D-5L (p < 0.001). The multiple regression analysis showed that the quality of life scores of the patients were significantly predicted by hypoglycaemia fear, duration of T2DM diagnosis, and age. (F = 91.691, p < 0.001). Hypoglycaemia fear, duration of T2DM diagnosis, and age explained 38.1% of the quality of life of patients. CONCLUSION We determined that the increase in hypoglycaemia fear resulted in a decrease in treatment adherence. Besides, hypoglycaemia fear increased with increasing age and duration of T2DM diagnosis.
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Affiliation(s)
- Dilek Yildirim
- Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Cennet Çiriş Yildiz
- Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Emine Ergin
- Department of Midwifery, Hamidiye Faculty of Health Sciences, Public Health Nursing, University of Health Sciences, Istanbul, Turkey
| | - İrem Özbay
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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25
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Chen SH, Lee MC, Pu C. Medication adherence in patients with type 2 diabetes after disability onset: a difference-in-differences analysis using nationwide data. BMC Med 2024; 22:102. [PMID: 38448936 PMCID: PMC10918964 DOI: 10.1186/s12916-024-03324-z] [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: 10/31/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Effectively managing the coexistence of both diabetes and disability necessitates substantial effort. Whether disability onset affects adherence to type 2 diabetes medication remains unclear. This study investigated whether disability onset reduces such adherence and whether any reduction varies by disability type. METHODS This study used the National Disability Registry and National Health Insurance Research Database from Taiwan to identify patients with type 2 diabetes who subsequently developed a disability from 2013 to 2020; these patients were matched with patients with type 2 diabetes without disability onset during the study period. Type 2 diabetes medication adherence was measured using the medication possession ratio (MPR). A difference-in-differences analysis was performed to determine the effect of disability onset on the MPR. RESULTS The difference-in-differences analysis revealed that disability onset caused a reduction of 5.76% in the 1-year MPR (P < 0.001) and 13.21% in the 2-year MPR (P < 0.001). Among all disability types, organ disabilities, multiple disabilities, rare diseases, and a persistent vegetative state exhibited the largest reductions in 2-year MPR. CONCLUSIONS Policies aimed at improving medication adherence in individuals with disabilities should consider not only the specific disability type but also the distinct challenges and barriers these patients encounter in maintaining medication adherence.
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Affiliation(s)
- Szu-Han Chen
- Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Miaw-Chwen Lee
- Department of Social Welfare, National Chung Cheng University, Chia-Yi, Taiwan
- Center for Innovative Research on Aging Society, National Chung Cheng University, Chiayi, Taiwan
- Advanced Institute of Manufacturing with High-tech Innovations, National Chung Cheng University, Chiayi, Taiwan
| | - Christy Pu
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, 155 Li-Nong ST, Sec 2, Peitou, Taipei, Taiwan.
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26
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Doya IF, Yahaya JJ, Ngaiza AI, Bintabara D. Low medication adherence and its associated factors among patients with type 2 diabetes mellitus attending Amana Hospital in Dar es Salaam, Tanzania: a cross-sectional study. Int Health 2024; 16:200-207. [PMID: 37310004 PMCID: PMC10911532 DOI: 10.1093/inthealth/ihad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Low medication adherence among patients with type 2 diabetes mellitus (T2DM) is associated with significant morbidity and mortality globally. We investigated the prevalence of low medication adherence and its associated factors among patients with T2DM. METHODS We used the Bengali version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in measuring medication adherence among patients with T2DM who were attending the diabetes clinic at Amana Regional Referral Hospital in Dar es Salaam, Tanzania, from December 2021 to May 2022. Binary logistic regression analysis under multivariate analysis was used to determine the predictors of low medication adherence after controlling for confounders. A two-tailed p-value <0.05 was considered significant. RESULTS The prevalence of low medication adherence was 36.7% (91/248) of the subjects included in the study. Lack of formal education (adjusted odds ratio [AOR] 5.3 [95% confidence interval {CI} 1.717 to 16.312], p=0.004), having comorbidities (AOR 2.1 [95% CI 1.134 to 3.949], p=0.019) and drinking alcohol (AOR 3.5 [95% CI 1.603 to 7.650], p=0.031) were the independent predictors of low medication adherence. CONCLUSION More than one-third of the patients with T2DM in this study had low medication adherence. Our study also showed that a lack of formal education, having comorbidities and drinking alcohol were significantly associated with low medication adherence.
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Affiliation(s)
- Irene F Doya
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - James J Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda
| | - Advera I Ngaiza
- Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Pathology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Deogratius Bintabara
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
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27
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Nemlekar PM, Hannah KL, Green CR, Norman GJ. Association Between Adherence, A1C Improvement, and Type of Continuous Glucose Monitoring System in People with Type 1 Diabetes or Type 2 Diabetes Treated with Intensive Insulin Therapy. Diabetes Ther 2024; 15:639-648. [PMID: 38289464 PMCID: PMC10942933 DOI: 10.1007/s13300-023-01529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/22/2023] [Indexed: 03/16/2024] Open
Abstract
INTRODUCTION Use of continuous glucose monitoring (CGM) systems by people with diabetes is associated with improved glycemic outcomes, including lower glycated hemoglobin (A1C). Less is known about adherence to CGM systems, whether glycemic outcomes are impacted by levels of adherence, or whether adherence rates differ between types of CGM systems-intermittently scanned CGM (isCGM) or real-time CGM (rtCGM). METHODS A retrospective analysis of de-identified US administrative health claims and linked laboratory data was conducted using the Merative™ MarketScan® Research Database. The cohort included CGM-naïve people with type 1 diabetes (T1D) or type 2 diabetes treated with intensive insulin therapy (T2D-IIT) who initiated rtCGM or isCGM between August 1, 2019 and March 31, 2021 (defined as the index date). Adherence was calculated over a 12-month period using the proportion of days covered (PDC) with PDC ≥ 0.8 defined as adherent. A1C values were obtained within 6 months of the index date. RESULTS A total of 7669 individuals were identified. Subgroups included T1D using isCGM (n = 1578), T1D using rtCGM (n = 1244), T2D-IIT using isCGM (n = 3567), and T2D-IIT using rtCGM (n = 1280). After 12 months, PDC was 0.71 (0.30)-0.72 (0.31) (mean(SD)) for T1D and T2D-IIT rtCGM users and 0.55 (0.34)-0.56 (0.34) for T1D and T2D-IIT isCGM users. The proportion of adherent users (PDC ≥ 0.8) was 56.8-59.7% for rtCGM users and 36.3-37.6% for isCGM users. Overall, regardless of diabetes type, the odds of adherence were over two times higher for rtCGM users compared to isCGM users. For those with available A1C information (T1D n = 213; T2D-IIT n = 346), independent of CGM type, adherence to CGM was associated with a greater reduction in A1C and more people reaching A1C targets of < 7.0% or < 8.0%. CONCLUSION For people with T1D or T2D-IIT, higher adherence to CGM is associated with greater reductions in A1C, and higher adherence rates were observed with rtCGM systems than with isCGM systems.
