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Li N, Liu X, Wang H, Duan Y, Zhang Y, Zhou P, Dai H, Lan T. "Qi Nan" agarwood restores podocyte autophagy in diabetic kidney disease by targeting EGFR signaling pathway. Chin Med 2024; 19:63. [PMID: 38654354 DOI: 10.1186/s13020-024-00923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is a microvascular complication of diabetes mellitus, contributing to end-stage renal disease with limited treatment options. The development of DKD is attributed to podocyte injury resulting from abnormal podocyte autophagy. Consequently, the restoration of podocyte autophagy is deemed a practicable approach in the treatment of DKD. METHODS Diabetic mice were induced by streptozotocin and high-fat diet feeding. Following 8 weeks of "QN" agarwood treatment, metrics such as albuminuria, serum creatinine (Scr), and blood urea nitrogen (BUN) were evaluated. Renal histological lesions were evaluated by H&E, PAS, Masson, and Sirius red staining. Evaluation of the effects of "QN" agarwood on renal inflammation and fibrosis in DKD mice through WB, q-PCR, and IHC staining analysis. Cytoscape 3.7.1 was used to construct a PPI network. With the DAVID server, the gene ontology (GO) functional annotation and the Kyoto encyclopedia of genes and genomes (KEGG) signaling pathways of the target enrichment were performed. Molecular docking and binding affinity calculations were conducted using AutoDock, while PyMOL software was employed for visualizing the docking results of active compounds and protein targets. RESULTS The results of this study show that "QN" agarwood reduced albuminuria, Scr, and BUN in DKD mice, and improved the renal pathological process. Additionally, "QN" agarwood was observed to downregulate the mRNA and protein expression levels of pro-inflammatory and pro-fibrotic factors in the kidneys of DKD mice. Network pharmacology predicts that "QN" agarwood modulates the epidermal growth factor receptor (EGFR) signaling pathway. "QN" agarwood can increase the expression of LC3B and Nphs1 in DKD mice while reducing the expression of EGFR. CONCLUSION The present study demonstrated that "QN" agarwood ameliorated renal injury in DKD by targeting EGFR and restoring podocyte autophagy.
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Affiliation(s)
- Ning Li
- Department of Pharmacology, School of Pharmacy, Guangdong Pharmaceutical University, No. 280 Wai Huan Dong Road, Guangzhou, 510006, China
| | - Xuenan Liu
- Department of Pharmacology, School of Pharmacy, Guangdong Pharmaceutical University, No. 280 Wai Huan Dong Road, Guangzhou, 510006, China
| | - Hao Wang
- National Key Laboratory for Tropical Crop Breeding, Institute of Tropical Bioscience and Biotechnology, International Joint Research Center of Agarwood, Hainan Engineering Research Center of Agarwood, Chinese Academy of Tropical Agricultural Sciences, No. 4 Xue Yuan Road, Haikou, 571101, China
| | - Yingling Duan
- Department of Pharmacology, School of Pharmacy, Guangdong Pharmaceutical University, No. 280 Wai Huan Dong Road, Guangzhou, 510006, China
| | - Yu Zhang
- Department of Pharmacology, School of Pharmacy, Guangdong Pharmaceutical University, No. 280 Wai Huan Dong Road, Guangzhou, 510006, China
| | - Ping Zhou
- Department of Pediatric Nephrology and Rheumatology, Sichuan Provincial Maternity and Child Health Care Hospital, Sichuan Clinical Research Center for Pediatric Nephrology, 290 Shayan West Second Street, Wuhou District, Chengdu, 610045, Sichuan, China.
| | - Haofu Dai
- National Key Laboratory for Tropical Crop Breeding, Institute of Tropical Bioscience and Biotechnology, International Joint Research Center of Agarwood, Hainan Engineering Research Center of Agarwood, Chinese Academy of Tropical Agricultural Sciences, No. 4 Xue Yuan Road, Haikou, 571101, China.
| | - Tian Lan
- Department of Pharmacology, School of Pharmacy, Guangdong Pharmaceutical University, No. 280 Wai Huan Dong Road, Guangzhou, 510006, China.
- Department of Pharmacology, College of Pharmacy, Harbin Medical University, Harbin, 150086, China.
