Treatment Patterns, Effectiveness, and Satisfaction Among Patients with Type 2 Diabetes Treated with Insulin in Saudi Arabia: Results of the RIMODIS Study

A cross-sectional study evaluating insulin injection techniques and the impact of instructions from various healthcare professionals on insulin users in the southern region of Saudi Arabia

Background

It is evident that proper use of the insulin injection technique (IIT) is important for optimizing the efficacy of the therapy. Despite the readily available manufacturers' instructions, healthcare professionals (HCPs) play a major role in educating patients. This study aims to investigate the knowledge, practices, and challenges faced by insulin users regarding IIT, as well as the impact of healthcare professionals' education on it.

Methods

We conducted a questionnaire-based cross-sectional study using a validated online questionnaire to gather demographic and clinical data, as well as the participants' knowledge, practices, and challenges related to insulin therapy.

Results

The mean age of the participants was 38.25 ± 15.58 (mean ± SD) years, with a nearly equal distribution of genders. Thirty-six percent of the participants educated by the diabetes educators demonstrated an appropriate IIT, such as storage, priming the insulin pen (54%), skin folding (63%), injection hold time, and "use-by" date. Furthermore, the absence of diabetes education specialist training increases the likelihood of errors, potentially leading to a loss of glycemic control. Patients reported carrying insulin when traveling as one of the major challenges (27.9%), followed by timely injections (23.7%), priming (21.6%), and adjusting the insulin dose (16.8%). Forgetfulness (47.7%), traveling or altering the regular routine (15.5%), missing a meal (15.5%), and being overly busy (13.5%) were among the reasons for missing the insulin dose; all of which are easily manageable with proper education.

Conclusion

Consistent education and re-education are necessary for the insulin users to resolve the issues associated with suboptimal IIT. The inclusion of all stakeholders in insulin therapy, particularly the diabetes education specialists, is essential. Therefore, the Ministry of Health in Saudi Arabia should take the initiative to ensure that appropriately trained diabetes education specialists, pharmacists, nurses and other HCPs assess and follow up on patients.

Level of Satisfaction Among Patients Using Insulin Administered by Pen vs Vial/Syringe. An Observational Prospective Study

Purpose

To determine the satisfaction of patients with diabetes mellitus who used subcutaneous insulin application devices in Colombia.

Patients and Methods

An observational prospective study of patients with diabetes mellitus receiving insulin treatment in Colombia. Sociodemographic, comorbidity and pharmacological data were taken from a drug dispensing database. Through telephone calls, satisfaction with application devices was evaluated with Diabetes Treatment Satisfaction Questionnaire status version (DTSQ-s). Satisfaction was considered high at a score ≥30 points. The change in the type of insulin delivery device (ie, from pen to vial/syringe, and from vial/syringe to pen) was evaluated during a 1-year follow-up.

Results

A total of 382 patients from 75 cities were selected, with a median age of 66.0 years, and 56.3% were women, and 65.2% were treated with long-acting insulins. The mean DTSQ-s score was 26.6±5.3 points, and 38.7% presented high satisfaction, without statistically significant differences between pen and vial/syringe. A total of 18.8% changed the administration device, mainly those that came from Bogotá-Cundinamarca (OR:2.19; 95% CI:1.01-4.75), in concomitant treatment with other antidiabetic drugs (OR:2.28; 95% CI:1.00-5.22) and those who previously used insulin in vial/syringe (OR:33.90; 95% CI:11.88-96.74).

Conclusion

The participants had low satisfaction with the insulin delivery device. No statistically significant differences were found in satisfaction between those who received pen vs vial/syringe insulin, and patients using the latter had a high probability of switching to insulin pen.

Burden of Illness of Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Five-Year Longitudinal Study

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is associated with huge clinical and economic burden in the Kingdom of Saudi Arabia (KSA) which can be curtailed by efficacious treatment. In order to achieve this, current treatment pathways for T2DM and associated costs need to be assessed.

METHODS

A longitudinal cohort review was conducted to collect country-specific and patient-specific clinical data, over a minimum observation period of 5 years in the KSA. Patient demographics, clinical characteristics and treatment patterns were recorded. The IQVIA Core Diabetes Model (CDM) version 9.5 Plus was used to assess the burden of illness, which included long-term projections of clinical (life expectancy [LE], quality-adjusted life-years [QALYs], event rates of diabetes-related complications) and direct medical cost (per-patient annual or lifelong [50 years]) outcomes of the most commonly used first-line (1st-line) regimens for T2DM from a payer perspective in the KSA.