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Affiliation(s)
| | - Katia L Hannah
- Dexcom, Inc., 6340 Sequence Dr., San Diego, CA, 92121, USA
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28
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Alomar OO, Rabbani U. Patients' Perspectives on Type 2 Diabetes, Vitamin B12 Deficiency, and Supplementation in Buraidah, Saudi Arabia. Cureus 2024; 16:e55345. [PMID: 38559501 PMCID: PMC10981927 DOI: 10.7759/cureus.55345] [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: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Long-term metformin is associated with vitamin B12 deficiency. There is a significant misunderstanding among both physicians and patients regarding vitamin B12 indications. This study aims to identify knowledge gaps and attitudes toward vitamin B12 among diabetic patients. Materials and methods A cross-sectional study was conducted among type 2 diabetic patients visiting four primary healthcare centers in Buraidah, Saudi Arabia. The data were collected using a structured self-administered questionnaire. Data were collected on diabetes and vitamin B12 knowledge and attitude toward vitamin B12 supplementation. Logistic regression analyses were used to assess the predictors of knowledge and attitude. Results Of the 388 participants, 192 (49.5%) were male. About 84.5% of the total diabetics were on metformin. Nearly three-fourths (72.7%) were taking vitamin B12. A large proportion, 160 (41.2%), believed that it is necessary to take vitamin B12 for every diabetic patient. Nearly half, 193 (49.7%), did not know the factors affecting vitamin B12 deficiency. Young (less than 39 years) diabetics were more likely to perceive that vitamin B12 is recommended for all diabetics, OR (95% CI) [6.26 (1.86-21.06)], as compared to participants aged more than 59. Similarly, younger patients were more likely to assume vitamin B12 necessary, OR (95% CI) [3.71 (1.26-10.89)]. Conclusion We found the knowledge and attitude of diabetic patients regarding vitamin B12 to be poor. It is, therefore, recommended that primary health care providers educate their patients about vitamin B12 supplementation to reduce the number of medications and financial burden. Further large-scale studies are also needed to generate stronger evidence of the problem.
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Affiliation(s)
- Osama O Alomar
- Family Medicine, Family Medicine Academy, Qassim Health Cluster, Buraidah, SAU
| | - Unaib Rabbani
- Family Medicine, Family Medicine Academy, Qassim Health Cluster, Buraidah, SAU
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29
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Munshi M, Ritzel R, Jude EB, Dex T, Melas-Melt L, Rosenstock J. Advancing type 2 diabetes therapy with iGlarLixi in older people: Pooled analysis of four randomized controlled trials. Diabetes Obes Metab 2024; 26:851-859. [PMID: 38082473 DOI: 10.1111/dom.15377] [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: 07/26/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 12/22/2023]
Abstract
AIM To assess the efficacy and safety of iGlarLixi in older people (≥65 years) with type 2 diabetes (T2D) advancing or switching from oral agents, a glucagon-like peptide-1 receptor agonist (GLP-1RA), or basal insulin. MATERIALS AND METHODS The data of participants aged <65 years and ≥65 years from four LixiLan trials (LixiLan-O, LixiLan-G, LixiLan-L, SoliMix) were evaluated over 26 or 30 weeks. RESULTS Participants aged <65/≥65 years (n = 1039/n = 497) had a mean baseline body mass index of 31.4 and 30.7 kg/m2 and glycated haemoglobin (HbA1c) concentration of 66 mmol/mol (8.2%) and 65 mmol/mol (8.1%), respectively. Least squares mean HbA1c change from baseline to end of treatment (EOT) was -14.32 mmol/mol (-1.31%) (95% confidence interval [CI] -14.97, -13.77 [-1.37%, -1.26%]) for those aged <65 years and -13.66 mmol/mol (-1.25%) (95% CI -14.54, -12.79 [-1.33%, -1.17%]) for those aged ≥65 years. At EOT, achievement of HbA1c targets was similar between the group aged <65 years and the group aged ≥65 years: <53 mmol/mol (<7%) (59.0% and 56.5%, respectively), <59 mmol/mol (<7.5%) (75.5% and 73.0%, respectively) and <64 mmol/mol (<8%) (83.8% and 84.1%, respectively). The incidence and event rate of American Diabetes Association Level 1 hypoglycaemia during the studies were also comparable between the two groups: 26.7% and 28.2% and 1.7 and 2.1 events per patient-year for the group aged <65 years and the group aged ≥65 years, respectively. A clinically relevant reduction in HbA1c (>1% from baseline for HbA1c ≥64 mmol/mol [≥8%] or ≥0.5% from baseline for HbA1c <64 mmol/mol [<8%]) without hypoglycaemia was attained by 50.0% and 47.6% of participants aged <65 years and ≥65 years, respectively. Adverse events were similar between the two age groups. CONCLUSIONS iGlarLixi is a simple, well-tolerated, once-daily alternative for treatment advancement in older people with T2D that provides significant improvements in glycaemic control without increasing hypoglycaemia risk, thus reducing the treatment burden.
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Affiliation(s)
- Medha Munshi
- Joslin Diabetes Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Robert Ritzel
- Klinikum Schwabing and Klinikum Bogenhausen, Munich, Germany
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton under Lyne and University of Manchester/Manchester Metropolitan University, Manchester, UK
| | - Terry Dex
- Sanofi, Bridgewater, New Jersey, USA
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30
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Visentin R, Cobelli C, Sieber J, Dalla Man C. Short- and Long-Term Effects on Glucose Control of Nonadherence to Insulin Therapy in People With Type 2 Diabetes An In Silico Study. J Diabetes Sci Technol 2024; 18:309-317. [PMID: 38284154 DOI: 10.1177/19322968231223936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Strict adherence to multiple daily insulin (MDI) therapy is a cornerstone for the achievement of good glucose control in people with advanced type 2 diabetes (T2D). Here, we aim to in silico assess glucose control in T2D subjects with poor adherence to MDI therapy. METHODS We tuned the Padova T2D Simulator, originally describing early-stage T2D physiology, around advanced T2D people. One hundred in silico advanced T2D subjects were generated and equipped with optimal MDI therapy: specifically, basal and bolus insulin amounts and injection times were individualized for each subject by applying titration algorithms that iteratively update insulin dose based on glucose deviation from its target. Then, the effect of nonadhering to MDI therapy was assessed using standard glucose control metrics calculated in two 6-month 3-meal/day in silico scenarios: in Scenario 1, subjects received the optimal basal and prandial insulin bolus at each meal; in Scenario 2, subjects received optimal basal insulin and randomly delayed or skipped the prandial insulin bolus in 3 lunches during working days and 1 dinner during weekends. RESULTS A statistically significant degradation was found in all glucose control outcome metrics in Scenario 2 versus Scenario 1: e.g., percent time above 180 mg/dL increased by 22.2% and glucose management index by 0.2%. CONCLUSIONS Impaired adherence to MDI therapy in T2D leads to glucose control deteriorations in both short and long terms. Interestingly, short-term hyperglycemia seems being contrasted by residual endogenous insulin secretion, which statistically increased by 3-fold after delayed/skipped insulin boluses compared with optimal ones.
