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Studer CM, Linder M, Pazzagli L. A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:122. [PMID: 37936205 PMCID: PMC10631092 DOI: 10.1186/s41043-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Antidiabetic medication adherence is a key aspect for successful control of type 2 diabetes mellitus (T2DM). This systematic review aims to provide an overview of the associations between socioeconomic factors and antidiabetic medication adherence in individuals with T2DM. METHODS A study protocol was established using the PRISMA checklist. A primary literature search was conducted during March 2022, searching PubMed, Embase, Web of Science, as well as WorldCat and the Bielefeld Academic Search Engine. Studies were included if published between 1990 and 2022 and included individuals with T2DM. During primary screening, one reviewer screened titles and abstracts for eligibility, while in the secondary screening, two reviewers worked independently to extract the relevant data from the full-text articles. RESULTS A total of 15,128 studies were found in the primary search, and 102 were finally included in the review. Most studies found were cross-sectional (72) and many investigated multiple socioeconomic factors. Four subcategories of socioeconomic factors were identified: economic (70), social (74), ethnical/racial (19) and geographical (18). The majority of studies found an association with antidiabetic medication adherence for two specific factors, namely individuals' insurance status (10) and ethnicity or race (18). Other important factors were income and education. CONCLUSIONS A large heterogeneity between studies was observed, with many studies relying on subjective data from interviewed individuals with a potential for recall bias. Several socioeconomic groups influencing medication adherence were identified, suggesting potential areas of intervention for the improvement of diabetes treatment adherence and individuals' long-term well-being.
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Affiliation(s)
- Christian Ming Studer
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Laura Pazzagli
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Mishra A, Pradhan SK, Sahoo BK, Das A, Singh AK, Parida SP. Assessment of Medication Adherence and Associated Factors Among Patients With Diabetes Attending a Non-communicable Disease Clinic in a Community Health Centre in Eastern India. Cureus 2023; 15:e43779. [PMID: 37731408 PMCID: PMC10507421 DOI: 10.7759/cureus.43779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/22/2023] Open
Abstract
Background Non-adherence to medication represents a modifiable risk factor for patients with type 2 diabetes mellitus (T2DM). Identification of patients with poor adherence can have a significant impact on clinical and socio-economic outcomes in the management of diabetes. This study aimed to assess medication adherence and its associated factors among patients with T2DM attending a non-communicable disease (NCD) clinic in a rural community health centre (CHC) in eastern India. Methods The study was a facility-based study that included 207 study participants with an age greater than 18 years. A structured questionnaire was used to collect data on socio-demographic characteristics, health-seeking behaviour, self-care practices, risk factors, clinical information on diabetes, prescription practices, and medication practices. The Hill-Bone Medication Adherence Scale (HB-MAS) has been used to assess medication adherence among study participants. Results The study found that the medication adherence rate among the study participants was 67.1%. On multivariate analysis, subjects with social insurance (adjusted odds ratio (AOR) = 2.73, 95% confidence interval (CI) = 1.01-7.38, p-value = 0.047), current smoking status (AOR = 5.47, 95% CI = 1.55-19.23, p-value = 0.008), anxiety (AOR= 3.52, 95% CI= 1.62- 7.61, p-value= 0.001), polypharmacy (AOR= 3.79, 95% CI= 1.25- 11.45, p-value= 0.018), and using alternative medicine (AOR= 5.82, 95% CI= 1.58 - 21.39, p-value= 0.008), were found to have a significantly higher chance of non-adherence. On the other hand, patients practising regular physical activity (AOR = 0.31, 95% CI= 0.12-0.79, p-value = 0.015) and with deprescription (AOR = 0.12, 95% CI= 0.03-0.47, p-value = 0.002) were found to have less chance of non-adherence as compared to their counterparts. Conclusion The study highlights the need to identify patients with poor medication adherence and develop interventions according to their requirements through a holistic approach. The study contributes to the existing literature on medication adherence among diabetes patients in rural healthcare settings in eastern India.
