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Hauss O, Hinzmann R, Huffman B. Drug Interference in Self-Monitoring of Blood Glucose and the Impact on Patient Safety: We Can Only Guard Against What We Are Looking for. J Diabetes Sci Technol 2024; 18:727-732. [PMID: 36514199 PMCID: PMC11089864 DOI: 10.1177/19322968221140420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Self-monitoring of blood glucose is a key aspect of diabetes management. Depending on the technology used, however, various substances can jeopardize the reliability of the measurements and precipitate complications with potentially life-threatening consequences when blood glucose was deemed well-controlled. As such, it is important for all involved to be aware of those factors. Officially suggested procedures for testing and alternatives have each their own advantages and limitations, and interferences may be found beyond the substances to be tested provided by the various pertinent institutions. This article reviews these pros and cons and illustrates how interference testing beyond established standards contributes to patient safety. Once identified, interfering substances are included in product labeling and healthcare professionals and users need to be trained to be aware of these risks.
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Affiliation(s)
- Oliver Hauss
- Dr. Hauss Training & Consulting, Maxdorf, Germany
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2
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Vuković M, Jovičić Bata J, Todorović N, Puača G, Vesković D, Čanji Panić J, Dugandžija T, Lalić-Popović M. Diabetes management, dietary supplements use and the effect of coronavirus pandemic on diabetes patients in Serbia: a cross-sectional study. Curr Med Res Opin 2024; 40:165-174. [PMID: 38112408 DOI: 10.1080/03007995.2023.2296963] [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] [Received: 10/03/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Diabetes mellitus (DM) is a significant public health challenge in Serbia, mirroring the situation in other European middle-income countries. The aims of this study were to examine the disease-related characteristics and management of diabetes, as well as the prevalence of use of dietary supplements (DS) among diabetes patients in Serbia, and to analyze the effects of the coronavirus pandemic on DM patients in Serbia. METHODS The study was carried out as an online, observational, cross-sectional study involving 422 adult diabetes type 1 (DM1) and type 2 (DM2) patients residing in Serbia. RESULTS DM1 patients were more likely than DM2 patients to self-control glucose levels (p < 0.001). Almost one-third of DM2 patients (31.4%) did not know their HbA1c value. Polypharmacy has been reported by 9.7% of DM1 patients and 23.5% of DM2 patients. During the coronavirus pandemic increased anxiety levels for one-third of respondents was noticed. The prevalence of DS use among DM patients was very high (95.3%), with vitamin C, zinc, vitamin D and magnesium being the most commonly used. Women were more likely to use vitamin D (p = 0.001) and magnesium DS (p = 0.005) than men. Most patients (76.9%) faced limited access to healthcare services during the coronavirus pandemic with, sometimes, detrimental consequences. A significant portion of respondents (41.2%) consulted a pharmacist more often in 2021 than in previous years. CONCLUSIONS Special caution is needed regarding the potential interactions of DS with chronic therapy. To enhance diabetes care, Serbia needs more accessible mental health support, improved diabetes education, expanded CGM availability, and carefully planned emergency healthcare measures for chronic patients.
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Affiliation(s)
- Milana Vuković
- Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | | | | | - Gorana Puača
- Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | - Dunja Vesković
- Clinic for Dermatology, Clinical Center of Vojvodina, Novi Sad, Serbia
- Department of Dermatovenereology, University of Novi Sad, Novi Sad, Serbia
| | | | - Tihomir Dugandžija
- Department of Epidemiology, University of Novi Sad, Novi Sad, Serbia
- Department of Epidemiology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Mladena Lalić-Popović
- Department of Pharmacy, University of Novi Sad, Novi Sad, Serbia
- Centre for Medical and Pharmaceutical Investigations and Quality Control (CEMPhIC), University of Novi Sad, Novi Sad, Serbia
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3
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Dabidian A, Obarcanin E, Ali Sherazi B, Schlottau S, Schwender H, Laeer S. Impact of a Digital Tool on Pharmacy Students' Ability to Perform Medication Reviews: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:1968. [PMID: 37444802 DOI: 10.3390/healthcare11131968] [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: 05/29/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Digital Medication Review Tools (DMRTs) are increasingly important in pharmacy practice. To ensure that young pharmacists are sufficiently competent to perform medication reviews after graduation, the introduction of DMRTs teaching in academic education is necessary. The aim of our study was to demonstrate the effect of DMRTs use on pharmacy students' performance when conducting a medication review (MR) in a randomized controlled pre-post design. Forty-one pharmacy students were asked to complete a MR within 60 min, followed by a 10-min consultation with (intervention group) and without a DMRT (control group). The MR performance was subdivided into four categories: communication skills, subjective and objective patient data, assessment, and plan. Performance was assessed using objective structured clinical examinations (OSCEs) and analytical checklists. With the use of DMRTs, the overall performance was improved by 17.0% compared to the control group (p < 0.01). Improvement through DMRTs was seen in the subcategories "Assessment" and "Plan". Furthermore, pharmacy students liked using DMRTs and felt more confident overall. Our study results demonstrate that DMRTs improve the performance of MRs, hence DMRTs should become an integral part of pharmacy curriculum. Consequently, digitally enabled pharmacists using DMRTs will be better prepared for their professional careers in pharmacy practice.
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Affiliation(s)
- Armin Dabidian
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
| | - Emina Obarcanin
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
- Department of Pharmacy, National University Singapore, 18 Science Drive 4, Singapore 117559, Singapore
| | - Bushra Ali Sherazi
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Sabina Schlottau
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
| | - Holger Schwender
- Mathematical Institute, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
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4
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Faquetti ML, la Torre AMD, Burkard T, Obozinski G, Burden AM. Identification of polypharmacy patterns in new-users of metformin using the Apriori algorithm: A novel framework for investigating concomitant drug utilization through association rule mining. Pharmacoepidemiol Drug Saf 2023; 32:366-381. [PMID: 36579709 DOI: 10.1002/pds.5583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/23/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE With increased concomitant chronic diseases in type 2 diabetes mellitus (T2DM), the use of multiple drugs increases as well as the risk of drug-drug interactions (DDI) and adverse drug reactions (ADR). Nevertheless, how medication patterns vary in T2DM patients across different sex and age groups is unclear. This study aims to identify and quantify common drug combinations in first-time metformin users with polypharmacy (≥5 co-medications). METHODS New users of metformin were identified from the IQVIA Medical Research Data incorporating data from THIN, A Cegedim Database (2016-2019). A descriptive cohort study explored prescription patterns in patients with polypharmacy. The Apriori algorithm, used to find frequent item-sets in databases, was first-time applied to identify and quantify drug combinations of up to seven drugs to investigate potential harmful polypharmacy patterns. RESULTS The cohort included 34 169 new-users of metformin, of which 20 854 (61.0%) received polypharmacy. Atorvastatin was the most frequently co-prescribed drug with metformin overall (38.7%), in women (34.3%) and men (42.6%). In the stratified analysis, a higher proportion of women received polypharmacy (65.6%) compared to men (57.4%). Moreover, the proportion of patients receiving polypharmacy increased with age (18-39 years = 30.4%, 40-59 years = 50.5%, 60-74 years = 70.9%, and ≥75 years = 84.3%). CONCLUSION This study is the first to identify and quantify commonly prescribed combinations of drugs compounds in patients with polypharmacy using the Apriori algorithm. The high polypharmacy prevalence at all strata indicates the need to optimize polypharmacy to minimize DDI and ADR.
