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Negussie YM, Abebe AT. Hypertension and associated factors among patients with diabetes mellitus attending a follow-up clinic in central Ethiopia. Sci Rep 2025; 15:13150. [PMID: 40240455 PMCID: PMC12003655 DOI: 10.1038/s41598-025-97909-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 04/08/2025] [Indexed: 04/18/2025] Open
Abstract
Hypertension and diabetes mellitus are highly prevalent chronic diseases worldwide, and their coexistence presents a growing public health challenge, particularly in low-resource settings like Ethiopia. Thus, this study aimed to assess hypertension and its associated factors in patients with diabetes mellitus attending a follow-up clinic in central Ethiopia. A health facility-based cross-sectional study was conducted. Study participants were selected using a systematic random sampling method. Data were collected through a structured, interviewer-administered questionnaire and patient record reviews. A binary logistic regression model was employed to examine the association between hypertension and the explanatory variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to estimate the strength of associations, and statistical significance was determined at a p-value of < 0.05. A total of 379 patients with diabetes mellitus participated in the study. The prevalence of hypertension was 34.6% (95% CI: 29.8-39.4). Being aged 41-60 years (AOR = 2.26, 95% CI: 1.23-4.15), having type 2 diabetes (AOR = 3.83, 95% CI: 1.07-13.65), the presence of comorbidities (AOR = 2.72, 95% CI: 1.59-4.67), and poor medication adherence (AOR = 2.06, 95% CI: 1.12-3.77) were statistically significant factors associated with hypertension among diabetes mellitus patients. More than one-third of patients with diabetes mellitus had hypertension. Older age, type 2 diabetes, the presence of comorbidities, and poor medication adherence were factors associated with hypertension. Regular blood pressure checks, especially for older patients, managing comorbidities, and improving medication adherence through education and simpler regimens are recommended.
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Affiliation(s)
| | - Abel Tezera Abebe
- School of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Kassaw EA, Sendekie AK, Enyew BM, Abate BB. Machine learning applications to classify and monitor medication adherence in patients with type 2 diabetes in Ethiopia. Front Endocrinol (Lausanne) 2025; 16:1486350. [PMID: 40182636 PMCID: PMC11965118 DOI: 10.3389/fendo.2025.1486350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 02/28/2025] [Indexed: 04/05/2025] Open
Abstract
Background Medication adherence plays a crucial role in determining the health outcomes of patients, particularly those with chronic conditions like type 2 diabetes. Despite its significance, there is limited evidence regarding the use of machine learning (ML) algorithms to predict medication adherence within the Ethiopian population. The primary objective of this study was to develop and evaluate ML models designed to classify and monitor medication adherence levels among patients with type 2 diabetes in Ethiopia, to improve patient care and health outcomes. Methods Using a random sampling technique in a cross-sectional study, we obtained data from 403 patients with type 2 diabetes at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), excluding 13 subjects who were unable to respond and 6 with incomplete data from an initial cohort of 422. Medication adherence was assessed using the General Medication Adherence Scale (GMAS), an eleven-item Likert scale questionnaire. The responses served as features to train and test machine learning (ML) models. To address data imbalance, the Synthetic Minority Over-sampling Technique (SMOTE) was applied. The dataset was split using stratified K-fold cross-validation to preserve the distribution of adherence levels. Eight widely used ML algorithms were employed to develop the models, and their performance was evaluated using metrics such as accuracy, precision, recall, and F1 score. The best-performing model was subsequently deployed for further analysis. Results Out of 422 enrolled patients, 403 data samples were collected, with 11 features extracted from each respondent. To mitigate potential class imbalance, the dataset was increased to 620 samples using the Synthetic Minority Over-sampling Technique (SMOTE). Machine learning models including Logistic Regression (LR), Support Vector Machine (SVM), K Nearest Neighbor (KNN), Decision Tree (DT), Random Forest (RF), Gradient Boost Classifier (GBC), Multilayer Perceptron (MLP), and 1D Convolutional Neural Network (1DCNN) were developed and evaluated. Although the performance differences among the models were subtle (within a range of 0.001), the SVM classifier outperformed the others, achieving a recall of 0.9979 and an AUC of 0.9998. Consequently, the SVM model was selected for deployment to monitor and detect patients' medication adherence levels, enabling timely interventions to improve patient outcomes. Conclusions This study highlights a variety of machine learning (ML) models that can be effectively used to monitor and classify medication adherence in diabetic patients in Ethiopia. However, to fully realize the potential impact of digital health applications, further studies that include patients from diverse settings are necessary. Such research could enhance the generalizability of these models and provide insights into the broader applicability of digital tools for improving medication adherence and patient outcomes in varying healthcare contexts.
