Evaluation of the quality of life of patients with diabetes mellitus treated with conventional or analogue insulins

Retrospective evaluation of prescribing pattern and utilization of antiepileptic drugs in pediatric, neurosurgery, and psychiatry wards: A comparative study to the standard treatment guidelines

Antiepileptic drugs (AED) are progressively utilized for off-label conditions other than epilepsy, like bipolar disorder and migraine. The objective of this study was to evaluate current prescribing patterns and utilization of AED in pediatric, neurosurgery, and psychiatry wards and to compare them to the standard treatment guidelines. A descriptive, cross-sectional study was conducted in Ayyub Teaching Hospital, Abbottabad from December 1st, 2018 to April 2019. Data on demographic and clinical characteristics, utilization patterns of AED, adherence to standard treatment guidelines, and frequency of potential drug-drug interactions were analyzed using descriptive statistics. Among 410 patients, 54.3% (n = 223) were male, 45.6%(n = 187) were female, and 63.7% (n = 261) were from the 1 to 18 years' age group. The majority 47.3% (n = 194) were from the pediatric ward followed by neurosurgery 28.7%(n = 118). Among the studied patients, 96.1% of them had comorbid conditions other than epilepsy alone. With regards to types of seizures unclassified seizures were the most common seizure type (59.8%; n = 245) followed by generalized tonic clonic seizures 23.4% (n = 96). In this study, the most frequently utilized AED was sodium valproate 59.0% (n = 242) followed by antiepileptic first-generation medicines were commonly used (76.3%). Although a total of 77.6% of the patients showed nonadherence to National Institute for Health and Care Excellence guidelines and 87.6% of them showed drug interactions. Findings from this study showed prescription patterns and utilization of AED in patients with epilepsy and non-epilepsy disorders which may help healthcare providers in making accurate clinical decisions.

A Cross-Sectional Study of Quality of Life Among Brazilian Adults With Type 1 Diabetes Treated With Insulin Glargine: Findings and Implications

This article describes a cross-sectional study involving 401 adults with type 1 diabetes treated with insulin glargine in Minas Gerais, Brazil. Health-related quality of life was assessed, and worse scores were found to be associated with a low level of education, self-perceived health reported as poor/very poor, being bedridden and not physically exercised, having seen a doctor more than four times in the past year, and having reported comorbidities and episodes of hypoglycemia.

Availability of secondary healthcare data for conducting pharmacoepidemiology studies in Colombia: A systematic review

Real-world evidence (RWE) is emerging as a fundamental component of the post-marketing evaluation of medicinal products. Even though the focus on RWE studies has increased in Colombia, the availability of secondary data sources to perform this type of research is not well documented. Thus, we aimed at identifying and characterizing secondary data sources available in Colombia. We performed a systematic literature review on PubMed, EMBASE, and VHL using a combination of controlled vocabulary and keywords for the concepts of electronic health records, epidemiologic studies and Colombia. A total of 323 publications were included. These comprised 123 identified secondary data sources including pharmacy dispensing databases, government datasets, disease registries, insurance databases, and electronic heath records, among others. These data sources were mostly used for cross-sectional studies focused on disease epidemiology in a specific population. Almost all databases (95%) contained demographic information, followed by pharmacological treatment (44%) and diagnostic tests (39%). Even though the database owner was identifiable in 94%, access information was only available in 44% of the articles. Only a pharmacy-dispensing database, local cancer registries, and government databases included a description regarding the quality of the information available. The diversity of databases identified shows that Colombia has a high potential to continue enhancing its RWE strategy. Greater efforts are required to improve data quality and accessibility. The linkage between databases will expand data pooling and integration to boost the translational potential of RWE.

Quality of life of Latin-American individuals with type 2 diabetes mellitus: A systematic review

OBJECTIVE

Diabetes mellitus is a serious public health problem that causes a decrease in the patients' quality of life. The present study was aimed to analyze the quality of life of patients with diabetes mellitus in Latin-American population through a systematic review, using the two instruments of greater validity and reliability at international level, SF-36 and WHOQOL.

METHODS

We performed extensive searches in Redalyc, SciELO, PubMed, Scopus and Web of Science databases. To delimit our search, we only included countries that are members of the Latin American Association of Diabetes. We identified 2168 articles, where 35 were considered relevant for this systematic review.

RESULTS

Our results showed that patients that regularly receive guidance and treatment to control the diabetes, showed better quality of life; in contrast, patients with foot ulcers or comorbidities showed the worse quality of life.

CONCLUSION

The current literature analysis suggests that this disease greatly influences in the quality of life of the patients.

Quality of Life of Patients with Type 1 Diabetes Mellitus Using Insulin Analog Glargine Compared with NPH Insulin: A Systematic Review and Policy Implications

INTRODUCTION

Insulin analog glargine (GLA) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control. Studies have shown that a decrease in the frequency of hypoglycemic episodes improves the quality of life (QoL) of diabetic patients. However, there are appreciable acquisition cost differences between different insulins. Consequently, there is a need to assess their impact on QoL to provide future guidance to health authorities.

METHOD

A systematic review of multiple databases including Medline, LILACS, Cochrane, and EMBASE databases with several combinations of agreed terms involving randomized controlled trials and cohorts, as well as manual searches and gray literature, was undertaken. The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed.

RESULTS

Eight studies were eventually included in the systematic review out of 634 publications. Eight different QoL instruments were used (two generic, two mixed, and four specific), in which the Diabetes Treatment Satisfaction Questionnaire (DTSQ) was the most used. The systematic review did not consistently show any significant difference overall in QoL scores, whether as part of subsets or combined into a single score, with the use of GLA versus neutral protamine Hagedorn (NPH) insulin. Only in patient satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin, but not using the Well-being Inquiry for Diabetics (WED) scale. However, none of the cohort studies scored a maximum on the Newcastle-Ottawa scale for quality, and they generally were of moderate quality with bias in the studies.

CONCLUSION

There was no consistent difference in QoL or patient-reported outcomes when the findings from the eight studies were collated. In view of this, we believe the current price differential between GLA and NPH insulin in Brazil cannot be justified by these findings.

Prescription patterns and costs of antidiabetic medications in a large group of patients

AIMS

To determine the prescription patterns of antidiabetic medications and the variables associated with their use in a Colombian population.

METHODS

A cross-sectional study using a systematized database of approximately 3.5 million affiliates of the Colombian Health System. Patients of both genders and all ages treated uninterruptedly with antidiabetic medications for three months (June-August 2015) were included. A database was designed that included sociodemographic, pharmacological, comedication, and cost variables.

RESULTS

A total of 47,532 patients were identified; the mean age was 65.5 years, and 56.3% were women. Among the patients, 56.2% (n=26,691) received medication as monotherapy. The most prescribed medications were metformin, 81.3% (n=38,664), insulins, 33.3% (n=15,848), and sulfonylureas, 21.8% (n=10,370). Among the patients, 92.8% received comedications, including antihypertensives (79.7%), hypolipemiants (65.5%), antiplatelet drugs (56.3%), analgesics (33.9%), antiulcerants (33.1%), and thyroid hormone (17.3%). The cost per 1000 inhabitants/day was $1.21 USD for metformin, $3.89 USD for insulins, and $0.02 USD for glibenclamide.

CONCLUSIONS

Generally, rational prescription habits predominated, however in some cases an overuse of comedications (such as antiulcer drugs) and a large group of patients with high cost formulations were observed. Subsequent effectiveness and cost-benefit analyzes are required.