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Chan JCN, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Dessapt-Baradez C, Chantelot JM, Aschner P. One in Seven Insulin-Treated Patients in Developing Countries Reported Poor Persistence with Insulin Therapy: Real World Evidence from the Cross-Sectional International Diabetes Management Practices Study (IDMPS). Adv Ther 2021; 38:3281-3298. [PMID: 33978906 PMCID: PMC8189989 DOI: 10.1007/s12325-021-01736-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although poor adherence to insulin is widely recognised, periodic discontinuation of insulin may cause more severe hyperglycaemia than poor adherence. We assessed persistence with insulin therapy in patients with type 1 (T1D) or type 2 diabetes (T2D) in developing countries and the reasons for insulin discontinuation. METHODS The International Diabetes Management Practices Study collected real-world data from developing countries in seven waves between 2005 and 2017. In Wave 7 (2016-2017), we asked adult patients with T1D and insulin-treated T2D to report whether they had ever discontinued insulin, the estimated duration of discontinuation and underlying reasons. RESULTS Among 8303 patients recruited from 24 countries by 620 physicians, 4596 were insulin-treated (T1D: 2000; T2D: 2596). In patients with T1D, 14.0% (95% CI: 12.5-15.6) reported having self-discontinued insulin for a median duration of 1.0 month (IQR: 0.5, 3.5). The respective figures in patients with T2D were 13.7% (12.4-15.1) and 2.0 months (IQR: 1.0, 6.0). The main reasons for discontinuation were impact on social life (T1D: 41.0%; T2D: 30.5%), cost of medications and test strips (T1D: 34.4%; T2D: 24.5%), fear of hypoglycaemia (T1D: 26.7%; T2D: 28.0%) and lack of support (T1D: 26.4%; T2D: 25.9%). Other factors included age < 40 years, non-university education and short disease duration (T1D: ≤ 1 year; T2D: > 1-≤ 5 years). Patients with T1D who did not perform self-monitoring of blood glucose (SMBG) or self-adjust their insulin dosage, and patients with T1D or T2D without glucose meters were less likely to persist with insulin. Nearly 50% of patients who reported poor persistence had HbA1c > 75 mmol/mol (> 9%) and > 50% of physicians recommended diabetes education programmes to improve treatment persistence. CONCLUSION In developing countries, poor persistence with insulin is common among insulin-treated patients, supporting calls for urgent actions to ensure easy access to insulin, tools for SMBG and education.
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Affiliation(s)
- Juliana C N 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, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
| | - Juan José Gagliardino
- CENEXA, Center of Experimental and Applied Endocrinology (La Plata National University-La Plata National Scientific and Technical Research Council), La Plata, Argentina
| | - Hasan Ilkova
- Division of Endocrinology Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fernando Lavalle
- Facultad de Medicina de la Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Marina Shestakova
- Endocrinology Research Center, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | - Pablo Aschner
- Javeriana University School of Medicine, Bogotá, Colombia
- San Ignacio University Hospital, Bogotá, Colombia
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Egan AM, Vellinga A, Harreiter J, Simmons D, Desoye G, Corcoy R, Adelantado JM, Devlieger R, Van Assche A, Galjaard S, Damm P, Mathiesen ER, Jensen DM, Andersen L, Lapolla A, Dalfrà MG, Bertolotto A, Mantaj U, Wender-Ozegowska E, Zawiejska A, Hill D, Jelsma JGM, Snoek FJ, Worda C, Bancher-Todesca D, van Poppel MNM, Kautzky-Willer A, Dunne FP. Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe. Diabetologia 2017; 60:1913-1921. [PMID: 28702810 PMCID: PMC6448875 DOI: 10.1007/s00125-017-4353-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/26/2017] [Indexed: 12/03/2022]
Abstract
AIMS/HYPOTHESIS Accurate prevalence estimates for gestational diabetes mellitus (GDM) among pregnant women in Europe are lacking owing to the use of a multitude of diagnostic criteria and screening strategies in both high-risk women and the general pregnant population. Our aims were to report important risk factors for GDM development and calculate the prevalence of GDM in a cohort of women with BMI ≥29 kg/m2 across 11 centres in Europe using the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)/WHO 2013 diagnostic criteria. METHODS Pregnant women (n = 1023, 86.3% European ethnicity) with a BMI ≥29.0 kg/m2 enrolled into the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) pilot, lifestyle and vitamin D studies of this pan-European multicentre trial, attended for an OGTT during pregnancy. Demographic, anthropometric and metabolic data were collected at enrolment and throughout pregnancy. GDM was diagnosed using IADPSG/WHO 2013 criteria. GDM treatment followed local policies. RESULTS The number of women recruited per country ranged from 80 to 217, and the dropout rate was 