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Affiliation(s)
- Roberto Visentin
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Woman and Child's Health, University of Padua, Padua, Italy
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
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Crosswell R, Norman K, Cassim S, Papa V, Keenan R, Paul R, Chepulis L. Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study. J Prim Health Care 2024; 16:61-69. [PMID: 38546777 DOI: 10.1071/hc23141] [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: 11/01/2023] [Accepted: 02/02/2024] [Indexed: 04/02/2024] Open
Abstract
Introduction In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim This study aims to explore patients' the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results In total, 11 participants aged 19-65 years completed the interviews (female n = 9 and male n = 20); the comprised Māori (n = 5), NZ European (n = 5) and Asian (n = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau.
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Affiliation(s)
- Rebekah Crosswell
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
| | - Kimberley Norman
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
| | - Shemana Cassim
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand; and School of Psychology, Massey University, Auckland, New Zealand
| | - Valentina Papa
- Department of Nursing, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
| | - Ryan Paul
- Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
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Iqbal MZ, Alqahtani SS, Mubarak N, Shahid S, Mohammed R, Mustafa A, Khan AH, Iqbal MS. The influence of pharmacist-led collaborative care on clinical outcomes in type 2 diabetes mellitus: a multicenter randomized control trial. Front Public Health 2024; 12:1323102. [PMID: 38476498 PMCID: PMC10929610 DOI: 10.3389/fpubh.2024.1323102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
Background Health care providers are mandated to deliver specialized care for the treatment and control of type 2 diabetes mellitus. In Malaysia, Diabetes Medication Therapy Adherence Clinics (DMTAC) in tertiary hospitals have designated pharmacists to administer these services. Objective To assess the effects of pharmacist-led interventions within DMTAC on the outcomes of patients with type 2 diabetes mellitus in two distinct hospitals in Kedah, Malaysia. Methods Patients with type 2 diabetes were randomly selected from the two hospitals included in this study. The study population was divided into two equal groups. The control group consisted of 200 patients receiving routine care from the hospitals. On the other hand, the intervention group included those patients with type 2 diabetes (200), who received separate counseling sessions from pharmacists in the DMTAC departments along with the usual treatment. The study lasted 1 year, during which both study groups participated in two distinct visits. Results Parametric data were analyzed by a paired t-test and one-way ANOVA, while non-parametric data were analyzed by a Chi-squared test using SPSS v24. A p < 0.05 was considered statistically significant. The study presented the results of a greater reduction in HBA1c levels in the intervention group compared to the control group, i.e., 3.59 and 2.17% (p < 0.001). Moreover, the Systolic and Diastolic values of BP were also significantly reduced in the intervention group, i.e., 9.29 mmHg/7.58 mmHg (p < 0.005). Furthermore, cholesterol levels were significantly improved in patients in the intervention group, i.e., 0.87 mmol/L (p < 0.001). Conclusion Based on the findings of the current study it has been proven that the involvement of pharmacists leads to improved control of diabetes mellitus. Therefore, it is recommended that the government initiate DMTAC services in both private and government hospitals and clinics throughout Malaysia. Furthermore, future studies should assess the impact of pharmacist interventions on other chronic conditions, including but not limited to asthma, arthritis, cancer, Alzheimer's disease, and dementia.
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Affiliation(s)
- Muhammad Zahid Iqbal
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Saad Saeed Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Naeem Mubarak
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Sara Shahid
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Rafiuddin Mohammed
- Department of Health Informatics, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Abid Mustafa
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Gao D, Friedman S, Hosler AS, Sheridan S, Zhang W, Yu F, Lin S. Ambient heat and diabetes hospitalizations: Does the timing of heat exposure matter? THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169011. [PMID: 38040382 DOI: 10.1016/j.scitotenv.2023.169011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Although ambient heat exposure is linked with diabetes mortality, the impacts of heat exposure on diabetes-related hospitalizations remain controversial. Previous research did not examine the timing of heat-diabetes associations and relation with comorbidities/risk factors. OBJECTIVE We examined the association between heat exposure and diabetes-related hospitalizations in the transitional and summer months and identified populations vulnerable to heat. METHODS We conducted a time-stratified case-crossover study. Data on diabetes hospital admissions (primary diagnosis of type 1 and type 2 diabetes, 2013-2020) were collected by the New York State (NYS) Department of Health under the state legislative mandate. We treated temperature and air pollutants as continuous variables and defined the heat exposure as per interquartile range (IQR, a measure between the 25th and 75th percentiles) increase of daily mean temperature. Conditional logistic regressions were performed to quantify the heat-diabetes associations after controlling for air pollutants and time variant variables. Multiplicative-scale interactions between heat and demographics/comorbidities/risk factors on diabetes hospitalizations were investigated. RESULTS Each IQR increase in temperature was associated with significantly increased risks for diabetes admissions that occurred immediately and lasted for an entire week during multi-day lags in the transitional month of May (ranges of excess risk: 3.1 %-4.8 %) but not in the summer (June-August) (ranges of excess risk: -0.3 %-1.3 %). The significant increases in the excess risk of diabetes were also found among diabetes patients with complications of neuronopathy (excess risk: 27.7 %) and hypoglycemia (excess risk: 19.1 %). Furthermore, the modification effects on the heat-diabetes association were significantly stronger in females, Medicaid enrollees, non-compliant patients, and individuals with comorbidities of atherosclerotic heart disease and old myocardial infarction. CONCLUSIONS Ambient heat exposure significantly increased the burden of hospital admissions for diabetes in transitional rather than summer months indicating the importance of exposure timing. Vulnerability to heat varied by demographics and heart comorbidity.
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Affiliation(s)
- Donghong Gao
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | | | - Akiko S Hosler
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | - Scott Sheridan
- Department of Geography, Kent State University, Kent, OH, USA
| | - Wangjian Zhang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fangqun Yu
- Atmospheric Sciences Research Center, University at Albany, Albany, NY, USA
| | - Shao Lin
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA; Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, USA.