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O'Connor H, Hutt Vater C, DiSalvo M, Faraone SV, Wozniak J. Stimulant Treatment and Potential Adverse Outcomes in Pediatric Populations With Bipolar Disorder: A Systematic Review of the Literature. J Atten Disord 2024; 28:740-750. [PMID: 38156605 DOI: 10.1177/10870547231218045] [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: 01/03/2024]
Abstract
OBJECTIVE To explore outcomes of stimulant treatment for ADHD in pediatric populations with particular attention to bipolar disorder (BPD). METHOD We conducted a literature search of PubMed articles published prior to August 25, 2022 that focused on BPD, mania, and psychosis prior to, or as result of, stimulant treatment. We excluded studies: (1) unrelated to stimulants, (2) general stimulant research, (3) articles older than 40 years, (4) study protocols, or (5) case reports. RESULTS A total of 11 articles met all inclusion/exclusion criteria. Some reports found stimulant treatment safe and well-tolerated in children with comorbid BPD and ADHD. Others found evidence of treatment-emergent mania (TEM), discontinuation, and other adverse events with stimulant treatment. CONCLUSION Poor outcomes associated with stimulant treatment in pediatric populations with BPD necessitate work to identify patients at risk of serious stimulant-related adverse events. Our results were limited by automated search filters and a pediatric, primarily male sample.
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Affiliation(s)
| | | | | | | | - Janet Wozniak
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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Hidaka T, Suzuki R, Hashimoto K, Inoue M, Terada Y, Endo S, Kakamu T, Gunji M, Abe K, Fukushima T. Perceived Future Outcomes of Unsuccessful Treatment and Their Association with Treatment Persistence Among Type-2 Diabetes Patients: A Cross-Sectional Content Analysis. Diabetes Ther 2023:10.1007/s13300-023-01433-1. [PMID: 37340230 PMCID: PMC10363091 DOI: 10.1007/s13300-023-01433-1] [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: 04/26/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Despite the known strong association between patients' knowledge of outcomes of type 2 diabetes mellitus (T2DM) and treatment persistence, this knowledge in this patient population requires further clarification. The aim of our study was to reveal the perception of unsuccessful treatment outcomes among patients with T2DM and its association with treatment persistence by analysing answers to open-ended questions. METHODS In this cross-sectional study, 106 patients with T2DM who lived in Fukushima Prefecture, Japan, had a medical record in the Fukushima National Health Insurance Organisation database and had no cognitive problems were enrolled by purposive sampling. Treatment status was defined as "non-persistent" when a participant's treatment medical record was absent for a continuous period of ≥ 6 months; otherwise, it was referred to as "persistent". We asked about the possible future problems of untreated T2DM, inductively classified the open answers into 15 codes and then statistically examined the association between these codes and treatment persistence using logistic regression analysis adjusted for age and sex. RESULTS Persistent treatment was prevalent among participants who mentioned the code "treatment", which encompasses the terms that indicated invasiveness, such as dialysis, insulin injection, and shots (odds ratio 4.339; 95% confidence interval 1.104-17.055). CONCLUSION Persistent treatment was prevalent among patients with T2DM who mentioned the code "treatment", suggesting that these patients may anticipate a threat due to the invasiveness of diabetes and thus participate in persistent treatment to avoid this threat. Healthcare professionals should provide appropriate information and supportive conditions to achieve both a reduced feeling of threat and persistent treatment engagement.
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Affiliation(s)
- Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan.