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Affiliation(s)
- Abhisek Mishra
- Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Somen K Pradhan
- Community Medicine, Maharaja Krishna Chandra Gajapati (MKCG) Medical College & Hospital, Berhampur, IND
| | - Bimal K Sahoo
- Community Medicine, Sri Jagannath Medical College & Hospital, Puri, IND
| | - Ambarish Das
- Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Arvind K Singh
- Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Swayam Pragyan Parida
- Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Liu H, Yao Z, Shi S, Zheng F, Li X, Zhong Z. The Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients with Type 2 Diabetes. Patient Prefer Adherence 2023; 17:1657-1670. [PMID: 37465055 PMCID: PMC10351528 DOI: 10.2147/ppa.s413385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Background Patients with type 2 diabetes have poor medication adherence. Medication literacy is one of the influencing factors of medication adherence among patients with type 2 diabetes. However, the mechanism by which medication literacy affects medication adherence among patients with type 2 diabetes is unclear. The aim of this study was to verify the mediating role of self-efficacy in the relationship between medication literacy and medication adherence. Methods A total of 402 patients with type 2 diabetes were enrolled in this study. The Chinese versions of the Medication Literacy Scale, the Self-Efficacy for Appropriate Medication Use Scale and the Morisky Medication Adherence Scale-8 were used in the survey. Pearson correlation analysis was used to find correlations among medication literacy, self-efficacy and medication adherence. The PROCESS macro (Version 4.1) with Model 4 for SPSS was used to verify the mediating role of self-efficacy. Results Twenty-four percent of the participants had poor medication adherence. Self-efficacy and medication literacy (r=0.499, p < 0.01) and medication adherence (r=0.499, p < 0.01) were significantly and positively correlated. Self-efficacy partially mediated the relationship between medication knowledge and medication adherence among patients with type 2 diabetes, accounting for 36.7% of the total effect. Conclusion Self-efficacy had a partial mediating effect on the relationship between medication literacy and medication adherence among patients with type 2 diabetes. Self-efficacy should be improved through effective measures to increase patients' confidence in adherence to antihyperglycemic drugs.
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Affiliation(s)
- Haoqi Liu
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
| | - Ziqiang Yao
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
| | - Shuangjiao Shi
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Feng Zheng
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
- Cardiology Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xia Li
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Endocrinology Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Zhuqing Zhong
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
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Islam MT, Bruce M, Alam K. Cascade of diabetes care in Bangladesh, Bhutan and Nepal: identifying gaps in the screening, diagnosis, treatment and control continuum. Sci Rep 2023; 13:10285. [PMID: 37355725 PMCID: PMC10290703 DOI: 10.1038/s41598-023-37519-w] [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: 03/31/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023] Open
Abstract
Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018-2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1; confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2; CI:1.9, 19.9].
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Affiliation(s)
- Md Tauhidul Islam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
| | - Mieghan Bruce
- School of Veterinary Medicine and Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Medication adherence and environmental barriers to self-care practice among people with diabetes: A cross-sectional study in a lifestyle clinic in eastern India. J Taibah Univ Med Sci 2023; 18:909-916. [PMID: 36852344 PMCID: PMC9958071 DOI: 10.1016/j.jtumed.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Objective The study was conducted to estimate the prevalence of non-adherence to medications among patients with type 2 diabetes attending a lifestyle clinic in a tertiary care hospital in West Bengal, India; to identify the environmental barriers to self-care practices, including diet, exercise, glucose testing and medication; and to identify the socio-demographic and environmental determinants of medication non-adherence. Methods A cross-sectional study was performed among the patients with type 2 diabetes taking oral hypoglycemic drugs and attending a lifestyle clinic of a teaching hospital in 2021. The participants were interviewed in clinical settings via a structured questionnaire in the local language. Medication adherence was assessed with Morisky Medication Adherence Scale-8 (MMAS), and environmental barriers were assessed with the Environmental Barrier Assessment Scale (EBAS). Results Among 178 participants, a high level of adherence (MMAS score 8.0) was found among 3 (1.7%) participants, and moderate adherence (MMAS score 6.0 to 7.75) was found among 67 (37.6%; 95% CI 30.3%, 44.9%) participants. The prevalence of non-adherence was 60.7% (95% CI: 53.4%, 68.0%). The overall mean barrier score was 134 (SD 13). All environmental barrier components were distributed equally among the predictor variables except the diet score, which was lower among men (mean difference 1.3; 95% CI: 0.04, 2.5) and people with higher education (mean difference 1.8; 95% CI: 0.6, 3.1). Conclusion The study indicated poor adherence to OHA in this population. Barriers to self-care practice and medication adherence were observed acrross all socio-economic strata. Poor medication adherence poses a major challenge to clinicians and public health experts in achieving treatment goals.