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Affiliation(s)
- Maria Luisa Faquetti
- ETH Zurich, Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, Zurich, Switzerland
| | - Adrian Martinez-De la Torre
- ETH Zurich, Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, Zurich, Switzerland
| | - Theresa Burkard
- ETH Zurich, Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, Zurich, Switzerland
| | | | - Andrea M Burden
- ETH Zurich, Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, Zurich, Switzerland
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5
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Phillips S, Setford S, Grady M, Liu Z, Cameron H. Post-Market Surveillance of a Blood Glucose Test Strip Demonstrates No Evidence of Interference on Clinical Accuracy in a Large Cohort of People with Type 1 or Type 2 Diabetes. J Diabetes Sci Technol 2023; 17:141-151. [PMID: 34486429 PMCID: PMC9846393 DOI: 10.1177/19322968211042352] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Regulations and industry guidance relating to testing for interference in blood glucose monitoring (BGM) systems continue to focus on in vitro laboratory bench tests. Post-market surveillance (PMS) in a clinical setting allows for BGM accuracy assessments to evaluate the impact of real-world exposure to polypharmacy in people with diabetes. This study evaluated the OneTouch Select Plus® BGM test-strip accuracy with respect to polypharmacy using a clinical registry dataset. METHODS Medication profiles were analysed for 1023 subjects (425 with type 1 (T1D) and 598 with type 2 diabetes (T2D)) attending 3 UK hospitals. Blood samples were analysed to determine clinical accuracy of the BGM test-strip against a laboratory comparator. RESULTS 538 different medications (48 diabetes and 490 non-diabetes) were recorded across the 1023 subjects. Patients took on average 6.9 (n = 1-36) individual medications and 4.1 (n = 1-13) unique medication classes. Clinical accuracy to EN ISO 15197:2015 criteria were met irrespective of increasing average number of individual medications, categorized from 1-3, 4-6, 7-9, 10-12 and >12 taken per subject (97.7%, 97.7%, 97.8%, 97.8%, and 98.4%, respectively). Clinical accuracy criteria were met across 15 classes of medication using the combined dataset (97.9%; 29784/30433). Surveillance Error Grid (SEG) analysis showed 98.7% (29959/30368) of readings presented no clinical risk. No individual class or combination of medication classes impacted clinical accuracy of the BGM test-strip. CONCLUSIONS Clinical performance for the test strip under assessment demonstrated no evidence of interference from over 500 prescription medications, with clinical accuracy maintained across a range of polypharmacy conditions in people with diabetes.
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Affiliation(s)
- Stuart Phillips
- LifeScan Scotland Ltd, Inverness,
UK
- Stuart Phillips M.Sc., LifeScan Scotland
Ltd, Beechwood Park North, Inverness, IV2 3ED, UK.
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6
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Xu NY, Nguyen KT, DuBord AY, Pickup J, Sherr JL, Teymourian H, Cengiz E, Ginsberg BH, Cobelli C, Ahn D, Bellazzi R, Bequette BW, Gandrud Pickett L, Parks L, Spanakis EK, Masharani U, Akturk HK, Melish JS, Kim S, Kang GE, Klonoff DC. Diabetes Technology Meeting 2021. J Diabetes Sci Technol 2022; 16:1016-1056. [PMID: 35499170 PMCID: PMC9264449 DOI: 10.1177/19322968221090279] [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] [Indexed: 11/16/2022]
Abstract
Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 4 to November 6, 2021. This meeting brought together speakers to discuss various developments within the field of diabetes technology. Meeting topics included blood glucose monitoring, continuous glucose monitoring, novel sensors, direct-to-consumer telehealth, metrics for glycemia, software for diabetes, regulation of diabetes technology, diabetes data science, artificial pancreas, novel insulins, insulin delivery, skin trauma, metabesity, precision diabetes, diversity in diabetes technology, use of diabetes technology in pregnancy, and green diabetes. A live demonstration on a mobile app to monitor diabetic foot wounds was presented.
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Affiliation(s)
- Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | | | | | | | - Eda Cengiz
- University of California, San
Francisco, San Francisco, CA, USA
| | | | | | - David Ahn
- Mary & Dick Allen Diabetes Center
at Hoag, Newport Beach, CA, USA
| | | | | | | | - Linda Parks
- University of California, San
Francisco, San Francisco, CA, USA
| | - Elias K. Spanakis
- Baltimore VA Medical Center,
Baltimore, MD, USA
- University of Maryland, Baltimore,
MD, USA
| | - Umesh Masharani
- University of California, San
Francisco, San Francisco, CA, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Sarah Kim
- University of California, San
Francisco, San Francisco, CA, USA
| | - Gu Eon Kang
- The University of Texas at Dallas,
Richardson, TX, USA
| | - David C. Klonoff
- Diabetes Research Institute,
Mills-Peninsula Medical Center, San Mateo, CA, USA
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7
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Imre E, Imre E. Polypharmacy is Associated with Diabetic Foot Ulcers in Type 2 Diabetes mellitus. INT J LOW EXTR WOUND 2022:15347346221090756. [PMID: 35321576 DOI: 10.1177/15347346221090756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives: This observational study aimed to investigate the relationship between polypharmacy and the existence of diabetic foot ulcers in patients with type 2 diabetes. Methods: Patients with T2DM with and without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were involved in the study. Overall, five hundred and twelve patients with T2DM (293 patients with diabetic foot ulcer and 219 patients without diabetic foot ulcer) were included. The exclusion criteria were pregnancy, lactation, type 1 diabetes, patients under 18 years and over 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. Results: The comparison of the two groups revealed that patients with diabetic foot ulcers had significantly higher rates of diabetic retinopathy (p = 0.017). The patients with diabetic foot ulcers who had polypharmacy had significantly higher rates of hypertension, ischaemic heart disease, diabetic retinopathy, and complaints of diabetic neuropathy (P < 0.001, P < 0,001, p = 0.021 and P = 0.004, respectively). In the binary logistic regression analyses, polypharmacy was independently associated with diabetic foot ulcers in all models. Conclusion: Polypharmacy should be seriously concerned in type 2 diabetes mellitus in patients with diabetic foot ulcers and polypharmacy was related to diabetic foot ulcers.
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Affiliation(s)
- Eren Imre
- 506083D.Ersin Arslan Education and Research Hospital, Department of Endocrinology and Metabolism, Gaziantep, Turkey
| | - Erdi Imre
- Abdulkadir Yuksel State Hospital, Department of Orthopaedics and Traumatology, Gaziantep, Turkey
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8
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Pasangha E, George B, Bhuvana KB, Padmini D. Predictors of Pharmacotherapy and Quality of Life Among Patients With Diabetic Foot Syndrome: A Cross-Sectional Study from a Tertiary Care Hospital in India. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221080291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess the patterns and predictors of pharmacotherapy and QOL in DFS patients in an Indian tertiary care hospital. Methods: A cross-sectional study was conducted among inpatients with DFS. Data on sociodemographic and clinical factors, pharmacotherapy, clinical outcomes, and QOL were analyzed using the chi-squared test, independent sample t-test, and binary logistic regression. Results: We screened 3284 inpatients and included consecutive 87 (2.7%) DFS patients. The mean age was 56.08 ± 11.05 years, with a male preponderance (75.8%). Mean HbA1c was 9.9 ± 2.483. About 75% of patients received insulin, and polypharmacy was noticed in 82.7%. About 67.8% of DFS patients had other vascular complications of diabetes, with diabetic retinopathy being the most common in 89%. Amputations were noticed in 32.1% of patients. Overall, poor QOL was seen in 79.3% of patients. The mean scores for different domains were as follows: physical, 41.51 ± 14.15; psychological, 42.90 ± 11.16; social relationships, 43.06 ± 19.36; and environment, 47.17 ± 13. The presence of complications from diabetes was a significant predictor of the utilization of antihypertensives (OR: 2.92, CI [1.09, 7.79], P = 0.03) and poor QOL (OR: 4.54, CI [0.965, 21.41], P = 0.05). Conclusion: DFS patients in this study were found to be younger with poor glycemic control and other vascular complications of diabetes. The presence of other complications of diabetes in DFS patients was found to be a predictor of pharmacotherapy and poor QOL.