| | - Rieko Suzuki
- Koriyama City Public Health Center, 15-1, Asahi 2, Koriyama, Fukushima, 9638024, Japan
| | - Katsue Hashimoto
- Koriyama City Public Health Center, 15-1, Asahi 2, Koriyama, Fukushima, 9638024, Japan
| | - Mariko Inoue
- CMR Development Division, Novo Nordisk Pharma Ltd., 2-1-1, Marunouchi, Chiyoda-ku, Tokyo, 1000005, Japan
| | - Yukiko Terada
- CMR Development Division, Novo Nordisk Pharma Ltd., 2-1-1, Marunouchi, Chiyoda-ku, Tokyo, 1000005, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan
| | - Mariko Gunji
- Koriyama City Public Health Center, 15-1, Asahi 2, Koriyama, Fukushima, 9638024, Japan
| | - Koichi Abe
- Igarashi Clinic of Medicine and Surgery, 12-7, Namiki 2, Koriyama, Fukushima, 9638026, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan
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Chen S, Li B, Chen L, Jiang H. Uncovering the mechanism of resveratrol in the treatment of diabetic kidney disease based on network pharmacology, molecular docking, and experimental validation. J Transl Med 2023; 21:380. [PMID: 37308949 DOI: 10.1186/s12967-023-04233-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) has been the leading cause of chronic kidney disease in developed countries. Evidence of the benefits of resveratrol (RES) for the treatment of DKD is accumulating. However, comprehensive therapeutic targets and underlying mechanisms through which RES exerts its effects against DKD are limited. METHODS Drug targets of RES were obtained from Drugbank and SwissTargetPrediction Databases. Disease targets of DKD were obtained from DisGeNET, Genecards, and Therapeutic Target Database. Therapeutic targets for RES against DKD were identified by intersecting the drug targets and disease targets. GO functional enrichment analysis, KEGG pathway analysis, and disease association analysis were performed using the DAVID database and visualized by Cytoscape software. Molecular docking validation of the binding capacity between RES and targets was performed by UCSF Chimera software and SwissDock webserver. The high glucose (HG)-induced podocyte injury model, RT-qPCR, and western blot were used to verify the reliability of the effects of RES on target proteins. RESULTS After the intersection of the 86 drug targets and 566 disease targets, 25 therapeutic targets for RES against DKD were obtained. And the target proteins were classified into 6 functional categories. A total of 11 cellular components terms and 27 diseases, and the top 20 enriched biological processes, molecular functions, and KEGG pathways potentially involved in the RES action against DKD were recorded. Molecular docking studies showed that RES had a strong binding affinity toward PPARA, ESR1, SLC2A1, SHBG, AR, AKR1B1, PPARG, IGF1R, RELA, PIK3CA, MMP9, AKT1, INSR, MMP2, TTR, and CYP2C9 domains. The HG-induced podocyte injury model was successfully constructed and validated by RT-qPCR and western blot. RES treatment was able to reverse the abnormal gene expression of PPARA, SHBG, AKR1B1, PPARG, IGF1R, MMP9, AKT1, and INSR. CONCLUSIONS RES may target PPARA, SHBG, AKR1B1, PPARG, IGF1R, MMP9, AKT1, and INSR domains to act as a therapeutic agent for DKD. These findings comprehensively reveal the potential therapeutic targets for RES against DKD and provide theoretical bases for the clinical application of RES in the treatment of DKD.
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Affiliation(s)
- Shengnan Chen
- Department of Critical Care Nephrology and Blood Purification, The First Affiliated Hospital of Xi'an Jiaotong University, West Yanta Road No.277, Xi'an, 710061, Shaanxi, China
| | - Bo Li
- Department of Nephrology, Ningxia Medical University Affiliated People's Hospital of Autonomous Region of Ningxia, Yinchuan, 750002, Ningxia, China
| | - Lei Chen
- Department of Critical Care Nephrology and Blood Purification, The First Affiliated Hospital of Xi'an Jiaotong University, West Yanta Road No.277, Xi'an, 710061, Shaanxi, China
| | - Hongli Jiang
- Department of Critical Care Nephrology and Blood Purification, The First Affiliated Hospital of Xi'an Jiaotong University, West Yanta Road No.277, Xi'an, 710061, Shaanxi, China.
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Tan B, Pan XH, Chew HSJ, Goh RSJ, Lin C, Anand VV, Lee ECZ, Chan KE, Kong G, Ong CEY, Chung HC, Young DY, Chan MY, Khoo CM, Mehta A, Muthiah MD, Noureddin M, Ng CH, Chew NWS, Chin YH. Efficacy and safety of tirzepatide for treatment of overweight or obesity. A systematic review and meta-analysis. Int J Obes (Lond) 2023:10.1038/s41366-023-01321-5. [PMID: 37253796 DOI: 10.1038/s41366-023-01321-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Recent studies suggest that tirzepatide, a dual glucose-dependent insulinotropic-peptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA), has significant weight loss effects. This systematic review and meta-analysis aims to assess the efficacy and safety of tirzepatide for weight loss in patients with overweight or obesity. METHODS Medline, Embase and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) on tirzepatide's weight loss efficacy for these patients. A single arm meta-analysis of proportions estimated primary outcomes, ≥5%, ≥10%, and ≥15% weight loss, and adverse events (AEs); while meta-analysis of means estimated secondary outcomes. Comparative meta-analysis was conducted between tirzepatide and control arms where mean differences and odds ratios were estimated for continuous and dichotomous outcomes respectively. RESULTS RCTs included in this study revealed that among 5800 patients, 78.22% (95% CI: 72.15% to 83.73%), 55.60% (95% CI: 46.54% to 64.47%), 32.28% (95% CI: 23.17% to 42.12%) achieved ≥5%, ≥10%, and ≥15% weight loss, respectively. Tirzepatide 5 mg demonstrated weight loss superiority relative to placebo (MD: -12.47 kg, 95% CI: -13.94 kg to -11.00 kg) and semaglutide (n = 1409, MD: -1.90 kg, 95% CI: -2.97 kg to -0.83 kg) with dose-dependent increase for 10 mg and 15 mg doses. The comparison between tirzepatide and semaglutide was examined in the SURPASS-2 trial that was included in this systematic review. For AEs, there was increase odds of experiencing gastrointestinal AEs with tirzepatide compared to placebo, but no significant difference with semaglutide. CONCLUSION Tirzepatide has significant potential as a weight loss drug in patients with overweight and obesity, with little increase in AEs compared to other weight loss drugs. With its ability to concurrently target multiple aspects of metabolic syndrome, it should be considered as the next helm of weight loss therapies.
