An evaluation of patients' adherence with hypoglycemic medications among Papua New Guineans with type 2 diabetes: influencing factors

A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes

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.

Socio-personal factors affecting adherence to treatment in patients with type 2 diabetes: A systematic review and meta-analysis

PURPOSE

The purpose of study was to identify the socio-personal factors affecting adherence to the treatment of patients with type 2 diabetes.

METHODS

Cross-sectional articles were extracted from databases such as Web of Science, PubMed, Elsevier. A meta-analysis was performed using integrated odds ratios (OR) and 95% confidence interval (CIs) for age, BMI, depression, educational level, gender, employment status, marital status, smoking status. STATA 12.0 was used to estimate pooled RR in definite subgroups. The quality of the studies included was evaluated using the STROBE checklist.

RESULTS

Thirty-one studies out of 7407 extracted articles were finally selected for the meta-analysis. The results showed that younger people had a 17% higher risk than older people, smokers had a 22% higher risk than non-smokers, and the employed had a 15% higher risk of non-adherence to treatment.

CONCLUSION

In conclusion, older age, smoking and employment can lead to non-adherence to T2D treatment. Interventions are suggested to be made besides common health care considering the socio-personal features on type 2 diabetes patients' treatment adherence.

Effect of Pharmacist-Led Interventions on Medication Adherence and Glycemic Control in Type 2 Diabetic Patients: A Study from the Chinese Population

PURPOSE

Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China.

PATIENTS AND METHODS

T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient's self-reported compliance with prescribed medication during the last 3 months.

RESULTS

A total of 763 T2DM patients were included. The average age was 63.26±11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846±4.185 to 29.831±7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437-0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069-4.543); often (OR=2.984, 95% CI 1.107-8.044)), following the doctor's advice to visit (OR 2.129, 95% CI 1.079-4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094-7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716.

CONCLUSION

Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor's advice. The recall bias with self-reported results needs further objective data to verify.

Evaluation of pharmacist-led telemedicine medication management for hypertension established patients during COVID-19 pandemic: A pilot study

Aim

To evaluate the impact of a telemedicine medication management service in patients with hypertension.

Methods

Participants were allocated to either a telemedicine service (N = 173) or usual care (UC) (N = 179). The primary outcome was blood pressure (BP) reduction from baseline to the 6-month follow-up visit, the proportion of the target BP achievement, overall adherence to prescribed medication as well as a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death.

Results

At 6 months, BP was controlled in 89.6% (n = 155) of intervention patients and 78.8% (n = 141) of UC patients (OR = 1.14, 95% CI = 1.04-1.25, P = 0.006), giving a mean difference of -6.0 (-13.0 to -2.5 mmHg) and -2.0 mmHg (-4.0 to -0.1 mmHg) in SBP and DBP, respectively. 17.9% (n = 31) of the patients in the intervention group were non-adherent with medications, compared with 29.1% (n = 52) in the UC group (P = 0.014). The composite clinical endpoints were reached by 2.9% in the intervention group and 4.5% in the control group with no significant differences (OR = 1.566, 95% CI = 0.528-4.646).

Conclusion

Telemedicine medication management for hypertension management had led to better BP control and medication adherence improvement than UC during COVID-19 epidemic, resulting in a reduction of overall adverse cardiovascular events occurrence.

Adherence to Antidiabetic Medications Among Sudanese Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Survey

Background:

Adherence to antidiabetic medications is crucial for optimum glycemic control and decreasing complications. This study aimed to assess adherence to antidiabetic medications and the associated factors among individuals with type 2 diabetes attending Jabir Abu Eliz Diabetes Centre in Khartoum state, Sudan.

Methods:

This was a descriptive cross-sectional study, recruited 213 individuals with type 2 diabetes, and used a pretested questionnaire. Data were analyzed using the Statistical Package of Social Sciences version 21. Logistic regression analysis was used to check for factors that linked to poor adherence to diabetes medication.