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Affiliation(s)
- E. Pasangha
- St. John’s Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - B. George
- Department of Endocrinology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - K. B. Bhuvana
- Department of Pharmacology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - D. Padmini
- Department of Pharmacology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
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9
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Lum ZK, Chang KL, Tsou KYK, Tan JY, Wong CSM, Kok ZY, Kwek SC, Gallagher PJ, Lee JYC. Enhancing diabetes care with community pharmacist-involved collaborative care model: A multi-centre randomised controlled trial. Diabetes Res Clin Pract 2022; 185:109238. [PMID: 35131378 DOI: 10.1016/j.diabres.2022.109238] [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] [Received: 09/01/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the clinical and humanistic outcomes of a community pharmacist-involved collaborative care model in diabetes management. METHODS This was a parallel arm, open-label, multi-centre randomized controlled trial conducted over 6 months. Subjects with type 2 diabetes, HbA1c ≥ 7.0% (53 mmol/mol) and taking ≥ 5 medications were included. Participants were randomized into intervention (collaborative care) and control groups (physician-centric care). The intervention included medication therapy management and telephonic follow-up with visits to family physicians, nurses, and dietitians. Clinical outcomes included changes in HbA1c, systolic blood pressure (SBP), lipids, and hypoglycaemic incidences. Humanistic outcomes included self-care capabilities and quality of life. Linear mixed models were constructed. Intention-to-treat analyses, with sensitivity analyses, were conducted. RESULTS A total of 264 participants were randomized (intervention: 131, control: 133). Significantly greater reduction in HbA1c was observed in the intervention group (intervention: -0.32% (-3.52 mmol/mol) vs. control: -0.06% (-0.66 mmol/mol), p = 0.038). Changes in SBP, lipids, and incidences of hypoglycaemia were not significant over 6 months between both groups. Significantly greater improvements in self-management (p < 0.001) and quality of life (p = 0.003) were observed within the intervention group. CONCLUSION Partnering community pharmacists in a collaborative care team improved glycaemic control, quality of life and self-care capabilities of patients with diabetes and polypharmacy.
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy, National University of Singapore, Singapore
| | - Kai Li Chang
- Department of Pharmacy, National University of Singapore, Singapore
| | | | | | | | - Zi Yin Kok
- Keat Hong Family Medicine Clinic, Singapore
| | | | | | - Joyce Yu-Chia Lee
- School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, USA.
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10
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İnci H. Evaluation of multiple drug use in patients with type 2 diabetes mellitus. Diabetol Int 2021; 12:399-404. [PMID: 34567922 DOI: 10.1007/s13340-021-00495-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
Objective Multiple drug use (Polypharmacy) is common in Diabetes Mellitus (DM) patients. The purpose of this study was to evaluate the presence of polypharmacy and comorbid conditions in patients with DM. Method The sociodemographic data, comorbidity diseases, and prescription records of 607 patients diagnosed with type 2 DM were retrospectively analyzed. Polypharmacy was defined as the use of five or more different drugs. Results The mean number of drugs used by the DM patients was 6.7 ± 2.5. It was observed that 77.9% of the DM patients had polypharmacy. The mean number of drugs used by the patients in the polypharmacy group was 7.7 ± 1.7. The most common comorbidities in DM patients were diseases of the musculoskeletal system. The use of drugs for musculoskeletal diseases and the number of drugs were statistically higher in female patients than in male patients. In the DM patients, polypharmacy was higher in the females, those older age, those having a longer history of DM disease, and those having a comorbid disease. Conclusion The total number of drugs used by the DM patients showed the presence of polypharmacy. Advanced age, long disease duration, female gender, and presence of comorbidities were predictive factors for polypharmacy in diabetic patients. Before starting additional medication for DM patients, it is necessary to pay attention to the interaction of the drugs to be used and to plan prescriptions considering the medications used by the patient continuously.
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Affiliation(s)
- Habibe İnci
- Department of Family Medicine, Faculty of Medicine, Karabuk University, Karabuk, Turkey
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11
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Coutinho DF, de Figueiredo RC, Duncan BB, Schmidt MI, Barreto SM, Diniz MDFHS. Association between control of diabetes mellitus and polypharmacy at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Pharmacoepidemiol Drug Saf 2021; 30:749-757. [PMID: 33772928 DOI: 10.1002/pds.5236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To determine whether desirable diabetes control is associated with polypharmacy and to evaluate potential drug interactions (DI) in participants with diabetes mellitus in the Brazilian Longitudinal Study on Adult Health (ELSA-Brasil). METHODS This cross-sectional study included 1418 participants with medical diagnosis of diabetes at study baseline (2008-2010). Polypharmacy was defined as the use of ≥5 drugs. We described the frequency of the most common pharmacological groups used by patients and the potential DI.The association between desirable diabetes control (normal A1c, blood pressure and lipid levels) and polypharmacy was investigated using logistic regression. RESULTS Most participants were men (52.5%), mean age 57.6 (SD 8.4) years, educated to the university level (39.4%), and self-reported as white (42.9%). In this study, 7.1% (n = 101) of participants had desirable control of diabetes, while 40.4% (n = 573) used polypharmacy, and this use was not significantly associated with better diabetes control (adjusted odds ratio (OR = 1.35 [95%CI 0.86-2.13] P = .19).The pharmacological groups most frequently used were oral antidiabetics followed by acetylsalicylic acid, angiotensin-converting enzyme inhibitors (ACE inhibitors) and statins.The prevalence of potentially mild, moderate and severe DI were, respectively, 2.5%, 14.7% and 0.9%; however, in the desirable control of DM group, these potential DI were related to comorbidity control. CONCLUSION Faced with the importance of achieving optimal control of diabetes and minimizing risks of potential DI, these results, which are in keeping with previous findings described in the literature, might indicate that guidelines for the patient-centered management of control of diabetes must be revised.
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Affiliation(s)
- Danila Félix Coutinho
- Graduate Program in Sciences Applied to Adult Health Care, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Bruce B Duncan
- Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandhi Maria Barreto
- Public Health Department, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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12
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van Oort S, Rutters F, Warlé‐van Herwaarden MF, Schram MT, Stehouwer CD, Tack CJ, Abbink EJ, Wolffenbuttel BH, van der Klauw MM, DeVries JH, Siegelaar SE, Sijbrands EJ, Özcan B, de Valk HW, Silvius B, Schroijen MA, Jazet IM, van Ballegooijen AJ, Beulens JWJ, Elders PJ, Kramers C. Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort. Diabet Med 2021; 38:e14406. [PMID: 32961611 PMCID: PMC8048843 DOI: 10.1111/dme.14406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 09/11/2020] [Indexed: 12/30/2022]
Abstract
AIM To describe the prevalence and characteristics of polypharmacy in a Dutch cohort of individuals with type 2 diabetes. METHODS We included people with type 2 diabetes from the Diabetes Pearl cohort, of whom 3886 were treated in primary care and 2873 in academic care (secondary/tertiary). With multivariable multinomial logistic regression analyses stratified for line of care, we assessed which sociodemographic, lifestyle and cardiometabolic characteristics were associated with moderate (5-9 medications) and severe polypharmacy (≥10 medications) compared with no polypharmacy (0-4 medications). RESULTS Mean age was 63 ± 10 years, and 40% were women. The median number of daily medications was 5 (IQR 3-7) in primary care and 7 (IQR 5-10) in academic care. The prevalence of moderate and severe polypharmacy was 44% and 10% in primary care, and 53% and 29% in academic care respectively. Glucose-lowering and lipid-modifying medications were most prevalent. People with severe polypharmacy used a relatively large amount of other (i.e. non-cardiovascular and non-glucose-lowering) medication. Moderate and severe polypharmacy across all lines of care were associated with higher age, low educational level, more smoking, longer diabetes duration, higher BMI and more cardiovascular disease. CONCLUSIONS Severe and moderate polypharmacy are prevalent in over half of people with type 2 diabetes in primary care, and even more in academic care. People with polypharmacy are characterized by poorer cardiometabolic status. These results highlight the significance of polypharmacy in type 2 diabetes.