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Affiliation(s)
- Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vickram Vijay Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Charlotte Chung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Centre, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Cheng Han Ng
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore.
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore, Singapore.
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Galindo RJ, Ramos C, Cardona S, Vellanki P, Davis GM, Oladejo O, Albury B, Dhruv N, Peng L, Umpierrez GE. Efficacy of a Smart Insulin Pen Cap for the Management of Patients with Uncontrolled Type 2 Diabetes: A Randomized Cross-Over Trial. J Diabetes Sci Technol 2023; 17:201-207. [PMID: 34293955 PMCID: PMC9846390 DOI: 10.1177/19322968211033837] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND We studied a smart insulin pen cap that can be plugged to several brand of insulin pens, to track insulin administration via smart-phone Bluetooth technology, with alarm/reminder system aiming. METHODS This pilot randomized, cross-over design study assessed the use of a smart insulin pen cap in improving adherence, glycemic control and patient satisfaction in insulin-treated patients with poorly controlled type 2 diabetes. Eighty patients on basal insulin ± oral agents with hemoglobin A1C (HbA1c) between 7.0% and 12.0% were randomized to a 12-week active phase receiving alarms/reminders and a 12-week control/masked phase without feedback. We assessed differences between groups on treatment adherence, insulin omission, and mistiming of insulin injections, HbA1c, treatment satisfaction (using Diabetes Treatment Satisfaction Questionnaire Status). RESULTS Compared to the control/masked phase, the active phase resulted in lower mean daily blood glucose (147.0 ± 34 vs 157.6 ± 42 mg/dL, P < .01); and greater reduction in HbA1c from baseline (-0.98% vs -0.72%, P = .006); however, no significant differences in treatment adherence, insulin omission or insulin mistiming were observed. High patient satisfaction scores were reported in both active and control phases, with DTSQc of 15.5 ± 3.7 and 14.9 ± 3.6, respectively. Statistical models showed no residual effect after cross-over between active and control phases. CONCLUSIONS The results of this pilot study indicates that this smart insulin pen cap was effective in improving glycemic control with overall good satisfaction in insulin treated patients with type 2 diabetes. Future studies are needed to confirm its potential for improving care in insulin treated patients with diabetes.
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Affiliation(s)
- Rodolfo J. Galindo
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
| | - Clementina Ramos
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
| | - Saumeth Cardona
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
| | - Priyathama Vellanki
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
| | - Georgia M. Davis
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
| | - Omolade Oladejo
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
| | - Bonnie Albury
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
| | | | - Limin Peng
- Emory University Rollins School of
Public Health, Atlanta, GA, USA
| | - Guillermo E. Umpierrez
- Emory University School of Medicine,
Division of Endocrinology and Diabetes, Grady Memorial Hospital, Atlanta, GA,
USA
- Guillermo E. Umpierrez, MD, CDE, FACE,
MACP, Emory University School of Medicine, 69 Jesse Hill Jr. Dr., Glenn
Building, Suite 202, Atlanta, GA 30303, USA.