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Shahabi N, Hosseini Z, Aghamolaei T, Ghanbarnejad A, Behzad A. Application of Pender's health promotion model for type 2 diabetes treatment adherence: protocol for a mixed methods study in southern Iran. Trials 2022; 23:1056. [PMID: 36578044 PMCID: PMC9795658 DOI: 10.1186/s13063-022-07027-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) mellitus treatment as a chronic disease requires adequate adherence to treatment including controlling blood glucose levels and lifestyle management. The aim of this study is to investigate the factors affecting of adherence to T2D treatment from the perspective of patients and design an intervention program based on Pender's health promotion model (HPM) to increase T2D treatment adherence in Bandar Abbas, a city located in the south of Iran. METHODS This mixed method study will consist of qualitative stage, questionnaire design and a randomized, open-label, parallel-group interventional study based on HPM in southern Iran. Sampling for qualitative stage will continue until reaching the saturation. In the intervention stage, participants will be 166 T2D patients referring to the Bandar Abbas Diabetes Clinic will be randomized into intervention and control groups (allocation 1:1). After identifying the factors affecting adherence to treatment in T2D patients by qualitative study and literature review, a questionnaire based on HPM will be designed. In the next stage, 10 sessions of intervention for the intervention group will be designed. To evaluate the effect of the intervention, intervention and control groups will be tested for hemoglobin A1c (HbA1c) before and 3 months after the intervention. DISCUSSION This designed study is a program for improving treatment adherence in T2D based on the HPM model and contributes to a better understanding of effective factors in adherence to treatment in T2D patients. The results of this project can be used for macro-diabetic planning. TRIAL REGISTRATION This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.
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Affiliation(s)
- Nahid Shahabi
- grid.412237.10000 0004 0385 452XStudent Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- grid.412237.10000 0004 0385 452XSocial Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teamur Aghamolaei
- grid.412237.10000 0004 0385 452XCardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnejad
- grid.412237.10000 0004 0385 452XSocial Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ahmad Behzad
- grid.412237.10000 0004 0385 452XSocial Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Chin R, Nagaoka S, Nakasawa H, Tanaka Y, Inagaki N. Safety and effectiveness of dulaglutide 0.75 mg in Japanese patients with type 2 diabetes in real-world clinical practice: 36 month post-marketing observational study. J Diabetes Investig 2022; 14:247-258. [PMID: 36367417 PMCID: PMC9889676 DOI: 10.1111/jdi.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS/INTRODUCTION This study evaluated the safety and effectiveness of dulaglutide in patients with type 2 diabetes in the real-world setting in Japan. MATERIALS AND METHODS This prospective, observational post-marketing surveillance study was conducted for 36 months (July 2016 to July 2021) in Japan. Investigators reported data via an electronic data capture system. Data were analyzed by overall population and age group (<65, ≥65 to <75, and ≥75 years). RESULTS The analysis population (N = 3,136) included 1,538 (49.04%), 869 (27.71%), and 729 (23.25%) patients aged <65 years, ≥65 to <75 years, and ≥75 years, respectively. Overall, 231 patients (7.37%) experienced ≥1 adverse drug reactions, with the highest frequency in the ≥75 years group. The most common adverse drug reactions were gastrointestinal disorders (n = 106; 3.38%). Severe hypoglycemia (n = 4; 0.13%), major adverse cardiovascular events (n = 4; 0.13%), and acute pancreatitis (n = 1; 0.03%) were uncommon. The mean glycated hemoglobin and bodyweight were reduced from baseline by -0.76% and -1.6 kg, respectively (last observation carried forward). The rate of dulaglutide continuation at 36 months was 58.03% overall and 59.43%, 63.13%, and 48.88% in the <65, ≥65 to <75, and ≥75 years groups, respectively. A factor analysis showed age ≥65 years was associated with a greater incidence of gastrointestinal adverse drug reactions as well as larger reductions in glycated hemoglobin and bodyweight. CONCLUSIONS The current real-world data are in accordance with clinical trial findings and further confirm the safety and effectiveness of dulaglutide for elderly patients, whose numbers were limited in the clinical trials.
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Affiliation(s)
- Rina Chin
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Soshi Nagaoka
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Haru Nakasawa
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Yoko Tanaka
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Nobuya Inagaki
- Division of Diabetes, Metabolism and EndocrinologyKyoto UniversityKyotoJapan
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