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Affiliation(s)
- S. van Oort
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
| | - F. Rutters
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | | | - M. T. Schram
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. D. Stehouwer
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. J. Tack
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - E. J. Abbink
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - B. H. Wolffenbuttel
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - M. M. van der Klauw
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - J. H. DeVries
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - S. E. Siegelaar
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - E. J. Sijbrands
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - B. Özcan
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - H. W. de Valk
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - B. Silvius
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - M. A. Schroijen
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - I. M. Jazet
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - A. J. van Ballegooijen
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of NephrologyAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research InstituteAmsterdamthe Netherlands
| | - J. W. J. Beulens
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - P. J. Elders
- Department of General Practice and Elderly Care MedicineAmsterdam University Medical Center, location VUmc, Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - C. Kramers
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
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13
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Grady M, Cameron H, Phillips S, Smith G, Setford S. Analysis of a Unique Postmarket Surveillance Dataset That a Glucose Test-Strip Demonstrates no Evidence of Interference and Robust Clinical Accuracy Irrespective of the Prescription Medication Status of a Large Cohort of Patients With Diabetes. J Diabetes Sci Technol 2021; 15:82-90. [PMID: 31478385 PMCID: PMC7783023 DOI: 10.1177/1932296819873053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite a marked increase in polypharmacy in patients with diabetes there have been no thorough evaluations of the impact of polypharmacy on the accuracy of any current blood glucose monitoring (BGM) system. This study evaluated the accuracy of a BGM test-strip with respect to polypharmacy using a large clinical registry dataset. METHODS Medication profiles were analyzed for 830 subjects (334 with type 1 [T1D] and 496 with type 2 diabetes [T2D]) attending three hospitals. Blood samples were analyzed to determine clinical accuracy of the BGM test-strip compared to a laboratory comparator. RESULTS Across the 830 subjects, 473 different medications (41 diabetes and 432 nondiabetes) were recorded. Patients took on average 6.5 (n = 1-23) individual medications and 4 (n = 1-11) unique classes of medication. Clinical accuracy to EN ISO 15197:2015 criteria was met irrespective of increasing average number of individual medication, categorized from 1 to 4, 5 to 8, 9 to 12, and >12 taken per subject (97.7%, 98.4%, 98.1%, and 98.5%, respectively). Clinical accuracy to EN ISO 15197:2015 criteria was also met across 15 classes of medication using the combined dataset (98.1%; 13 003/13 253). Surveillance error grid analysis showed 98.8% (13 079/13 232) of readings presented no clinical risk. No individual class or combination of medication classes impacted clinical accuracy of the BGM test-strip. CONCLUSIONS This comprehensive analysis for this specific test-strip platform demonstrated no evidence of interference and robust clinical accuracy of this test strip, irrespective of the prescription medication status of patients with diabetes.
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Affiliation(s)
- Mike Grady
- LifeScan Scotland Ltd, Inverness, UK
- Mike Grady, PhD, LifeScan Scotland Ltd, Beechwood Park North, Inverness IV2 3ED, UK.
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14
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Oktora MP, Alfian SD, Bos HJ, Schuiling-Veninga CCM, Taxis K, Hak E, Denig P. Trends in polypharmacy and potentially inappropriate medication (PIM) in older and middle-aged people treated for diabetes. Br J Clin Pharmacol 2020; 87:2807-2817. [PMID: 33269485 PMCID: PMC8359203 DOI: 10.1111/bcp.14685] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 01/04/2023] Open
Abstract
Aims Polypharmacy is common in people with diabetes and is associated with the use of potentially inappropriate medication (PIM). This study aimed to assess trends in the prevalence of polypharmacy and PIM in older and middle‐aged people with diabetes. Methods A repeated cross‐sectional study using the University Groningen IADB.nl prescription database was conducted. All people aged 45 years and over who were treated for diabetes registered in the period 2012–2016 were included. Polypharmacy was assessed for three age groups. PIMs were assessed using Beers criteria for people ≥65 years old, and PRescribing Optimally in Middle‐aged People's Treatments (PROMPT) criteria for 45–64 years old. Chi‐square tests and regression analysis were applied. Results The prevalence of polypharmacy increased significantly in all age groups in the study period. In 2016, the prevalence of polypharmacy was 36.9% in patients aged 45–54 years, 50.3% in those aged 55–64 years, and 66.2% in those aged ≥65 years. The prevalence of older people with at least one PIM decreased by 3.1%, while in the middle‐aged group this prevalence increased by 0.9% from 2012 to 2016. The most common PIMs in both age groups were the use of long‐term high‐dose proton pump inhibitors, benzodiazepines and strong opioids without laxatives. Of those, only benzodiazepines showed a decreasing trend. Conclusions Polypharmacy increased in older and middle‐aged people with diabetes. While the prevalence of PIM decreased over time in older age, this trend was not observed in middle‐aged people with diabetes. Efforts are needed to decrease the use of PIMs in populations already burdened with many drugs, notably at middle age.
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Affiliation(s)
- Monika Pury Oktora
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Sofa Dewi Alfian
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands.,Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - H Jens Bos
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | | | - Katja Taxis
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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15
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Abstract
PURPOSE OF REVIEW Due to treatment advancements, individuals with type 1 diabetes (T1D) are living longer, presenting a unique understudied population with advanced complex needs. This article is a review of the aging literature in T1D and identifies existing gaps while serving as a call to the research community. RECENT FINDINGS Recent studies have identified an association between cognitive impairment and glycemic variability, as well as increased risk and frequency of hypoglycemia in older adults with T1D. However, limited research exists about additional physical and mental health conditions and barrier to successful treatment in this population. Older adults may experience both age- and diabetes-related barriers to diabetes management. Due to the scarcity of aging T1D research, current treatment guidelines for this age group are based on type 2 diabetes research. There is a critical need to further investigate the physical and mental effects of T1D and aging as well as public health policy; insurance challenges; and needs for support and interventions for older adults with T1D.
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Affiliation(s)
| | | | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, 32610-0165, USA
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16
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Forbes A. Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research. Front Endocrinol (Lausanne) 2020; 11:133. [PMID: 32256448 PMCID: PMC7089919 DOI: 10.3389/fendo.2020.00133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 02/27/2020] [Indexed: 01/09/2023] Open
Abstract
This review considers the burden of mortality observed in the older population of people with diabetes and identifies the risk factors associated with mortality hazard in this population. The mortality gap between older people with and without diabetes is enduring, with excess mortality being 10% greater than in the general population. While early mortality in men with diabetes is significantly greater than females with diabetes, the relative mortality risk in females is much higher compared to women without diabetes. Older people who have developed diabetes in middle age have significantly higher mortality hazard compared to those who develop it in old age, emphasizing the continued importance of optimizing diabetes care in all ages. To minimize mortality hazard in older age it is important to address some of the factors that convey risk, these include: comorbidity; polypharmacy; physical and mental frailty; safe glycemic targets for older people; hypoglycemia; glycemic targets; and the hypoglycemic agents. While the data to determine optimal management approaches are limited, the overall need is for a more diligent approach in assessing the needs of older people with diabetes to inform individualized care strategies and therapy goals that minimize potential hazards.
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17
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Horii T, Iwasawa M, Kabeya Y, Atuda K. Polypharmacy and oral antidiabetic treatment for type 2 diabetes characterised by drug class and patient characteristics: A Japanese database analysis. Sci Rep 2019; 9:12992. [PMID: 31506542 PMCID: PMC6736933 DOI: 10.1038/s41598-019-49424-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/23/2019] [Indexed: 11/09/2022] Open
Abstract
Polypharmacy (PP) occurs in patients with type 2 diabetes (T2DM) owing to multimorbidity. We evaluated concomitant PP and medication adherence in T2DM 3 years after initiation of administration of a hypoglycaemic agent using a nationwide claim-based database in Japan. Factors associated with medication PP and imperfect adherence were identified using multivariable logistic regression. PP was defined as using ≥6 medications. Patients with proportion of days covered (PDC) of <80% were defined as having poor medication adherence. A total of 884 patients were analysed. Multivariate analysis revealed that age, total number of consultations and body mass index (BMI) are factors that influence PP. Factors associated with PDC < 80% were 2–3, 4–5 and ≥ 6 medications compared with 1 medication, male sex, <17 consultations and age 50–59 and ≥ 60 years compared with <40 years. In conclusion, older age, high total number of consultations and BMI ≥ 25 kg/m2 are risk factors for PP. PP influenced good medication adherence at the end of the observation period.