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Sims TJ, Boye KS, Robinson S, Kennedy-Martin T. Treatment-Related Attributes of Diabetes Therapies and How People with Type 2 Diabetes Report Their Impact on Indicators of Medication-Taking Behaviors. Patient Prefer Adherence 2022; 16:1919-1939. [PMID: 35958887 PMCID: PMC9359496 DOI: 10.2147/ppa.s367046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Understanding the treatment-related attributes influencing medication-taking behaviors in people with type 2 diabetes (T2D) is important for delivery of patient-centered care. This review aimed to identify and summarize studies in which people with T2D (PwD) directly indicated the treatment-related attributes associated with medication-taking behaviors or intentions. Materials and Methods EMBASE and PubMed were searched for studies (Jan 2005-May 2021) reporting the link between PwD-expressed diabetes treatment-related attributes and the decision to initiate, adhere to, or discontinue a T2D medication. Eligible studies reported attributes associated with oral antidiabetes drugs or injectables (not insulin). Studies not explicitly exploring the link between attributes and indicators of behaviors (eg most discrete-choice experiments [DCE] and those interrogating electronic medical records or claims databases) were excluded, as were studies where the link between attribute and behavior came from anyone but the PwD. Results Of the 6464 studies identified, 16 were included. Studies were conducted across multiple countries; the USA was most represented (n = 8 studies). The impact of treatment attributes was described on indicators of initiation (n = 3), adherence (n = 12), and discontinuation (n = 4). Some studies evaluated multiple behaviors. PwD perspectives were solicited by structured questionnaires (n = 10), qualitative approaches (n = 4), or DCE explicitly exploring the link to medication-taking behaviors (n = 2). Closed- (n = 9) and open-ended questions (n = 7) were employed. Across studies, several factors including glycemic efficacy (n = 9), weight change (n = 9), dosing frequency (n = 9), hypoglycemia (n = 8), gastrointestinal adverse events (n = 8), regimen complexity (n = 6), route of administration (n = 3), and cardiovascular risk (n = 1) were reported as influencing behaviors, being motivators or barriers to initiation, adherence, or discontinuation. Conclusion Several attributes influence how PwD take their medications. Insights gained directly from PwD have the potential to assist stakeholders in making more informed, patient-centered, treatment decisions, thus choosing and managing medications that PwD are comfortable initiating and persisting with over the longer term.
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González-Saldivar G, Millan-Alanis JM, González-González JG, Sánchez-Gómez RA, Obeso-Fernández J, McCoy RG, Maraka S, Brito JP, Ospina NS, Oyervides-Fuentes S, Rodríguez-Gutiérrez R. Treatment burden and perceptions of glucose-lowering therapy among people living with diabetes. Prim Care Diabetes 2022; 16:568-573. [PMID: 35466069 PMCID: PMC9357113 DOI: 10.1016/j.pcd.2022.04.002] [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: 01/13/2022] [Revised: 03/20/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022]
Abstract
AIMS Address treatment burden and general perceptions of pharmacological treatment in patients with diabetes. METHODS We surveyed adult patients with diabetes cared for in a tertiary academic medical center about: i) knowledge about the impact of glucose-lowering medication use on diabetes control and complications, ii) common beliefs about natural medicine and insulin use, iii) attitudes towards glucose-lowering medications, iv) burden of treatment, v) general knowledge of diabetes pharmacological treatment, and vi) perceptions of shared decision-making. RESULTS Two hundred-four participants completed the survey. While most (90%) agreed that adherence to medication would control diabetes and improve quality of life, 30-40% were not certain that it would translate to fewer disease complications. About one of three thought medications could be harmful (29.4%). Over 50% agreed or was unsure that natural remedies were as good/better than prescribed medications. About 30% acknowledged difficulties taking their diabetes medications and monitoring blood glucose, and over 50% were concerned about treatment costs. Nearly 30% denied receiving a detailed explanation from their clinician regarding their disease and is treatment. CONCLUSIONS Our results highlight the importance of patient education regarding pharmacological treatment for diabetes, and eliciting sources of distress and treatment burden among patients with diabetes.