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Davis DD, Hale G, Moreau C, Joseph T, Perez A, Rosario E. Evaluating Pharmacist-Driven Interventions in a Primary Care Setting to Improve Proportion of Days Covered and Medication Adherence. J Pharm Pract 2024; 37:27-34. [PMID: 35981874 DOI: 10.1177/08971900221111144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Medication nonadherence is the leading cause of poor health outcomes and increased risk of hospitalizations. Previous studies have shown that pharmacist interventions can help improve medication adherence and CMS quality measures. Objective: The purpose of this study was to examine the impact of clinical pharmacists' interventions on medication adherence and PDC scores for ACEi/ARBs, statins, and noninsulin antidiabetic medications in the primary care setting. Methods: This observational study was conducted at four primary care clinics to evaluate PDC scores pre- and post-pharmacist interventions from April 2020 to December 2020. Eligible patients were Humana Part D beneficiaries with a baseline PDC score <85%. The primary outcome of this study was to evaluate the average change in final PDC scores, and 1-month change in PDC scores following a pharmacist intervention. Secondary outcomes were number and types of adherence barriers identified, interventions provided by the pharmacist, and barriers and interventions category (pharmacy, patient or physician-related). Results: A total of 89 barriers were identified and 208 interventions were completed. A statistically significant difference in the average change of final PDC score from baseline was seen among those on ACEi/ARBs (72.5 to 78.0, p = 0.004) and statins (73.3 to 76.6, p < 0.001). Similarly, a statistically significant change was observed from baseline to 1-month PDC among those on ACEi/ARBS (72.5 to 75.4, p = 0.001) and statins (73.3 to 74.9, p < 0.001). Conclusion: Pharmacists located in a primary care setting improved medication adherence and PDC score for patients on ACEIs/ARBs and statins.
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Affiliation(s)
| | - Genevieve Hale
- Pharmacy Practice, Nova Southeastern University West Palm Beach Student Educational Center, Palm Beach Gardens, FL, USA
| | - Cynthia Moreau
- Ambulatory Pharmacy Services, Baptist Health South Florida, Miami, FL, USA
| | - Tina Joseph
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Alexandra Perez
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Elaina Rosario
- Ambulatory Pharmacy Services, Baptist Health South Florida, Miami, FL, USA
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Gow K, Rashidi A, Whithead L. Factors Influencing Medication Adherence Among Adults Living with Diabetes and Comorbidities: a Qualitative Systematic Review. Curr Diab Rep 2024; 24:19-25. [PMID: 38112977 PMCID: PMC10798913 DOI: 10.1007/s11892-023-01532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Medication adherence plays an important role in improving health outcomes related to diabetes and comorbidity. The potential factors influencing medication adherence and how they contribute to health behaviors have not been synthesized to date. This review synthesized qualitative studies that identified factors influencing medication adherence among adults living with diabetes and comorbidity. RECENT FINDINGS Twenty-eight findings were extracted and synthesized into four themes: perceived support, lack of knowledge, medication issues, and the importance of routine. The findings highlight the factors that support medication adherence and areas that can be targeted to support and promote medication adherence. The findings also support the potential role of healthcare providers in supporting people living with diabetes and comorbidity to adhere to and maintain medication regimes. Several factors were identified that are amenable to intervention within the clinical practice setting and have the potential to enhance medication adherence and improve health outcomes for people living with diabetes and comorbidities. The development of acceptable and effective interventions could have a positive effect on medication adherence and health outcomes.
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Affiliation(s)
- Kendall Gow
- Hollywood Private Hospital, 115 Monash Ave, Nedlands, WA, 6009, Australia
| | - Amineh Rashidi
- School of Nursing and Midwifery, Edith Cowan University Joondalup Campus, Joondalup, WA, 6027, Australia.
| | - Lisa Whithead
- School of Nursing and Midwifery, Edith Cowan University Joondalup Campus, Joondalup, WA, 6027, Australia
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Davison NJ, Guthrie NL, Medland S, Lupinacci P, Nordyke RJ, Berman MA. Cost-Effectiveness Analysis of a Prescription Digital Therapeutic in Type 2 Diabetes. Adv Ther 2024; 41:806-825. [PMID: 38170435 PMCID: PMC10838832 DOI: 10.1007/s12325-023-02752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION BT-001 (AspyreRx™) prescription digital therapy, a form of personalized cognitive behavioral therapy, has demonstrated clinically meaningful and durable hemoglobin A1c reductions in patients with type 2 diabetes (T2D). The current study examined the cost-effectiveness of BT-001 plus standard of care (SoC) versus SoC alone in T2D over a lifetime horizon from a healthcare payer perspective. METHODS We modeled the T2D pathway using an individual patient-level simulation; clinical data were sourced from the intention-to-treat subset of the BT-001 randomized clinical trial (RCT). SoC across both arms included the composition of oral and injectable treatments for T2D. Events were simulated using the United Kingdom Prospective Diabetes Study Outcomes Model 2 risk equation. A 3-month model cycle length was used in the first year, then annual model cycles were used in line with the original risk engine specifications. Patient characteristics informed event equations and Monte Carlo random sampling was used to assess the occurrence of events within each model cycle. Incidence of hypoglycemic events, drug discontinuation, costs, and health utilities and disutility values were sourced from the literature. RESULTS From a payer perspective, BT-001 plus SoC versus SoC alone was dominant with a gain in quality-adjusted life years (QALYs) of 0.101 and cost savings of $7343 per patient over the lifetime horizon (i.e., more effective and less costly). BT-001 plus SoC was cost-effective at a willingness-to-pay of $100,000 per QALY (incremental net monetary benefit was $17,443). Savings with BT-001 were primarily driven by a reduction in drug acquisition costs. The reduction in hemoglobin A1c with BT-001 was associated with fewer T2D complications. CONCLUSIONS BT-001 plus SoC was estimated to dominate SoC alone over the lifetime horizon from a payer perspective, suggesting that using BT-001 can empower patients to better manage their diabetes with the potential for lifelong advantages.
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Affiliation(s)
| | - Nicole L Guthrie
- Better Therapeutics, 548 Market St, San Francisco, CA, 49404, USA
| | | | - Paul Lupinacci
- Villanova University, 800 Lancaster Ave, Villanova, PA, USA
| | | | - Mark A Berman
- Better Therapeutics, 548 Market St, San Francisco, CA, 49404, USA
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Golembiewski EH, Garcia Bautista AE, Polley E, Umpierrez GE, Galindo RJ, Brito JP, Montori VM, Gockerman JP, Tesulov M, Labatte B, Mickelson MM, McCoy RG. Outcomes and Attributes Patients Value When Choosing Glucose-Lowering Medications: A Mixed-Methods Study. Clin Diabetes 2024; 42:371-387. [PMID: 39015157 PMCID: PMC11247043 DOI: 10.2337/cd23-0042] [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: 07/18/2024]
Abstract
This mixed-methods study sought to identify pharmacotherapy preferences among 40 noninsulin-treated adults with type 2 diabetes receiving care at two U.S. health care systems. Participants ranked by relative importance various health outcomes and medication attributes and then contextualized their rankings. Most participants ranked blindness (63%), death (60%), heart attack (48%), and heart failure (48%) as the most important health outcomes and glucose-lowering efficacy (68%) as the most important medication attribute, followed by oral administration (45%) and lack of gastrointestinal side effects (38%).