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Affiliation(s)
- Takeshi Horii
- Division of Clinical Pharmacy (Laboratory of Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan.
| | - Makiko Iwasawa
- Division of Clinical Pharmacy (Laboratory of Drug Information) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan
| | - Yusuke Kabeya
- Sowa Hospital, Department of Home Care Medicine, Sagamihara, Kanagawa, Japan
| | - Koichiro Atuda
- Division of Clinical Pharmacy (Laboratory of Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan
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18
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Li J, Chattopadhyay K, Xu M, Chen Y, Hu F, Wang X, Li L. Prevalence and predictors of polypharmacy prescription among type 2 diabetes patients at a tertiary care department in Ningbo, China: A retrospective database study. PLoS One 2019; 14:e0220047. [PMID: 31314797 PMCID: PMC6636754 DOI: 10.1371/journal.pone.0220047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/08/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives To determine the prevalence of polypharmacy prescription among type 2 diabetes (T2DM) patients at a tertiary care department in Ningbo, China, and to determine factors that independently predict this polypharmacy prescription. Methods A retrospective cross-sectional study was conducted using an existing computerised medical records database. This database was screened from 2012 to 2017 for adult patients with T2DM and parameters like prescribed medicines and socio-demographic, behavioural and other medical information. Polypharmacy prescription was defined as the simultaneous prescription of ≥5 medicines by the clinician at the time of discharge for daily usage by the patient as part of his/her long-term treatment plan. Results The study inclusion criteria were satisfied by 3370 T2DM patients. Over a 5-year period, 72.2% (n = 2432) of T2DM patients were prescribed polypharmacy. On an average, eight medicines were prescribed to them. The odds of polypharmacy prescription increased with patients’ age (18–39 years: 1; 40–59 years: OR 1.86, 95% CI 1.28–2.71; and ≥60 years: 2.42, 1.65–3.55), duration of T2DM (≤1 year: 1; >5–10 years: 1.70, 1.10–2.62; and >10 years: 2.55, 1.68–3.89), and length of hospital stay (≤5 days: 1; >5–10 days: 2.43, 1.86–3.17; and >10 days: 2.99, 2.24–3.99), and were higher in those with poor blood glucose level (2.09, 1.67–2.62) and with comorbidities like other endocrine, nutritional and metabolic diseases (2.24, 1.76–2.85), circulatory system diseases (4.35, 3.62–5.23), skin and subcutaneous tissue diseases (1.64, 1.04–2.59), and musculoskeletal system and connective tissue diseases (1.61, 1.27–2.03). The odds of polypharmacy prescription were lower in those with comorbidities like neoplasms (0.51, 0.36–0.70) and during pregnancy, childbirth and the puerperium (0.06, 0.01–0.49). Conclusions Around three fourth of T2DM patients at the tertiary care department were prescribed polypharmacy, and the predictors were identified. The study findings could be taken into consideration in future interventional studies aimed at supporting medicines optimisation (and deprescribing) among these patients.
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Affiliation(s)
- Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Yanshu Chen
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Fangfang Hu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Xingzhen Wang
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, PR China
- * E-mail:
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19
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Ikäheimo I, Karjalainen M, Tiihonen M, Haanpää M, Kautiainen H, Saltevo J, Mäntyselkä P. Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes. J Clin Pharm Ther 2019; 44:735-741. [DOI: 10.1111/jcpt.12854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Ilona Ikäheimo
- School of Pharmacy University of Eastern Finland Kuopio Finland
| | - Merja Karjalainen
- Institute of Public Health and Clinical Nutrition, General Practice University of Eastern Finland Kuopio Finland
- Inner Savo Health Center Suonenjoki Finland
| | - Miia Tiihonen
- School of Pharmacy University of Eastern Finland Kuopio Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company Vantaa Finland
- Department of Neurosurgery Helsinki University Hospital Helsinki Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital Helsinki Finland
- Primary Health Care Unit Kuopio University Hospital Kuopio Finland
| | - Juha Saltevo
- Central Finland Central Hospital Jyväskylä Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice University of Eastern Finland Kuopio Finland
- Primary Health Care Unit Kuopio University Hospital Kuopio Finland
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20
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Oktora MP, Denig P, Bos JHJ, Schuiling-Veninga CCM, Hak E. Trends in polypharmacy and dispensed drugs among adults in the Netherlands as compared to the United States. PLoS One 2019; 14:e0214240. [PMID: 30901377 PMCID: PMC6430511 DOI: 10.1371/journal.pone.0214240] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Polypharmacy is becoming increasingly common owing to the ageing population, which can pose problems for patients and society. We investigated the trends in polypharmacy and underlying drug groups among adults in the Netherlands from 1999 to 2014 stratified by age, and compared these with findings from the United States (US). METHODS We conducted a repeated cross-sectional study using the Dutch IADB.nl prescription database. All patients aged 20 years and older in the period 1999 to 2014 were included. Polypharmacy was defined as the dispensing of five or more chronic drugs at the pharmacological subgroup level. Chi-square tests were applied to calculate the p-value for trends. Changes in prevalences were compared between the Netherlands and the US. RESULTS The prevalence of polypharmacy increased from 3.1% to 8.0% (p-value for trend <0.001) over 15 years, and increased in all age groups. The highest rates were observed in patients aged ≥65 years, but the relative increase over time was higher in the younger age groups. Overall, large increases were observed for angiotensin-II inhibitors, statins and proton-pump inhibitors. The relative increase in polypharmacy was larger in the Netherlands than in the US (ratio of polypharmacy prevalence 2.4 versus 1.8). The Netherlands showed larger relative increases for angiotensin-II inhibitors, statins, proton-pump inhibitors, biguanides and smaller relative increases for antidepressants, benzodiazepines and insulins. CONCLUSIONS Polypharmacy more than doubled from 1999 to 2014, and this increase was not limited to the elderly. The relative increase was larger in the Netherlands compared to the US, which was partly due to larger increases in several guideline-recommended preventive drugs.
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Affiliation(s)
- Monika P. Oktora
- University of Groningen, University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- * E-mail:
| | - Petra Denig
- University of Groningen, University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Jens H. J. Bos
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Catharina C. M. Schuiling-Veninga
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
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21
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Silva MRRD, Diniz LM, Santos JBRD, Reis EA, Mata ARD, Araújo VED, Álvares J, Acurcio FDA. Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil. CIENCIA & SAUDE COLETIVA 2018; 23:2565-2574. [PMID: 30137126 DOI: 10.1590/1413-81232018238.10222016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/25/2016] [Indexed: 12/23/2022] Open
Abstract
The objective of this study was to evaluate the use of drugs and the factors associated with polypharmacy in patients with diabetes mellitus (DM) in Minas Gerais. Descriptive analysis of drugs in use and logistic regression to estimate the association between socio-demographic and clinical characteristics with polypharmacy were performed. Of the 2619 respondents, 56.5% were in polypharmacy. Drugs for DM, agent in renin-angiotensin system, and diuretics are the most frequently used. Factors such as age, comorbidities and increased access to health services were associated with polypharmacy. It was observed high prevalence of polypharmacy, which requires a suitable care and better quality of drug use in this population.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | | | - Jéssica Barreto Ribeiro Dos Santos
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | | | - Adriana Rodrigues da Mata
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | - Vânia Eloisa de Araújo
- Departamento de Odontologia, Pontifícia Universidade Católica de Minas Gerais. Belo Horizonte MG Brasil
| | - Juliana Álvares
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
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22
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Inkeri NM, Karjalainen M, Haanpää M, Kautiainen H, Saltevo J, Mäntyselkä P, Tiihonen M. Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes. J Clin Pharm Ther 2018; 44:229-235. [DOI: 10.1111/jcpt.12772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | - Merja Karjalainen
- Institute of Public Health and Clinical Nutrition, General Practice; University of Eastern Finland; Kuopio Finland
- Inner Savo Health Center; Suonenjoki Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company; Vantaa Finland
- Department of Neurosurgery; Helsinki University Hospital; Helsinki Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care; Helsinki University Central Hospital; Helsinki Finland
- Primary Health Care Unit; Kuopio University Hospital; Kuopio Finland
| | - Juha Saltevo
- Central Finland Central Hospital; Jyväskylä Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice; University of Eastern Finland; Kuopio Finland
- Primary Health Care Unit; Kuopio University Hospital; Kuopio Finland
| | - Miia Tiihonen
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
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23
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Janssen VE, Visseren FL, de Boer A, Grobbee DE, Westerink J, van der Graaf Y, Lafeber M. Combined use of polypill components in patients with type 2 diabetes mellitus. Eur J Prev Cardiol 2018; 25:1523-1531. [DOI: 10.1177/2047487318789494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives A polypill containing aspirin, a statin and blood pressure (BP)-lowering agents has been proposed for the prevention of cardiovascular disease. To increase adherence and reduce the gaps between indicated and used therapy, a polypill might be of interest for patients with type 2 diabetes (T2DM). Our aim was to assess the prevalence of the combined use of polypill components in patients with T2DM over time. Methods The combined use of polypill components was assessed between 1996 and 2015 in patients with T2DM in the prospective SMART cohort ( n = 1828). The results were dichotomized into patients without ( n = 568) and with ( n = 1260) vascular disease. The patient characteristics associated with the use of polypill components were evaluated. Results In total, 19% of patients with T2DM without vascular disease received a statin and ≥2 BP-lowering agents (‘cardiovascular polypill’) and 13% received additional oral glucose-lowering therapy (‘diabetic polypill’). Of the patients with T2DM with vascular disease, 42% received the combination of an antiplatelet agent, a statin and ≥2 BP-lowering agents (‘cardiovascular polypill’) and 30% received additional glucose-lowering therapy (‘diabetic polypill’). The prevalence of the use of the cardiovascular and diabetic polypill combination has substantially increased between 1996 and 2015 to 36 and 32% in patients without vascular disease and to 67 and 57% in patients with vascular disease. Conclusions Patients with T2DM frequently use polypill components, often together with oral glucose-lowering agents, and this rate of use has increased steadily between 1996 and 2015. Introducing a cardiovascular or diabetic polypill for patients with T2DM seems to be highly relevant.