7.1%. Overall, 39% of women developed GDM during pregnancy, with no significant differences in prevalence across countries. The prevalence of GDM was high (24%; 242/1023) in early pregnancy. Despite interventions used in the DALI study, a further 14% (94/672) had developed GDM when tested at mid gestation (24-28 weeks) and 13% (59/476) of the remaining cohort at late gestation (35-37 weeks). Demographics and lifestyle factors were similar at baseline between women with GDM and those who maintained normal glucose tolerance. Previous GDM (16.5% vs 7.9%, p = 0.002), congenital malformations (6.4% vs 3.3%, p = 0.045) and a baby with macrosomia (31.4% vs 17.9%, p = 0.001) were reported more frequently in those who developed GDM. Significant anthropometric and metabolic differences were already present in early pregnancy between women who developed GDM and those who did not. CONCLUSIONS/INTERPRETATION The prevalence of GDM diagnosed by the IADPSG/WHO 2013 GDM criteria in European pregnant women with a BMI ≥29.0 kg/m2 is substantial, and poses a significant health burden to these pregnancies and to the future health of the mother and her offspring. Uniform criteria for GDM diagnosis, supported by robust evidence for the benefits of treatment, are urgently needed to guide modern GDM screening and treatment strategies.
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Affiliation(s)
- Aoife M Egan
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Akke Vellinga
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Andre Van Assche
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, University Hospitals Leuven, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Liselotte Andersen
- Department of Endocrinology, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Urszula Mantaj
- Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - David Hill
- Recherche en Santé Lawson SA, St Gallen, Switzerland
| | - Judith G M Jelsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, EMGO+ Institute for Health and Care Research, VU University Medical Centre and Medical Psychology AMC, Amsterdam, the Netherlands
| | - Christof Worda
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dagmar Bancher-Todesca
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
- Institute of Sports Science, University of Graz, Graz, Austria.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Fidelma P Dunne
- Galway Diabetes Research Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland, University Road, Galway, H91 TK33, Ireland.
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Rosenstock J, Fonseca V, Schinzel S, Dain MP, Mullins P, Riddle M. Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes: Evidence from a long-term controlled trial. J Diabetes Complications 2014; 28:742-9. [PMID: 24856612 PMCID: PMC4802045 DOI: 10.1016/j.jdiacomp.2014.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 02/09/2023]
Abstract
AIMS This analysis evaluated HbA1c-adjusted hypoglycemia risk with glargine versus neutral protamine Hagedorn (NPH) over a 5-year study in patients with Type 2 diabetes mellitus (T2DM). Clinical significance was assessed using number needed to harm (NNH) to demonstrate the risk of one additional patient experiencing at least one hypoglycemic event. METHODS Individual patient-level data for symptomatic documented hypoglycemia and HbA1c values from a 5-year randomized study comparing once-daily glargine (n=513) with twice-daily NPH (n=504) were analyzed. Symptomatic hypoglycemia was categorized according to concurrent self-monitoring blood glucose levels and need for assistance. Hypoglycemic events per patient-year as a function of HbA1c were fitted by negative binomial regression using treatment and HbA1c at endpoint as independent variables. An estimate of NNH was derived from logistic regression models. RESULTS The cumulative number of symptomatic hypoglycemia events was consistently lower with glargine compared with NPH over 5years. Compared with twice-daily NPH, once-daily glargine treatment resulted in significantly lower adjusted odds ratios (OR) for all daytime hypoglycemia (OR 0.74; p=0.030) and any severe event (OR 0.64; p=0.035), representing a 26% and 36% reduction in the odds of daytime and severe hypoglycemia, respectively. Our model predicts that, if 25 patients were treated with NPH instead of glargine, then one additional patient would experience at least one severe hypoglycemic event. CONCLUSIONS This analysis of long-term insulin treatment confirms findings from short-term studies and demonstrates that glargine provides sustained, clinically meaningful reductions in risk of hypoglycemia compared with NPH in patients with T2DM.
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Affiliation(s)
- Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA.
| | - Vivian Fonseca
- Tulane University Health Sciences Center, New Orleans, LA, USA
| | | | | | - Peter Mullins
- Department of Statistics, University of Auckland, Auckland, New Zealand
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