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Affiliation(s)
- Gerardo González-Saldivar
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Juan Manuel Millan-Alanis
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Raymundo A Sánchez-Gómez
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Javier Obeso-Fernández
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Medicine Service,Central Arkansas Veterans Healthcare System, Little Rock, AR, USA; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephie Oyervides-Fuentes
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Roberto G, Girardi A, Barone-Adesi F, Pecere A, Ientile V, Bartolini C, Da Cas R, Spila-Alegiani S, Ferrajolo C, Francesconi P, Trifirò G, Poluzzi E, Baccetti F, Gini R. Time to Treatment Intensification in Patients Receiving DPP4 Inhibitors Versus Sulfonylureas as the First Add-On to Metformin Monotherapy: A Retrospective Cohort Study. Front Pharmacol 2022; 13:871052. [PMID: 35707398 PMCID: PMC9189773 DOI: 10.3389/fphar.2022.871052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: To verify whether, in patients on metformin (MET) monotherapy for type 2 diabetes (T2D), the add-on of a dipeptidyl peptidase inhibitor (DPP4i) compared to a sulfonylurea (SU) can delay the time to the subsequent treatment intensification (TI). Methods: Population-based administrative data banks from four Italian geographic areas were used. Patients aged ≥18 years on MET monotherapy receiving first DPP4i or SU dispensing between 2008 and 2015 (cohort entry) were followed up to the occurrence of TI (insulin dispensing or add-on of a third non-insulin hypoglicemic >180 days after cohort entry), treatment discontinuation, switch, cancer, death, TI occurrence within, end of data availability, end of study period (31 December 2016), whichever came first. Patients on MET + DPP4i were matched 1:1 with those on MET + SU by sex, age, year of cohort entry, and data bank. Hazard Ratio (HR) and 95% confidence intervals (95%CI) were estimated using multivariable Cox regression model including matching variables and potential confounders measured at baseline. Different sensitivity analyses were performed: i) matching at 180 days after cohort entry, ii) intent to treat (ITT) analysis, iii) matching by duration of MET monotherapy, iv) matching by propensity score. Results: The matched study cohort included 10,600 patients. Overall, 763 TI were observed (4.5/100 person-years; mean follow-up = 1.6 years). The primary analysis showed no difference in time to TI between the two groups (HR = 1.02; 95% CI = 0.88–1.19). Sensitivity analyses confirmed this result, except from the ITT analysis (HR = 1.27; 1.13–1.43). Conclusion: The use of a DPP4i rather than a SU as add-on to MET monotherapy was not associated with a delay in treatment intensification.
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Affiliation(s)
- Giuseppe Roberto
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
- *Correspondence: Giuseppe Roberto,
| | - Anna Girardi
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Francesco Barone-Adesi
- Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
| | - Alessandro Pecere
- Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
| | - Valentina Ientile
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, Messina, Italy
| | - Claudia Bartolini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Roberto Da Cas
- Centro Nazionale per la Ricerca e la Valutazione Preclinica e Clinica Dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Stefania Spila-Alegiani
- Centro Nazionale per la Ricerca e la Valutazione Preclinica e Clinica Dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Carmen Ferrajolo
- Dipartimento di Medicina Sperimentale, Università Degli Studi Della Campania “L. Vanvitelli” e Centro Regionale di Farmacovigilanza, Regione Campania, Napoli, Italy
| | - Paolo Francesconi
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Gianluca Trifirò
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, Messina, Italy
| | - Elisabetta Poluzzi
- Unità di Farmacologia, Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Fabio Baccetti
- Unità Operativa di Diabetologia Massa-Carrara, USL Toscana Nordovest, Massa, Italy
| | - Rosa Gini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
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Jia RB, Wu J, Luo D, Lin L, Chen C, Xiao C, Zhao M. The Beneficial Effects of Two Polysaccharide Fractions from Sargassum fusiform against Diabetes Mellitus Accompanied by Dyslipidemia in Rats and Their Underlying Mechanisms. Foods 2022; 11:foods11101416. [PMID: 35626992 PMCID: PMC9141567 DOI: 10.3390/foods11101416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 12/25/2022] Open
Abstract
The current study aimed to assess the anti-diabetic effects and potential mechanisms of two Sargassum fusiform polysaccharide fractions (SFPs, named SFP-1 and SFP-2). The carbohydrate-loading experiment revealed that SFP-2 could control postprandial hyperglycemia by inhibiting the activity of digestive enzymes in rats. The analysis of diabetic symptoms and serum profiles indicated that SFPs could mitigate diabetes accompanied by dyslipidemia, and SFP-2 showed better regulatory effects on body weight, food intake and the levels of total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C) and free fatty acid (FFA) in diabetic rats. Intestinal bacterial analysis showed that SFP treatment could reshape the gut flora of diabetic rats, and SFP-2 possessed a greater regulatory effect on the growth of Lactobacillus and Blautia than SFP-1. RT-qPCR analysis revealed that SFPs could regulate the genes involved in the absorption and utilization of blood glucose, hepatic glucose production and lipid metabolism, and the effects of SFP-2 on the relative expressions of Protein kinase B (Akt), Glucose-6-phosphatase (G-6-Pase), Glucose transporter 2 (GLUT2), AMP-activated protein kinase-α (AMPKα), Peroxisome proliferator-activated receptor γ (PPARγ) and Cholesterol 7-alpha hydroxylase (CYP7A1) were greater than SFP-1. All above results indicated that SFPs could be exploited as functional foods or pharmaceutical supplements for the treatment of diabetes and its complications.