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Affiliation(s)
| | | | - Eric Polley
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Guillermo E. Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Rodolfo J. Galindo
- Division of Endocrinology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Juan P. Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Victor M. Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Mindy M. Mickelson
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
- University of Maryland Institute for Health Computing, Bethesda, MD
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Krishna N S, Sharma S, Lahiri A, Sai M, Kesri S, Pakhare A, Kokane AM, Joshi R, Joshi A. Risk Factors for Unfavorable Glycemic Control Trajectory in Type-2 Diabetes Mellitus: A Community-based Longitudinal Study in Urbanslums of Central India. Curr Diabetes Rev 2024; 20:e270423216246. [PMID: 37102489 DOI: 10.2174/1573399819666230427094530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a chronic disease, which requires optimal glycemic control to prevent its ensuing vascular complications. Pathway to optimal glycemic control in T2DM has a complex socio-behavioral construct, especially in vulnerable populations, like slum dwellers, who have reduced health-care access and lower prioritization of health needs. OBJECTIVE The study aimed to map trajectories of glycemic control amongst individuals with T2DM living in urban slums and identify key determinants associated with unfavourable glycaemic trajectory. METHODS This study was a community-based longitudinal study conducted in an urban slum of Bhopal in Central India. Adult patients diagnosed with T2DM and on treatment for more than one year were included. All 326 eligible participants underwent a baseline interview, which captured sociodemographic, personal behavior, medication adherence, morbidity profile, treatment modality, anthropometric and biochemical measurements (HbA1c). Another 6-month follow-up interview was conducted to record anthropometric measurements, HbA1c and treatment modality. Four mixed effect logistic regression models (through theory-driven variable selections) were created with glycemic status as dependent variable and usage of insulin was considered as random effect. RESULTS A total of 231 (70.9%) individuals had unfavorable glycemic control trajectory (UGCT), and only 95 (29.1%) had a favorable trajectory. Individuals with UGCT were more likely to be women, with lower educational status, non-vegetarian food preference, consumed tobacco, had poor drug adherence, and were on insulin. The most parsimonious model identified female gender (2.44,1.33-4.37), tobacco use (3.80,1.92 to 7.54), and non-vegetarian food preference (2.29,1.27 to 4.13) to be associated with UGCT. Individuals with good medication adherence (0.35,0.13 to 0.95) and higher education status (0.37,0.16 to 0.86) were found to be protective in nature. CONCLUSION Unfavorable glycemic control trajectory seems to be an inescapable consequence in vulnerable settings. The identified predictors through this longitudinal study may offer a cue for recognizing a rational response at societal level and adopting strategy formulation thereof.
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Affiliation(s)
- Subba Krishna N
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Shweta Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Anuja Lahiri
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Madhu Sai
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Shashwat Kesri
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Arun M Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Rajnish Joshi
- Department of General Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
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Ravi S, Meyerowitz-Katz G, Murugesan A, Ayre J, Jayaballa R, Rintoul D, Sarkis M, McCaffery K, Maberly G, Bonner C. Qualitative and Quantitative Evaluation of an Innovative Primary and Secondary Diabetes Clinic in Western Sydney. Int J Integr Care 2024; 24:13. [PMID: 38406628 PMCID: PMC10885848 DOI: 10.5334/ijic.7548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Western Sydney Diabetes (WSD) established an innovative diabetes service in May 2020, using virtual and in-person care, linking primary care with the diabetes specialist team. This study evaluated the service's feasibility using qualitative and quantitative methods. Method Evaluation included: 1) thematic analysis of interviews and workshops with patients and health professionals (n = 28); 2) quantitative analysis of records of patients admitted July 2020-June 2021 (n = 110). Results Key themes related to 1) benefits: convenient location, access to integrated care, advantages of virtual care; 2) challenges: hard for patients to ask questions, technology issues; 3) confidence: shared care decision making, multidisciplinary team; and 4) future directions: additional multidisciplinary services, expanded insulin stabilisation service, promotion.Improvements between baseline and 3 months included 1.3% reduction in HbA1c (p < 0.05). Sulfonylurea dropped by 25% between initial appointment and follow-up, and GLP1RA/SGLT2i use increasing by 30% (p < 0.05). The clinic covered costs using Medicare billings and Nationally Weighted Activity Units. Discussion The findings suggest this integrated care model was feasible and perceived as beneficial by both patients and providers. The clinic offers a promising model of practice that could be developed further to roll out in other regions for rural delivery of care.
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Affiliation(s)
- Sumathy Ravi
- Western Sydney Diabetes, Integrated and Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gideon Meyerowitz-Katz
- Western Sydney Diabetes, Integrated and Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Anandhi Murugesan
- Western Sydney Diabetes, Integrated and Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rajini Jayaballa
- Western Sydney Diabetes, Integrated and Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
| | | | - Marina Sarkis
- Agency for Clinical Innovation, St Leonards, NSW, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Integrated and Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Mosleh R, U'wais A, Hamdan A, Ghanim M, Jarrar Y. Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine. Endocr Metab Immune Disord Drug Targets 2024; 24:441-454. [PMID: 35616669 DOI: 10.2174/1871530322666220523114806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020. AIMS This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs. METHODS A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire, including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal- Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A p-value < 0.05 was considered statistically significant. RESULTS More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These results are worth taking into consideration. CONCLUSION This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.
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Affiliation(s)
- Rami Mosleh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ala' U'wais
- Department of Pharmacology and Physiology, Basic Medical Unit/ Nursing College, Arab American University, Zababdeh, Jenin, Palestine
| | - Anas Hamdan
- Department of Allied and Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mustafa Ghanim
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yazun Jarrar
- College of Pharmacy, AlZaytoonah University of Jordan, Amman, Jordan
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Wang X, Xiao W, Liang Z, Li S, Tang Q. Efficacy and safety of once-weekly basal insulin versus once-daily basal insulin in patients with type 2 diabetes: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36308. [PMID: 38206709 PMCID: PMC10754560 DOI: 10.1097/md.0000000000036308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/03/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Once-weekly insulin is expected to improve treatment compliance and durability and lead to better glycemic control. Several clinical trials on once-weekly insulin have recently been published. We conducted a systematic review and meta-analysis to investigate the efficacy and safety of once-weekly insulin versus once-daily insulin in type 2 diabetes (T2D). METHODS The following databases were searched for studies: PubMed, EMBASE, and Cochrane library (From January 1, 1946 to May 9, 2023). All randomized trials comparing weekly versus daily insulin in T2D were eligible for inclusion. Data analysis was performed using STATA 17.0 software (Stata Corporation, College Station, TX). The main outcomes and indexes included reduction in Hemoglobin A1c (HbA1c), fasting plasma glucose and bodyweight, proportion of patients achieving HbA1c < 7%, time-in-range 70 to 180 mg/dL and adverse events. RESULTS This systematic review and meta-analysis included 7 randomized controlled studies involving 2391 patients (1347 receiving 1-week insulin and 1044 receiving 1-day insulin). Once-weekly insulin was not inferior to once-daily insulin in HbA1c change [estimated treatment difference (ETD) = -0.05; 95% confidence intervals (CI): -0.14 to 0.04), HbA1c < 7% (odds ratio = 1.14; 95% CI: 0.87-1.50), fasting plasma glucose (ETD = 0.09; 95% CI: -0.19 to 0.36) and body weight loss (ETD = 0.27; 95% CI: -0.36 to 0.91). In terms of time-in-range 70 to 180 mg/dL, weekly insulin was superior to daily insulin (MTD = 3.84; 95% CI: 1.55-6.08). Icodec was associated with higher incidence of all adverse events (odds ratio = 1.20; 95% CI: 1.03-1.48; P = .024), but did not result in high risk of serious and severe adverse events. Moreover, icodec and Basal Insulin Fc did not result in higher incidence of hypoglycemia compared with insulin daily. CONCLUSION Our meta-analysis found that insulin weekly was well tolerated and effective for glycemic control. Once-weekly insulin was not inferior to once-daily insulin in both efficacy and safety in T2D.