Results:

The median duration of antidiabetic medications use was 8 years; 15.0% were highly adherent to diabetes medications, 44.6% were medium adherent, and 40.4% showed low adherence. Main factors and barriers were medication side effects (18.3%), use of herbal medicine (12.3%), and unavailability of medication (7%). Predictors to nonadherence were gender, and housing status (0.043 and 0.042, respectively).

Conclusion:

Level of adherence to diabetes medication was unsatisfactory as only 15% showed high adherence. Predictors of nonadherence were gender, and housing status. Effective interventions should be implemented to improve medication adherence, like appropriate patient education and involvement in the treatment plan.

Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review

OBJECTIVES

To perform a systematic review search and critically review the empirical evidence concerning the factors affecting glycaemic control in patients with type 1 or 2 diabetes mellitus.

BACKGROUND

Previous primary studies have investigated the factors associated with glycaemic control among patients with type 1 or 2 diabetes, but attempts to amalgamate these evidences have been methodologically limited. Hence, a robust review of the evidence is essential to explore factors that can be addressed to promote good glycaemic control in patients with diabetes.

DESIGN

Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis 2009 flow diagram, integrating evidence from qualitative and quantitative studies (see Supporting Information File S1).

METHODS

A systematic review of the literature published between 2006-2017 was conducted in seven electronic databases (CINAHL, MEDLINE, Scopus, EMBASE, PsycINFO, PubMed and ScienceDirect) using the search terms "diabetes mellitus," "glycemic control," "self-concept," "knowledge," "self-efficacy," "empowerment," "race," "ethnicity," "duration," "medication," "obesity" and "comorbidity."

RESULTS

A total of 1,582 articles were initially retrieved, and 24 of these articles were included in this systematic literature review. The overall empirical evidence suggested that higher socio-economic status, greater dietary knowledge, and higher self-efficacy and empowerment improve glycaemic control among patients with diabetes mellitus.

CONCLUSIONS

This review presented the factors associated with glycaemic control that may pose significant socio-economic problems to most nations worldwide and impede development nationally, regionally and even globally. Greater emphasis needs to be placed on implementing lifestyle changes on a societal level to stem the tide of the epidemic.

RELEVANCE TO CLINICAL PRACTICE

There is a need to implement self-management initiatives, that incorporate dietary knowledge, to empower patients with diabetes in their own care. Future public health policy must be geared towards increasing the capability of dealing with the rising incidence of diabetes and implementing primary prevention.

Availability and Affordability of Essential Medicines: Implications for Global Diabetes Treatment

PURPOSE OF REVIEW

The purpose of this review is to highlight the key issues with regard to the value, affordability, and availability of diabetes treatments.

RECENT FINDINGS

Many of the medicines needed to manage diabetes are available as generics and, if purchased appropriately, can be made affordable to many individuals and systems. With new treatments for diabetes, additional costs to individuals and systems need to be assessed in terms of added clinical benefit and financial impact. As healthcare finances are limited, increased spending on diabetes medicines means fewer resources for other areas of diabetes care or for the population as a whole. This increased expenditure is driven by rising prevalence as well as the cost of newer treatments. With an increasing burden of disease and changing patterns of medicines in the market, we stress the need to focus attention on ensuring access for individuals to essential medicines. Universal health care offers unique opportunity to address the issue of access to medicines and the wider issues surrounding access to diabetes care, but this will require concerted action bringing together governments, civil society and the private sector.

Association between patients' beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

PURPOSE

The objective of this study was to identify, using the theory of planned behavior (TPB), patients' beliefs about taking oral antidiabetic drugs (OADs) as prescribed, and to measure the correlations between beliefs and medication adherence.

PATIENTS AND METHODS

We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs) relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Spearman's rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.

RESULTS

From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037) was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000), not accepting the disease (P=0.000), ignorance of life-long drug adherence (P=0.038), being busy (P=0.001), or poor memory (P=0.008) were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011).

CONCLUSION

The results indicate that the TPB model could be used to examine adherence to OADs. One facilitating control belief, and most of the barrier control beliefs of TPB were related to medication adherence among Chinese type 2 diabetes inpatients. It will be helpful to understand patients' self-medication and provide methods to develop instruments for identifying factors that influence OAD adherence.