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Affiliation(s)
- Rui-Bo Jia
- Chaozhou Branch of Chemistry and Chemical Engineering Guangdong Laboratory, Chaozhou 521000, China; (R.-B.J.); (D.L.); (L.L.)
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China;
| | - Juan Wu
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China;
| | - Donghui Luo
- Chaozhou Branch of Chemistry and Chemical Engineering Guangdong Laboratory, Chaozhou 521000, China; (R.-B.J.); (D.L.); (L.L.)
- School of Food Science and Engineering, Guangdong Ocean University, Yangjiang 529500, China
| | - Lianzhu Lin
- Chaozhou Branch of Chemistry and Chemical Engineering Guangdong Laboratory, Chaozhou 521000, China; (R.-B.J.); (D.L.); (L.L.)
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China;
| | - Chong Chen
- Hainan Key Laboratory of Storage and Processing of Fruits and Vegetables, Agricultural Products Processing Research Institute, Chinese Academy of Tropical Agricultural Sciences, Zhanjiang 524001, China;
| | - Chuqiao Xiao
- Chaozhou Branch of Chemistry and Chemical Engineering Guangdong Laboratory, Chaozhou 521000, China; (R.-B.J.); (D.L.); (L.L.)
- Correspondence: (C.X.); (M.Z.)
| | - Mouming Zhao
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China;
- Correspondence: (C.X.); (M.Z.)
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11
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Bastarache L, Brown JS, Cimino JJ, Dorr DA, Embi PJ, Payne PR, Wilcox AB, Weiner MG. Developing real-world evidence from real-world data: Transforming raw data into analytical datasets. Learn Health Syst 2022; 6:e10293. [PMID: 35036557 PMCID: PMC8753316 DOI: 10.1002/lrh2.10293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
Development of evidence-based practice requires practice-based evidence, which can be acquired through analysis of real-world data from electronic health records (EHRs). The EHR contains volumes of information about patients-physical measurements, diagnoses, exposures, and markers of health behavior-that can be used to create algorithms for risk stratification or to gain insight into associations between exposures, interventions, and outcomes. But to transform real-world data into reliable real-world evidence, one must not only choose the correct analytical methods but also have an understanding of the quality, detail, provenance, and organization of the underlying source data and address the differences in these characteristics across sites when conducting analyses that span institutions. This manuscript explores the idiosyncrasies inherent in the capture, formatting, and standardization of EHR data and discusses the clinical domain and informatics competencies required to transform the raw clinical, real-world data into high-quality, fit-for-purpose analytical data sets used to generate real-world evidence.
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Affiliation(s)
- Lisa Bastarache
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jeffrey S. Brown
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMassachusettsUSA
| | - James J. Cimino
- Informatics Institute, University of Alabama at BirminghamBirminghamAlabamaUSA
| | - David A. Dorr
- Department of Medical Informatics and Clinical EpidemiologyOregon Health Sciences UniversityPortlandOregonUSA
| | - Peter J. Embi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Philip R.O. Payne
- Institute for Informatics, Washington University in St. LouisSt. LouisMissouriUSA
| | - Adam B. Wilcox
- Institute for InformaticsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | - Mark G. Weiner
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNew YorkUSA
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12
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Boye KS, Shinde S, Kennedy-Martin T, Robinson S, Thieu VT. Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review. Patient Prefer Adherence 2022; 16:23-39. [PMID: 35023906 PMCID: PMC8747793 DOI: 10.2147/ppa.s328583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Type 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation. METHODS Searches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD). RESULTS Nine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug's weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type. CONCLUSION Findings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual's treatment, weight journey, and behaviors over time should be undertaken.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Indianapolis, IN, USA
- Correspondence: Kristina S Boye Eli Lilly and Company, Indianapolis, IN, USATel +1-317-651-4039 Email
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13