RESULTS

Data were collected from a subpopulation of 638 patients from 15 participating centres. There was an equal gender representation with a majority of the patients belonging to Arabian/Saudi ethnicity (71.0%). Biguanides (81.5%), sulfonylureas (51.6%), dipeptidyl peptidase 4 (DPP4) inhibitors (26.2%) and fast-acting insulins (17.2%) were the most prescribed 1st-line agents. The most frequently used 1st-line regimens resulted in an estimated LE of 25-28 years, QALYs of 18-21 years and lifelong total cost of illness of 201,377-437,371 Saudi Arabian riyal (53,700-116,632 US dollars).

CONCLUSION

Our study addresses gaps in the current research by providing a complete landscape of baseline demographic, clinical characteristics and treatment patterns from a heterogeneous group of patients with T2DM in the KSA. Additionally, the burden of illness analysis using CDM showed substantially higher cost of T2DM care from a payer perspective in the KSA.

The prevalence of glycemic control in patients with type 2 diabetes treated with insulin: a systematic review and meta-analysis

OBJECTIVES

To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package).

RESULTS

A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control.

CONCLUSIONS

This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.

Dissatisfaction of people with type 2 diabetes with the care received at a diabetes clinic in Ningbo, China: A cross-sectional study

Aim

The study aimed to assess the dissatisfaction of people with type 2 diabetes mellitus (T2DM) with the care that they received at a diabetes outpatient clinic in Ningbo, China and to determine the associated factors.

Methods

A cross-sectional study was conducted among 406 adults with T2DM in 2020-2021. Those who were treated at the diabetes outpatient clinic for at least six consecutive months before the survey date were eligible. The Short Assessment of Patient Satisfaction scale was used to assess participants' dissatisfaction with the care that they received.

Results

Of the participants, 25.1% were not satisfied with the care that they received at the diabetes outpatient clinic in Ningbo. The odds of dissatisfaction were higher in physically active people compared to those who were not (odds ratio [OR]: 3.41; 95% confidence interval [CI]: 1.56-7.45) and those with >1-5 years of T2DM compared to ≤1 year (OR: 2.18; 95% CI: 1.05-4.53).

Conclusion

A quarter of people with T2DM were dissatisfied with the care that they received at the diabetes outpatient clinic in Ningbo, China, and the factors associated with dissatisfaction were identified.

Quality of life and other patient-reported outcomes in adult Lebanese patients with type 2 diabetes during COVID-19 pandemic

INTRODUCTION

Several studies have shown that COVID-19 pandemic has a negative impact on type 2 diabetic mellitus (T2DM) patients' quality of life (QoL). However, very few studies were performed in Middle Eastern countries.

AIM

The aim of the current study was to assess, the QoL and diabetes-specific QoL, treatment satisfaction and psychological distress of Lebanese patients with T2DMs using: the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and Kessler 10 (K10) questionnaires and to compare results to those obtained during the pre-COVID-19 period.

RESULTS

461 patients with T2DM participated in the study; 52.6% men, 47.4% women; median age 59 years old. The respective median ADDQoL and DTSQs scores were - 2.2 (interval interquartile range (IQR) - 3.9, - 0.8) (range from - 9 maximum negative impact to + 3 maximum positive impact) and 30(IQR22-36) (range from 0 maximum dissatisfaction to 36 maximum satisfaction). K10 median score was 26(IQR18-35) (range from minimum score of 10 indicating no distress to maximum score of 50 indicating severe distress). Rural dwelling, lack of exercise, current smoking, diabetic complications, injectable diabetes treatment, and previous COVID-19 infection were all associated with significantly worse ADDQoL, DTSQs, and K10 score indicating greater distress. A significant worsening of ADDQoL scores followed onset of the pandemic with no significant change in DTSQs scores.

CONCLUSION

During the COVID-19 pandemic, T2DM Lebanese patients experienced more negative impact of diabetes on QoL and mental health. Those infected with COVID-19 also reported worse QoL, treatment satisfaction and mental health. This highlights the need for community and individual support.