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Affiliation(s)
- Vivi E Janssen
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Frank L Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Melvin Lafeber
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
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Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, Drweesh H, Sambamoorthi U. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open 2018; 8:e020852. [PMID: 29794097 PMCID: PMC5988096 DOI: 10.1136/bmjopen-2017-020852] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED ObjectivesPatients with diabetes are at high risk for polypharmacy (ie, use of multiple medications) for treatment of diabetes, associated comorbidities and other coexisting conditions. This study aims to estimate the prevalence of polypharmacy and factors associated with polypharmacy among adult patients with diabetes. METHODS A cross-sectional retrospective observational study of adults with diabetes, who visited the outpatient clinic of a tertiary teaching hospital in Saudi Arabia, was conducted. Data were extracted from the Electronic Health Record database for a period of 12 months (January-December 2016). Polypharmacy was defined as the cumulative use of five or more medications. Polypharmacy among adults with diabetes was measured by calculating the average number of medications prescribed per patient. A multivariable logistic regression model was used to examine the factors associated with polypharmacy. RESULTS A total of 8932 adults with diabetes were included in this study. Of these, nearly 78% had polypharmacy which was more likely among women as compared with men and more likely among older adults (age ≥60 years) as compared with the adults. Also, polypharmacy was two times as likely among patients with coexisting cardiovascular conditions (adjusted OR (AOR)=2.89; 95% CI 2.54 to 3.29), respiratory disease (AOR=2.42; 95% CI 1.92 to 3.03) and mental health conditions (AOR=2.19; 95% CI 1.74 to 2.76), and three times as likely among patients with coexisting musculoskeletal disease (AOR=3.16; 95% CI 2.31 to 4.30) as compared with those without these coexisting chronic conditions categories. CONCLUSIONS Polypharmacy is common among patients with diabetes, with an even higher rate in older adults patients. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimens and minimising medications to enhance the outcome of diabetes care.
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Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacy Service, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alduhaim
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Rawan Alabdulali
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Drweesh
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
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Dubovi I, Dagan E, Sader Mazbar O, Nassar L, Levy ST. Nursing students learning the pharmacology of diabetes mellitus with complexity-based computerized models: A quasi-experimental study. NURSE EDUCATION TODAY 2018; 61:175-181. [PMID: 29216602 DOI: 10.1016/j.nedt.2017.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/14/2017] [Accepted: 11/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Pharmacology is a crucial component of medications administration in nursing, yet nursing students generally find it difficult and self-rate their pharmacology skills as low. OBJECTIVES To evaluate nursing students learning pharmacology with the Pharmacology Inter-Leaved Learning-Cells environment, a novel approach to modeling biochemical interactions using a multiscale, computer-based model with a complexity perspective based on a small set of entities and simple rules. This environment represents molecules, organelles and cells to enhance the understanding of cellular processes, and combines these cells at a higher scale to obtain whole-body interactions. PARTICIPANTS Sophomore nursing students who learned the pharmacology of diabetes mellitus with the Pharmacology Inter-Leaved Learning-Cells environment (experimental group; n=94) or via a lecture-based curriculum (comparison group; n=54). METHODS A quasi-experimental pre- and post-test design was conducted. The Pharmacology-Diabetes-Mellitus questionnaire and the course's final exam were used to evaluate students' knowledge of the pharmacology of diabetes mellitus. RESULTS Conceptual learning was significantly higher for the experimental than for the comparison group for the course final exam scores (unpaired t=-3.8, p<0.001) and for the Pharmacology-Diabetes-Mellitus questionnaire (U=942, p<0.001). The largest effect size for the Pharmacology-Diabetes-Mellitus questionnaire was for the medication action subscale. Analysis of complex-systems component reasoning revealed a significant difference for micro-macro transitions between the levels (F(1, 82)=6.9, p<0.05). CONCLUSIONS Learning with complexity-based computerized models is highly effective and enhances the understanding of moving between micro and macro levels of the biochemical phenomena, this is then related to better understanding of medication actions. Moreover, the Pharmacology Inter-Leaved Learning-Cells approach provides a more general reasoning scheme for biochemical processes, which enhances pharmacology learning beyond the specific topic learned. The present study implies that deeper understanding of pharmacology will support nursing students' clinical decisions and empower their proficiency in medications administration.
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Affiliation(s)
- Ilana Dubovi
- Faculty of Education, Department of Learning, Instruction and Teacher Education, University of Haifa, Israel; Faculty of Social Welfare and Health Sciences, The Cheryl Spencer Department of Nursing, University of Haifa, Israel.
| | - Efrat Dagan
- Faculty of Social Welfare and Health Sciences, The Cheryl Spencer Department of Nursing, University of Haifa, Israel
| | - Ola Sader Mazbar
- Faculty of Social Welfare and Health Sciences, The Cheryl Spencer Department of Nursing, University of Haifa, Israel
| | - Laila Nassar
- Rambam Health Care Campus, Unit of Clinical Pharmacology and Toxicology, Israel
| | - Sharona T Levy
- Faculty of Education, Department of Learning, Instruction and Teacher Education, University of Haifa, Israel
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Diseases Linked to Polypharmacy in Elderly Patients. Curr Gerontol Geriatr Res 2017; 2017:4276047. [PMID: 29434639 PMCID: PMC5757103 DOI: 10.1155/2017/4276047] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/07/2017] [Indexed: 01/10/2023] Open
Abstract
Introduction Polypharmacy in several cases is deemed necessary and elderly patients are prone to this phenomenon. The objective of this study was to identify the prevalence and the predictors of polypharmacy among consecutively unplanned admissions of patients aged ≥65 years. Patients and Methods In 310 patients (51% women), mean age 80.24 years (95% CI 79.35–81.10), demographic characteristics, medical history, medications, and cause of admission were recorded. Parametric tests and multiple logistic regression analysis were applied to identify the factors that have significant association with polypharmacy. Results 53.5% of patients belonged to polypharmacy group. In multivariate analysis the independent predictors of polypharmacy were arterial hypertension (p = 0.003, OR = 2.708, and 95% CI 1.400–5.238), coronary artery disease (p = 0.001, OR = 8.274, and 95% CI 3.161–21.656), heart failure (p = 0.030, OR = 4.042, and 95% CI 1.145–14.270), atrial fibrillation (p = 0.031, OR = 2.477, and 95% CI 1.086–5.648), diabetes mellitus (p = 0.010, OR = 2.390, and 95% CI 1.232–4.636), dementia (p = 0.001, OR = 4.637, and 95% CI 1.876–11.464), and COPD (p = 0.022, OR = 3.626, and 95% CI 1.208–10.891). Conclusions Polypharmacy mainly was linked to cardiovascular diseases. If deprescribing is not feasible, physicians must oversee those patients in order to recognise early, possible drug reactions.