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Van J, Frias JP, Bonora E, Raha S, Meyer J, Jung H, Cox D, Konig M, Peleshok J, Bethel MA. Gastrointestinal Tolerability of Once-Weekly Dulaglutide 3.0 mg and 4.5 mg: A Post Hoc Analysis of the Incidence and Prevalence of Nausea, Vomiting, and Diarrhea in AWARD-11. Diabetes Ther 2021; 12:2783-2794. [PMID: 34514554 PMCID: PMC8479017 DOI: 10.1007/s13300-021-01140-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/06/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) events are the most frequent treatment-emergent adverse events (TEAEs) reported for glucagon-like peptide-1 receptor agonist therapies. This post hoc analysis of the AWARD-11 phase 3 trial assessed the GI tolerability of dulaglutide at once-weekly doses of 1.5, 3.0, and 4.5 mg. METHODS The AWARD-11 trial randomized patients to once-weekly dulaglutide 1.5 mg (n = 612), 3.0 mg (n = 616), or 4.5 mg (n = 614) for 52 weeks. Patients started on dulaglutide 0.75 mg for 4 weeks before escalating stepwise every 4 weeks until the final randomized dose was reached. This study analyzes the onsets, incidences, prevalences, and severities of nausea, vomiting, and diarrhea events reported through 52 weeks. RESULTS The highest incidences of nausea (≤ 8%), vomiting (≤ 2%), and diarrhea (≤ 4%) were primarily observed soon after the initiation of dulaglutide treatment at 0.75 mg. Incidence then declined throughout the remainder of the study, even with dose escalation to 1.5, 3.0, and 4.5 mg. Most of these GI TEAEs were mild to moderate in severity, with severe nausea, vomiting, or diarrhea events occurring in ≤ 0.6% of patients. Treatment discontinuation due to nausea was low across treatment groups (≤ 1.5%). CONCLUSIONS The tolerability profiles of dulaglutide 3.0 mg and 4.5 mg were consistent with that of the 1.5-mg dose. Patients experiencing GI events were most likely to do so within 2 weeks of treatment initiation, and few patients experienced a new GI event after escalating to the 3.0-mg or 4.5-mg dose. Severe events were infrequent, and when they did occur, no relationship with dose at time of event was observed. Supplementary file1 (MP4 33880 kb).
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Affiliation(s)
- Joanna Van
- Diabetes Research Center, 2492 Walnut Ave, Ste 130, Tustin, CA, 92780, USA
| | - Juan P Frias
- National Research Institute, 2010 Wilshire Blvd., Suite 302, Los Angeles, CA, 90057, USA
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism Department of Medicine University and Hospital Trust of Verona Ospedale Maggiore Piazzale Stefani 1, 37126, Verona, Italy
| | - Sohini Raha
- Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | | | - Heike Jung
- Lilly Deutschland GmbH, Werner-Reimers-Str. 2-4, 61352, Bad Homburg, Germany
| | - David Cox
- Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Manige Konig
- Eli Lilly and Company, Indianapolis, IN, 46285, USA
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14
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Widayanti AW, Sigalingging KK, Dewi FP, Widyakusuma NN. Issues Affecting Medication-Taking Behavior of People with Type 2 Diabetes in Indonesia: A Qualitative Study. Patient Prefer Adherence 2021; 15:989-998. [PMID: 34040353 PMCID: PMC8139640 DOI: 10.2147/ppa.s301501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE It has been widely acknowledged that non-adherence to medication among people with type 2 diabetes is a significant problem worldwide. Studies have suggested that non-adherence to medication may be caused by the complexity of issues surrounding medication use which further created burdens related to medication. However, studies on this topic in the Indonesian context were still limited. This study aimed to understand the experiences of people with type 2 diabetes in medication-taking and explore any practical issues that potentially affect their behavior when taking medication. METHODS Qualitative phenomenological study with semi-structured interviews was applied. The participants were purposefully recruited and selected from some primary healthcare facilities in Yogyakarta Province. The eligibility criteria included: diagnosed with type 2 diabetes by healthcare professionals for at least six months and were able to comprehend information. Information about the study was explained, and written informed consent was collected. The interviews were recorded, transcribed verbatim, and analyzed with a deductive qualitative content analysis method. RESULTS Fifty-one people with type 2 diabetes were involved in this study. Most of the participants were between 40 and 59 years old, and many of them were female and housewives. The thematic analysis found some practical issues that affected people's behavior in taking type 2 diabetes medication. These included individual's mealtime, characteristics of the medications, accessibility of healthcare services, experiences of side effects and social activities. CONCLUSION The practical issues identified in this study can be resolved by improving the role of healthcare providers in managing people with diabetes. Future research needs to be conducted to evaluate the effectiveness of interventions developed based on understanding of the practical factors identified.
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Affiliation(s)
- Anna Wahyuni Widayanti
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Furi Patriana Dewi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Niken Nur Widyakusuma
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
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