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Affiliation(s)
- Ewunate Assaye Kassaw
- Department of Biomedical Engineering, Institute of Technology, University of Gondar, Gondar, Ethiopia
- Center for Biomedical Engineering, Indian Institute of Technology, Delhi, New Delhi, India
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Bekele Mulat Enyew
- Department of Information Technology, College of Informatics, University of Gondar, Gondar, Ethiopia
| | - Biruk Beletew Abate
- College of Health Science, Woldia University, Woldia, Ethiopia
- School of Population Health, Curtin University, Bentley, WA, Australia
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Alfadda AA, Youssef AM, Al-Sofiani ME, Amin HS, AlOtaibi O, Mohamed N, Algohani HA, Isnani A, Rafiullah M. Medication Adherence and Treatment Satisfaction With Lipid-Lowering Drugs Among Patients With Diabetes and Dyslipidemia. Ann Pharmacother 2025; 59:105-116. [PMID: 39054790 DOI: 10.1177/10600280241262513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Poor adherence to lipid-lowering drugs in diabetic patients with dyslipidemia increases has been linked with an increased cardiovascular risk. A better understanding of the determinants of adherence to lipid-lowering drugs and treatment satisfaction among people with diabetes and dyslipidemia is crucial. OBJECTIVE We aimed to assess the prevalence of adherence to lipid-lowering drugs, identify its determinant factors, and evaluate treatment satisfaction among users of lipid-lowering drugs who have diabetes and dyslipidemia. METHODS We surveyed 398 adult patients with diabetes and dyslipidemia, using a validated medication adherence survey (Adherence to Refills and Medications Scale) and a validated treatment satisfaction survey (Treatment Satisfaction Questionnaire for Medication, TSQM). Sociodemographic and medical history data were collected through questionnaires. RESULTS The prevalence of poor medication adherence was 36%. Factors associated with poor adherence included adverse reactions to medications, lack of medication availability, and lack of family support. Adherent patients reported lower low-density lipoprotein-cholesterol (LDL-C) and total cholesterol levels, higher treatment satisfaction, and a higher prevalence of cardiovascular disease and comorbidities. Having a family history of dyslipidemia was negatively associated with adherence, while the number of comorbidities positively influenced it. The scores of TSQM components such as effectiveness, global satisfaction, and convenience were significantly higher in people who were adherent or achieved the LDL-C target. CONCLUSION AND RELEVANCE Our findings highlight the need for interventions targeting several factors impacting adherence to lipid-lowering drugs in patients with diabetes and dyslipidemia. Managing adverse effects, leveraging family support, and ensuring medication access represent crucial aspects of improving adherence and potentially mitigating cardiovascular risks in this high-risk population.