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Forbes A, Murrells T, Sinclair AJ. Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes - a 10-year cohort study of older people with and without diabetes. Diabet Med 2017; 34:387-395. [PMID: 27087619 DOI: 10.1111/dme.13132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 12/28/2022]
Abstract
AIMS To compare all-cause mortality in older people with or without diabetes and consider the associated risk of comorbidity and polypharmacy. METHODS A 10-year cohort study using data from the Health Innovation Network database (2003-2013) comparing mortality in people aged ≥ 70 years with diabetes (DM cohort) (n = 35 717) and without diabetes (No DM cohort) (n = 307 918). RESULTS The mean age of the DM cohort was 78.1 ± 5.8 years vs. 79.0 ± 6.3 years in the No DM cohort. Mean diabetes duration was 8.2 ± 8.1 years, and 30% had diabetes for > 10 years. The DM cohort had a greater comorbidity load and people in this cohort were prescribed more therapies than the No DM cohort. The 5- and 10-year survival rates were lower in the DM cohort at 64% and 39%, respectively, compared with 72% and 50% in the No DM cohort. The excess mortality in the DM cohort was greatest in those aged < 75 years with longer duration diabetes, the relative hazard for mortality was higher in females. Although comorbidity and polypharmacy were associated with increased mortality risk in the DM cohort, this risk was lower compared with the No DM cohort. The hazard ratios (95% confidence interval) for comorbidities > 4 and medicines ≥ 7 were 1.29 (1.19 to 1.41) and 1.34 (1.25 to 1.43) in the DM cohort and 1.63 (1.57 to 1.70) and 1.48 (1.40 to 1.56) in the No DM cohort, respectively. CONCLUSIONS There is significant excess mortality in older people with diabetes, which is unexplained by comorbidity or polypharmacy. This excess is greatest in the younger old with longer disease duration, suggesting that it may be related to the effect of diabetes exposure.
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Affiliation(s)
- A Forbes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
| | - T Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
| | - A J Sinclair
- Diabetes Frail and the University of Aston, Birmingham, UK
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Breuker C, Abraham O, di Trapanie L, Mura T, Macioce V, Boegner C, Jalabert A, Villiet M, Castet-Nicolas A, Avignon A, Sultan A. Patients with diabetes are at high risk of serious medication errors at hospital: Interest of clinical pharmacist intervention to improve healthcare. Eur J Intern Med 2017; 38:38-45. [PMID: 28007439 DOI: 10.1016/j.ejim.2016.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medication errors (ME) are major public health issues in hospitals because of their consequences on patients' morbi-mortality. This study aims to evaluate the prevalence of ME at admission and discharge of hospitalization in diabetic and non-diabetic patients, and determine their potential clinical impact. METHOD This prospective observational study was conducted at the Endocrinology-Diabetology-Nutrition Department. All adult patients admitted were eligible. A total of 904 patients were included, of which 671 (74.2%) with diabetes mellitus. Clinical pharmacists conducted medication reconciliation: they collected the Best Possible Medication History and then compared it with admission and discharge prescriptions to identify medication discrepancies. ME were defined as unintended medication discrepancies if corrected by the physician. RESULTS Clinical pharmacists allowed correcting ME in 176/904 (19.5%) patients at admission and in 86/865 (9.9%) patients at discharge. More than half of ME were omissions. Diabetic patients were more affected by ME than non-diabetic patients, both at admission (22.1% vs 12.0%, p<0.001) and at discharge (11.4% vs 5.7%, p=0.01). The diabetic group also had more potentially severe and very severe ME. Diabetic patients had on average twice more medications than non-diabetic patients (8.7±4.5 vs 4.4±3.4, p<0.001). The polypharmacy associated with diabetes, but not diabetes mellitus itself, was identified as a risk factor of ME. CONCLUSIONS The intervention of clinical pharmacists allowed correcting 378 ME in 25.8% of the cohort before they caused harm. Clinicians, pharmacists and other health care providers should therefore work together to improve patients' safety, in particular in high-risk patients such as diabetic patients.
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Affiliation(s)
- Cyril Breuker
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France.
| | - Océane Abraham
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Laura di Trapanie
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit, University Hospital, 39 Avenue Charles Flahault, 34295 Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital, 39 Avenue Charles Flahault, 34295 Montpellier, France
| | - Catherine Boegner
- Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Maxime Villiet
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Antoine Avignon
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Ariane Sultan
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France; Endocrinology-Diabetology-Nutrition Department, University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
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Hamada S, Gulliford MC. Drug prescribing during the last year of life in very old people with diabetes. Age Ageing 2017; 46:147-151. [PMID: 28181655 PMCID: PMC5388282 DOI: 10.1093/ageing/afw174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 10/05/2016] [Indexed: 12/24/2022] Open
Abstract
Objective to evaluate primary care drug utilisation during the last year of life, focusing on antidiabetic and cardiovascular drugs, in patients of advanced age with diabetes. Design population-based cohort study. Setting primary care database in the UK. Subjects patients with type 2 diabetes who died at over 80 years of age between 2011 and 13. Methods main outcome measures included proportions of patients prescribed different classes of drugs, comparing the first (Q1) and the fourth quarters (Q4) of the last year of life. Results the study included 5,324 patients, with the median age 86 years and 50% female. Three-fourths of the patients received five or more drugs, and the total number of drugs prescribed was almost stable at 6.2 ± 3.1 (mean ± SD) during the last year of life. Substantial proportions of patients were treated with antidiabetic drugs (78%), antihypertensive drugs (76%), statins (62%) and low-dose aspirin (46%) in Q1. Prescribing of these drugs slightly decreased by 3–8% in Q4. There were increases in prescribing of anti-infectives (35% in Q1 to 50% in Q4), drugs for nervous system (63% to 73%), drugs for respiratory system (24% to 33%) and systemic hormonal drugs (22% to 27%). Conclusion patients of advanced age with type 2 diabetes were often treated with antidiabetic and cardiovascular drugs even when approaching death. More research is needed to generate evidence to guide optimal drug utilisation for older people with a limited life expectancy.
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Affiliation(s)
- Shota Hamada
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
- Address correspondence to: S. Hamada, Department of Primary Care and Public Health Sciences, King's College London, 3rd floor, Addison House, London SE1 1UL, UK. Tel: +44 (0)20 7848 6426; Fax: +44 (0)20 7848 6620.
| | - Martin C. Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas’ NHS Foundation Trust, London, UK
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Martono DP, Hak E, Lambers Heerspink H, Wilffert B, Denig P. Predictors of HbA1c levels in patients initiating metformin. Curr Med Res Opin 2016; 32:2021-2028. [PMID: 27552675 DOI: 10.1080/03007995.2016.1227774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim was to assess demographic and clinical factors as predictors of short (6 months) and long term (18 months) HbA1c levels in diabetes patients initiating metformin treatment. RESEARCH DESIGN AND METHODS We conducted a cohort study including type 2 diabetes patients who received their first metformin prescription between 2007 and 2013 in the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was HbA1c level at follow-up adjusted for baseline HbA1c; the secondary outcome was failing to achieve the target HbA1c level of 53 mmol/mol. Associations were analyzed by linear and logistic regression. Multiple imputation was used for missing data. Additional analyses stratified by dose and adherence level were conducted. RESULTS The cohort included 6050 patients initiating metformin. Baseline HbA1c at target consistently predicted better HbA1c outcomes. Longer diabetes duration and lower total cholesterol level at baseline were predictors for higher HbA1c levels at 6 months. At 18 months, cholesterol level was not a predictor. Longer diabetes duration was also associated with not achieving the target HbA1c at follow-up. The association for longer diabetes duration was especially seen in patients starting on low dose treatment. No consistent associations were found for comorbidity and comedication. CONCLUSIONS Diabetes duration was a relevant predictor of HbA1c levels after 6 and 18 months of follow-up in patients initiating metformin treatment. Given the study design, no causal inference can be made. Our study suggests that prompt treatment intensification may be needed in patients who have a longer diabetes duration at treatment initiation.