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Affiliation(s)
- Xinxin Wang
- Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Nanhai District, Foshan City, Guangdong Province, China
| | - Wei Xiao
- Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Nanhai District, Foshan City, Guangdong Province, China
| | - Zhanpeng Liang
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangdong Province, China
| | - Shixiang Li
- School of Traditional Chinese Medicine, Jinan University, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Qizhi Tang
- . Department of Endocrinology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan City, Guangdong Province, the People’s Republic of China
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Davidson MB, Davidson SJ, Duran P. Beneficial Effect of Remote Glucose Monitoring and Computerized Insulin Dose Adjustment Algorithms Independent of Insulin Dose Increases in Sizeable Minorities of Patients. Clin Diabetes 2023; 42:364-370. [PMID: 39015160 PMCID: PMC11247028 DOI: 10.2337/cd23-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
This article describes a program through which interactions every 2-3 weeks between patients and primary care clinicians (PCCs), with recommendations based on analysis of remote glucose monitoring by computerized insulin dose adjustment algorithms, significantly improved diabetes control. Insulin doses increased by 30% in the majority of patients. A sizeable minority (36%) had a decrease or no increase in insulin doses, but still showed an improvement in diabetes control. Frequent interactions allowed PCCs the opportunity to recognize and address medication nonadherence.
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Affiliation(s)
- Mayer B. Davidson
- Charles R. Drew University, Los Angeles, CA
- Mellitus Health, Inc., Los Angeles, CA
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Tamuhla T, Raubenheimer P, Dave JA, Tiffin N. Routine health data describe adherence and persistence patterns for oral diabetes medication for a virtual cohort in the Khayelitsha sub-district of Cape Town, South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002730. [PMID: 38127875 PMCID: PMC10734983 DOI: 10.1371/journal.pgph.0002730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is managed with combined lifestyle modifications and antidiabetic drugs, but people on treatment often fail to reach glycaemic control. Adherence is important for achieving optimal glycaemic control, and management of diabetes with drugs is a lifelong process, so understanding adherence through analysis of longitudinal medications data is important. Using retrospective routine health data and metformin dispensing records as a proxy for medication use, we describe longitudinal persistence and adherence to oral diabetes medication in a virtual cohort of 10541 people with diabetes (PLWD) in Khayelitsha subdistrict, Cape Town. Adherence was measured in 120-day sliding windows over two years and used to estimate metformin adherence trajectories. Multinomial logistic regression identified factors influencing these trajectories. Analysis of pharmacy dispensing records showed varying medication refill patterns: while some PLWD refilled prescriptions consistently, others had treatment gaps with periods of non-persistence and multiple treatment episodes-from one to five per individual across two years. There was a general trend of decreasing adherence over time across all sliding windows in the two-year period, with only 25% of the study population achieved medication adherence (> = 80% adherence) after two years. Four adherence trajectories; 'low adherence gradual decline (A), 'high adherence rapid decline' (B), 'low adherence gradual increase (C) and 'adherent' (D) were identified. Only trajectory D represented participants who were adherent at treatment start and remained adherent after two years. Taking HIV antiretroviral treatment before or concurrently with diabetes treatment and taking metformin in combination with sulphonylurea and/or insulin were associated with the long-term adherence (trajectory D). Routine data shows real life medication implementation patterns which might not be seen under controlled study conditions. This study illustrates the utility of these data in describing longitudinal adherence patterns at both an individual and population level.
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Affiliation(s)
- Tsaone Tamuhla
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa
| | - Peter Raubenheimer
- Division of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, South Africa
| | - Joel A. Dave
- Division of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, South Africa
| | - Nicki Tiffin
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Kindratt TB, Boateng GO, Brannon GE, Sankuratri BYV, Brown KK. Testing proximal, intermediate, and health outcomes of patient centered communication among non-pregnant women of childbearing age with diabetes mellitus: Findings from the Medical Expenditure Panel Survey 2012-2018. PEC INNOVATION 2023; 3:100185. [PMID: 37457671 PMCID: PMC10344676 DOI: 10.1016/j.pecinn.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Objective To determine associations between patient-centered communication (PCC) and overall healthcare ratings, self-efficacy, and management adherence among reproductive-age women with diabetes within the framework of Epstein and Street's conceptual model. Methods We analyzed longitudinal data from the 2012-2018 Medical Expenditure Panel Survey. The sample included 493 non-pregnant women of childbearing age (18-45 years) with diabetes. Independent variables were domains of PCC (listening, explaining, respecting, spending time, giving instructions, among others). Dependent variables were overall healthcare ratings, self-efficacy, and management adherence. Crude and adjusted associations were evaluated. Results Non-pregnant women of childbearing age who reported that their provider always listened to them, explained things, showed respect, and spent enough time with them had greater odds of reporting high overall healthcare ratings. Those who reported their provider always listened to them and spent enough time with them had greater odds of reporting better diabetes care adherence than those whose health care providers did not. Conclusion Findings demonstrate that non-pregnant women of childbearing age who report having optimal PCC are more likely to adhere to their diabetes care regimen. Innovation This is the first known study using a nationally representative sample of non-pregnant women of childbearing age to examine multiple layers of PCC.