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Affiliation(s)
- Doti P Martono
- a Unit of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
- b School of Pharmacy , Institut Teknologi Bandung , Bandung , Indonesia
| | - Eelko Hak
- c Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Hiddo Lambers Heerspink
- d Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Bob Wilffert
- a Unit of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
- d Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Petra Denig
- d Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Formiga F, Agustí A, José AS. Polypharmacy in elderly people with diabetes admitted to hospital. Acta Diabetol 2016; 53:857-8. [PMID: 26607825 DOI: 10.1007/s00592-015-0818-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Antonia Agustí
- Clinical Pharmacology Service, Department of Pharmacology, Therapeutics and Toxicology, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio San José
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Formiga F, Martinez-Velilla N, Baztán JJ. [Clinical practice guidelines in geriatrics: Are they really useful?]. Rev Esp Geriatr Gerontol 2016; 51:252-3. [PMID: 27298197 DOI: 10.1016/j.regg.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat (Barcelona), España.
| | | | - Juan J Baztán
- Servicio de Geriatría, Hospital Central Cruz Roja San José y Santa Adela, Madrid, España
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Formiga F, Vidal X, Agustí A, Chivite D, Rosón B, Barbé J, López-Soto A, Torres OH, Fernández-Moyano A, García J, Ramírez-Duque N, San José A. Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabet Med 2016; 33:655-62. [PMID: 26333026 DOI: 10.1111/dme.12894] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
AIMS To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.
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Affiliation(s)
- F Formiga
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - X Vidal
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Agustí
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Chivite
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - B Rosón
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J Barbé
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
| | - A López-Soto
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic, Barcelona, Spain
| | - O H Torres
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Fernández-Moyano
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Seville, Spain
| | - J García
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicina Service, Hospital General Juan Ramón Jiménez, Huelva, Spain
| | - N Ramírez-Duque
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - A San José
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
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Noale M, Veronese N, Cavallo Perin P, Pilotto A, Tiengo A, Crepaldi G, Maggi S. Polypharmacy in elderly patients with type 2 diabetes receiving oral antidiabetic treatment. Acta Diabetol 2016; 53:323-30. [PMID: 26155958 DOI: 10.1007/s00592-015-0790-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Abstract
AIM Polypharmacy in older diabetics can have detrimental effects linked to poor adherence and the risk of drug interaction or more serious/frequent side effects. The aim of this study was to identify the characteristics associated with polypharmacy in a cohort of elderly diabetic patients being treated with oral hypoglycemic agents. METHODS The study population consisted of 1342 diabetic patients consecutively enrolled in 57 diabetes centers in Italy participating in the METABOLIC Study. Patients meeting the following inclusion criteria were enrolled: diagnosis of type 2 diabetes mellitus, age ≥65 years, and receiving oral antidiabetic treatment. Data concerning diabetes duration and complications, the medications the patients were taking, and the number of hypoglycemic events were registered. Multidimensional impairment was assessed using the Multidimensional Prognostic Index. RESULTS The mean age of the participants was 73.3 ± 5.5 years. Polypharmacy, defined as being prescribed contemporaneously at least five drugs, was found in 57.1 % of the study population. According to a multivariable logistic model, the female gender was significantly associated with polypharmacy, as were living in Northern Italian regions, diabetes duration longer than 4 years, and having a body mass index ≥30 kg/m(2). Comorbidities, diabetes complications, a better cognitive performance on the Short Portable Mental Status Questionnaire, and being malnourished/at risk of malnourishment according to the mini nutritional assessment were associated with polypharmacy. CONCLUSIONS Polypharmacy, a condition that may lead to many potential detrimental outcomes in older diabetic subjects, was significantly associated with some risk factors that may be useful to identify subjects at risk.
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Affiliation(s)
- Marianna Noale
- CNR - Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128, Padua, Italy.
| | | | | | - Alberto Pilotto
- Geriatrics Unit, Azienda ULSS, 16, S. Antonio Hospital, Padua, Italy
| | - Antonio Tiengo
- Department of Medicine, University of Padua, Padua, Italy
| | - Gaetano Crepaldi
- CNR - Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128, Padua, Italy
| | - Stefania Maggi
- CNR - Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128, Padua, Italy
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35
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Formiga F, Rodriguez Mañas L. Improving drug prescription in elderly diabetic patients. Rev Esp Geriatr Gerontol 2016; 51:127-9. [PMID: 27006270 DOI: 10.1016/j.regg.2015.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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36
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Chatterjee S, Davies MJ. Current management of diabetes mellitus and future directions in care. Postgrad Med J 2015; 91:612-21. [PMID: 26453594 DOI: 10.1136/postgradmedj-2014-133200] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/12/2015] [Indexed: 12/23/2022]
Abstract
The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular outcomes, but macrovascular outcomes and cardiovascular safety remain controversial with several glucose-lowering agents. Future directions in diabetes care include strategies such as the 'bionic pancreas', stem cell therapy and targeting the intestinal microbiome. All of these treatments are still being refined, and it may be several decades before they are clinically useful. Prevention and cure of diabetes is the Holy Grail but remain elusive due to lack of detailed understanding of the metabolic, genetic and immunological causes that underpin diabetes. Much progress has been made since the time of Prof MacLean 90 years ago, but there are still great strides to be taken before the life of the patient with diabetes improves even more significantly.
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Affiliation(s)
- Sudesna Chatterjee
- Leicester Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Leicester Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
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37
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Mittermayer F, Caveney E, De Oliveira C, Gourgiotis L, Puri M, Tai LJ, Turner JR. Addressing unmet medical needs in type 2 diabetes: a narrative review of drugs under development. Curr Diabetes Rev 2015; 11:17-31. [PMID: 25537454 PMCID: PMC4428473 DOI: 10.2174/1573399810666141224121927] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/12/2014] [Accepted: 12/19/2014] [Indexed: 12/19/2022]
Abstract
The global burden of type 2 diabetes is increasing worldwide, and successful treatment of this disease needs constant provision of new drugs. Twelve classes of antidiabetic drugs are currently available, and many new drugs are under clinical development. These include compounds with known mechanisms of action but unique properties, such as once-weekly DPP4 inhibitors or oral insulin. They also include drugs with new mechanisms of action, the focus of this review. Most of these compounds are in Phase 1 and 2, with only a small number having made it to Phase 3 at this time. The new drug classes described include PPAR agonists/modulators, glucokinase activators, glucagon receptor antagonists, anti-inflammatory compounds, G-protein coupled receptor agonists, gastrointestinal peptide agonists other than GLP-1, apical sodium-dependent bile acid transporter (ASBT) inhibitors, SGLT1 and dual SGLT1/SGLT2 inhibitors, and 11beta- HSD1 inhibitors.
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Affiliation(s)
| | | | | | | | | | | | - J Rick Turner
- Quintiles GmbH, Stella- Klein-Low Weg 15, Rund 4, Haus B, OG 4, 1020 Vienna, Austria.
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38
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Haidara MA, Assiri AS, Youssef MA, Mahmoud MM, Ahmed M S E, Al-Hakami A, Chandramoorthy HC. Differentiated mesenchymal stem cells ameliorate cardiovascular complications in diabetic rats. Cell Tissue Res 2014; 359:565-575. [PMID: 25413785 DOI: 10.1007/s00441-014-2034-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/14/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Mohamed A Haidara
- Department of Physiology, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abdullah S Assiri
- Center for Stem Cell Research, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Department of Cardiology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mary A Youssef
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Manal M Mahmoud
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eajaz Ahmed M S
- Department of Physiology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ahmed Al-Hakami
- Center for Stem Cell Research, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Harish C Chandramoorthy
- Center for Stem Cell Research, College of Medicine, King Khalid University, Abha, Saudi Arabia.
- Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Saudi Arabia.
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