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Affiliation(s)
- Tiffany B. Kindratt
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Godfred O. Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
- School of Global Health, York University, Toronto, ON, Canada
| | - Grace Ellen Brannon
- Department of Communication, University of Texas at Arlington, Arlington, TX, USA
| | | | - Kyrah K. Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
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Pieber TR, Asong M, Fluhr G, Höller V, Kristensen NR, Larsen JH, Ribel-Madsen R, Svehlikova E, Vinther S, Voortman M, Haahr H. Pharmacokinetic and pharmacodynamic properties of once-weekly insulin icodec in individuals with type 2 diabetes. Diabetes Obes Metab 2023; 25:3716-3723. [PMID: 37694740 DOI: 10.1111/dom.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
AIMS To characterize the pharmacokinetic and pharmacodynamic properties of once-weekly insulin icodec in type 2 diabetes (T2D). MATERIALS AND METHODS In an open-label trial, 46 individuals with T2D (18-75 years; body mass index 18.0-38.0 kg/m2 ; glycated haemoglobin ≤75 mmol/mol [≤9%]; basal insulin-treated) received subcutaneous once-weekly icodec for ≥8 weeks at individualized doses, aiming at a pre-breakfast plasma glucose concentration of 4.4 to 7.0 mmol/L (80-126 mg/dL) on the last three mornings of each weekly dosing interval. Frequent blood sampling to assess total serum icodec concentration (ie, albumin-bound and unbound) occurred from first icodec dose until 35 days after last dose. Icodec trough concentrations following initiation of once-weekly dosing were predicted by pharmacokinetic modelling. During the final 3 weeks of icodec treatment, while at steady state, the icodec glucose-lowering effect was assessed in three glucose clamps (target 7.5 mmol/L [135 mg/dL]): 0 to 36, 40 to 64 and 144 to 168 h post-dose, thus covering the initial, middle and last part of the 1-week dosing interval. Glucose-lowering effect during a complete dosing interval was predicted by pharmacokinetic-pharmacodynamic modelling. RESULTS Model-predicted icodec steady state was attained after 3 to 4 weeks. At steady state, model-predicted daily proportions of glucose-lowering effect on days 1 to 7 of the 1-week dosing interval were 14.1%, 16.1%, 15.8%, 15.0%, 14.0%, 13.0% and 12.0%, respectively. Icodec duration of action was at least 1 week in all participants. Once-weekly icodec was overall safe and well tolerated in the current trial. CONCLUSIONS The pharmacokinetic and pharmacodynamic characteristics of icodec in individuals with T2D support its potential as a once-weekly basal insulin.
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Affiliation(s)
- Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | | | - Gabriele Fluhr
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Vera Höller
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | | | | | | | - Eva Svehlikova
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
| | | | - Margarete Voortman
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Austria
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Nørlev JTD, Hejlesen O, Jensen MH, Hangaard S. Quantification of insulin adherence in adults with insulin-treated type 2 diabetes: A systematic review. Diabetes Metab Syndr 2023; 17:102908. [PMID: 38016266 DOI: 10.1016/j.dsx.2023.102908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
AIMS This systematic review aims to identify current methods used for the assessment of insulin adherence in adults with insulin-treated type 2 diabetes. The primary goal is to offer recommendations for clinical practice to improve quantification of adherence. METHODS The review was conducted in accordance with PRISMA 2020 and registered at PROSPERO (CRD42022334134). PubMed, Embase, CINAHL, and PsycINFO were searched on 15 November 2022 and included three blocks: Type 2 diabetes, insulin, and adherence. We considered primary full-text studies describing an assessment method and a threshold for assessment of insulin adherence in adults with insulin-treated type 2 diabetes. RESULTS A final sample of 50 studies were included. Identified methods fell into four categories: self-report, pharmacy claims, inulin count, and data from an insulin pen device. Commonly reported methods included: The Morisky Medication Adherence Scale, the (adjusted) Medication Possession Ratio, and the Proportions of Days Covered. A threshold of <80% was used to define non-adherence in nearly half of the studies. Yet, several thresholds were reported. CONCLUSIONS Most available methods for assessing insulin adherence in adults with insulin-treated type 2 diabetes are severely limited in providing in-depth insights into timing, dosing size, injection patterns, and adherence behavior. However, recognizing diverse types of non-adherence is crucial, as they denote unique behavioral entities requiring targeted intervention. Employing insulin injection data (e.g., from a smart insulin pen cap) to underlie an assessment method is a potential new approach to objectively assess insulin timing and dosing adherence in adults with insulin-treated type 2 diabetes.
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Affiliation(s)
- Jannie Toft Damsgaard Nørlev
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerløfs Vej 249, DK-9260, Gistrup, Denmark; Steno Diabetes Centre North Denmark, Sønder Skovvej 3E, DK-9000, Aalborg, Denmark.
| | - Ole Hejlesen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerløfs Vej 249, DK-9260, Gistrup, Denmark
| | - Morten Hasselstrøm Jensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerløfs Vej 249, DK-9260, Gistrup, Denmark; Data Science, Novo Nordisk A/S, Vandtårnsvej 112, DK-2680, Søborg, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerløfs Vej 249, DK-9260, Gistrup, Denmark; Steno Diabetes Centre North Denmark, Sønder Skovvej 3E, DK-9000, Aalborg, Denmark
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47
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Soileau LG, Nguyen A, Senthil A, Boullion JA, Talbot NC, Ahmadzadeh S, Shekoohi S, Kaye AD, Varrassi G. Bromocriptine and Colesevelam Hydrochloride: Novel Therapies for Type II Diabetes Mellitus. Cureus 2023; 15:e50138. [PMID: 38192911 PMCID: PMC10771968 DOI: 10.7759/cureus.50138] [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: 11/01/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
The increasing prevalence of type II diabetes mellitus (T2DM) is a worldwide healthcare concern. Over the years, our understanding of T2DM has grown considerably in uncovering the pathophysiology of the disease and, in turn, understanding how improved treatment methods can be used to slow disease progression. Some long-term complications that are responsible for most T2DM mortalities include cardiovascular disease, neurological decline, and renal failure. In treating T2DM, it is important that not only glycemic control be obtained but also control of associated complications. Bromocriptine and colesevelam hydrochloride have both been approved by the Food and Drug Administration (FDA) to treat T2DM but are not readily used in practice. These medications are known to treat glycemic dysregulation via unconventional mechanisms, which might contribute to their potential to provide protection against common diabetic complications such as cardiovascular disease. In order to ensure that these overlooked medications become more readily used, it is vital that more research be performed to further elucidate their efficacy in a clinical setting. Future studies should continue to provide clinicians a better understanding of the role these medications have on the treatment of T2DM such as their ability to be used in combination with other commonly used T2DM medications or as monotherapies.
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Affiliation(s)
- Lenise G Soileau
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Angela Nguyen
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Aarthi Senthil
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Jolie A Boullion
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Suprapti B, Izzah Z, Anjani AG, Andarsari MR, Nilamsari WP, Nugroho CW. Prevalence of medication adherence and glycemic control among patients with type 2 diabetes and influencing factors: A cross-sectional study. GLOBAL EPIDEMIOLOGY 2023; 5:100113. [PMID: 37638377 PMCID: PMC10446000 DOI: 10.1016/j.gloepi.2023.100113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background This study aimed to assess medication adherence, glycemic control, and their influencing factors among outpatients at an Indonesian clinic with type 2 diabetes. Methods A cross-sectional study was conducted among patients with type 2 diabetes at a hospital-based clinic in Surabaya, Indonesia, from September to December 2018. A purposive sampling was used; patients aged 18 years and older, had diabetes and any comorbidity, received hypoglycemic agents, and provided written informed consent were included. The previously validated Brief Medication Questionnaire was used to measure medication adherence, while glycosylated hemoglobin (A1C) levels were used to evaluate glycemic control. Binary logistic regression was used to identify factors associated with medication adherence and glycemic control. Results Of 321 patients enrolled in the study, 268 (83.5%) patients were medication nonadherent. Patients who did not engage regularly in physical activity (aOR: 0.49, 95% CI: 0.26-0.93) was more likely to be medication adherent. Poor glycemic control (A1C: >7%) was observed in 106 (33.0%) of the patients. Patients who used a combination of oral hypoglycemic agents and insulin (aOR: 2.74, 95% CI: 1.09-6.86), did not take biguanide (aOR: 2.73, 95% CI: 1.16-6.43), reported hyperglycemia (aOR: 4.24, 95% CI: 1.53-11.81), and had comorbid diseases (aOR: 4.33, 95% CI: 1.08-17.34) increased the risk of having poor glycemic control. Patients who were more likely to achieve good glycemic control were male (aOR: 0.39, 95% CI: 0.20-0.74) and aged older (aOR: 0.95, 95% CI: 0.92-0.99). Conclusions The proportion of patients who were medication nonadherent was much higher than those with poor glycemic control. Whereas regular exercise was a predictor of nonadherence, age, sex, diabetes medication, not taking biguanide, acute complications, and comorbidity were predictors of poor glycemic control. Therefore, strategies are needed to improve medication adherence and glycemic control.
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Affiliation(s)
- Budi Suprapti
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Zamrotul Izzah
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
| | - Ade Giriayu Anjani
- Master of Clinical Pharmacy Program, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Mareta Rindang Andarsari
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Wenny Putri Nilamsari
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Cahyo Wibisono Nugroho
- Department of Internal Medicine, Faculty of Medicine Universitas Airlangga, Mayjen Prof. Dr. Moestopo 47, Surabaya 60131, Indonesia
- Department of Internal Medicine, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
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Joho AA, Sandi F, Yahaya JJ. Determinants of knowledge, attitude, and practice among patients with type 2 diabetes mellitus: A cross-sectional multicenter study in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001351. [PMID: 38039284 PMCID: PMC10691713 DOI: 10.1371/journal.pgph.0001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/31/2023] [Indexed: 12/03/2023]
Abstract
Improvement of primary care for patients with type 2 diabetes mellitus (T2DM) through the promotion of good knowledge, attitude, and practice is of paramount importance for preventing its related complications. This study aimed to assess the levels of knowledge, attitude, and practice and associated factors among patients with T2DM. This was a cross-sectional multicenter hospital-based study that included 979 patients from 8 health facilities in Tanzania. A standardized semi-structured interviewer-administered questionnaire was used to extract the required data. Factor analysis was used to determine the level of knowledge, attitude, and practice. Multivariable analysis under binary logistic regression analysis was used to determine the predictors of knowledge, attitude, and practice. P<0.05 was considered significant. The levels of adequate knowledge, positive attitude, and appropriate practice were 62.1%, 54%, and 30.9%, respectively. Being self-employed (AOR = 1.74, 95% CI = 0.28-0.91, p = 0.040) predicted adequate knowledge. Being male (AOR = 1.46, 95% CI = 1.06-2.01, p = 0.021 and visiting regional hospitals (AOR = 2.17, 95% CI = 1.33-2.51, p = 0.013) were predictors of positive attitude. Residing in rural areas and not having adequate knowledge of diabetes were less likely associated with appropriate practice. This study has shown a significantly low level of appropriate practice among patients with T2DM towards general issues on diabetes, risk factors, and related complications. Therefore, emphasis should be placed on improving good practices that can help prevent related complications.
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Affiliation(s)
- Angelina A. Joho
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Frank Sandi
- Department of Ophthalmology, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
| | - James J. Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, Soroti, Uganda
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50
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Ata F, Khan AA, Khamees I, Iqbal P, Yousaf Z, Mohammed BZM, Aboshdid R, Marzouk SKK, Barjas H, Khalid M, El Madhoun I, Bashir M, Kartha A. Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis. Ann Med 2023; 55:533-542. [PMID: 36745515 PMCID: PMC9904305 DOI: 10.1080/07853890.2023.2175031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The increasing prevalence of diabetic ketoacidosis (DKA) related admissions poses a significant burden on the healthcare systems globally. However, data regarding the predictors of healthcare resource utilization in DKA is limited and inconsistent. This study aimed to identify key predictors of hospital length of stay (LOS), readmission and recurrent DKA episodes. METHODS We undertook a retrospective cross-sectional analysis of all DKA admissions from 2015 to 2021 across four hospitals in Qatar. The primary outcomes were the length of stay (LOS), 90-day readmission and 6-month and 1-year DKA recurrence. RESULTS We included 922 patients with a median age of 35 years (25-45). 62% were males with type-1 diabetes-mellitus (T1DM) and type-2 DM (T2DM), present in 52% and 48% of patients. The median LOS was 2.6 days (IQR 1.1-4.8), and the median DKA resolution time was 18 h (10.5-29). Male-gender, new-onset DM, higher Charlson Comorbidity Index (CCI), lower haemoglobin, sodium and potassium, higher urea, longer DKA duration and MICU admission predicted a longer LOS in a multivariate regression analysis. None of the factors were significantly associated with 90-day readmission. Patients with pre-existing T1DM were more likely to have a six-month DKA recurrence than pre-existing T2DM. Patients with a 6-month DKA recurrence, female gender and T1DM had higher odds of 12-month recurrence, whereas a consult with a diabetes educator at the index admission was associated with decreased odds of recurrence. CONCLUSIONS/INTERPRETATION This is the most extensive study from the Middle-East region reporting on LOS, readmissions and the recurrence of DKA. Results from this study with a diverse population may be valuable for physicians and healthcare systems to decrease the diabetes-related healthcare burden in DKA patients.
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Affiliation(s)
- Fateen Ata
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Adeel Ahmad Khan
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Khamees
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Phool Iqbal
- Department of Medicine, New York Medical College/Metropolitan Hospital Center, New York, NY, USA
| | - Zohaib Yousaf
- Department of Medicine, Reading Hospital-Tower Health, West Reading, PA, USA
| | | | - Reham Aboshdid
- Department of Geriatrics, Hamad Medical Corporation, Doha, Qatar
| | | | - Haidar Barjas
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Madiha Khalid
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ihab El Madhoun
- Department of Nephrology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Bashir
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Anand Kartha
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Weill Cornell Medicine, Doha, Qatar
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