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Affiliation(s)
- Assim A Alfadda
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amira M Youssef
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed E Al-Sofiani
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hussein Saad Amin
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Obeed AlOtaibi
- University Diabetes Center, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nourhan Mohamed
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hossam Ayed Algohani
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Arthur Isnani
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Rafiullah
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Sefah IA, Mensah M, Hutton-Nyameaye AA, Sarkodie E, Meyer JC, Godman B, Bangalee V. Insulin therapy adherence and its associated factors among diabetic patients in a Ghanaian primary care hospital. PLoS One 2025; 20:e0312094. [PMID: 39854487 PMCID: PMC11760006 DOI: 10.1371/journal.pone.0312094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 10/01/2024] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a global health problem. Adherence to intensive insulin therapy is necessary to achieve better glycemic control in types 1 and 2 DM. This study aimed to evaluate the extent of adherence to insulin therapy, its predictors and to identify barriers to its adherence. METHOD This was a cross-sectional survey among adult (≥18 years) diabetic patients who are currently using insulin, either alone or in combination with an oral antidiabetic regimen, and seeking primary care at Kwame Nkrumah University of Science and Technology Hospital in Ghana. A total of one hundred and eight-six patients were conveniently sampled, and interviewed. Insulin adherence was determined using the Medication Adherence Reporting Scale-5. Descriptive statistics, a chi-square test of independence, and a multiple logistic regression analysis were performed using STATA version 14 (StataCorp, TX USA). RESULTS The majority of the patients interviewed were over 60 years (40.32%); female (61.83%); married (68.82%); and had completed secondary education (48.39%). 67.20% of the patients were adherent to insulin therapy. Adherence level was associated with age (p = 0.020), marital status (p = 0.001), employment status (p = 0.012), type of DM (p<0.001), regular follow-up (p = 0.007) and comorbidities (p = 0.002) and was only predicted by the type of DM (aOR = 14.82 C.I 1.34-163.50, p-value = 0.028). CONCLUSION Adherence to insulin therapy among our study population was suboptimal, which is a concern considering the associated increased risk of complications. Adherence assessment and counselling by healthcare professionals to address barriers to poor adherence must be continually undertaken to achieve optimal glycemic control. IMPACT OF FINDINGS ON PRACTICE STATEMENTS Continuous adherence assessment and counselling must be offered to all diabetes mellitus patients on insulin therapy as part of their ambulatory care to help improve outcomes.Using the Medication Adherence Reporting Scale-5 to determine patient adherence levels is an easy-to-use and an inexpensive method; however, it should be used with caution due to the potential for misclassification.Efforts must be made to provide appropriate strategies to deal with barriers to insulin adherence at ambulatory care clinics as part of the individualized comprehensive diabetic care to reduce diabetic complications.
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Affiliation(s)
- Israel Abebrese Sefah
- University of Health and Allied Sciences, Ho, Ghana
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Emmanuel Sarkodie
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Benamor B, Sayadi H, Bayar I, Ghachem A, Hajji E, Marmouch H, Khochtali I. Evaluation de l’adhésion thérapeutique aux antihyperglycémiants chez les
patients diabétiques de type 2. LA TUNISIE MEDICALE 2025; 103:98-103. [PMID: 39812201 PMCID: PMC11906248 DOI: 10.62438/tunismed.v103i1.5265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 10/08/2024] [Indexed: 05/02/2025]
Abstract
Introduction-Aim: Type 2 diabetes (T2D) is a major public health problem. To succeed its management and prevent its complications, good therapeutic adherence must be ensured. The objectives of our work were to estimate the prevalence of poor therapeutic adherence in our patients and to identify its associated factors. METHODS we conducted a cross-sectional, single-center study that included type 2 diabetic outpatients. Therapeutic adherence to antihyperglycemic agents was assessed by the 8-item Morisky Medication Adherence Scale (MMAS-8). RESULTS We included 172 patients. The mean age was 59.7±9.5 years. The mean duration of T2D was 11.7±8.5 years. Glycemic targets were achieved in 35% of patients with a mean HbA1c of 8.5±1.8%. The prevalence of poor adherence was 66.1%. Factors associated with poor adherence were age <65 years (p=0.007), low educational level (p=0.026), diabetes follow-up < 2 consultations/year (p=0.004), non-practice of self-monitoring of blood glucose (p=0.008) and ignorance of glycemic targets (p=0.001). CONCLUSION Poor adherence affects a large proportion of our T2D patients. In order to improve it, therapeutic adherence should be an important theme in the education of patient.
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Affiliation(s)
- Bilel Benamor
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba Hospital, Monastir. Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Tunisia
| | - Hanene Sayadi
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba Hospital, Monastir. Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Tunisia
| | - Ines Bayar
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba Hospital, Monastir. Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Tunisia
| | - Aicha Ghachem
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba Hospital, Monastir. Tunisia
| | - Ekram Hajji
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba Hospital, Monastir. Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Tunisia
| | - Hela Marmouch
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba Hospital, Monastir. Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Tunisia
| | - Ines Khochtali
- Department of Endocrinology and Internal Medicine, Fattouma Bourguiba Hospital, Monastir. Tunisia
- Faculty of Medicine of Monastir, University of Monastir, Tunisia
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Kordbagheri M, Bagheri SM, Heris NJ, Matbouraftar P, Azarian M, Mousavi SM. The mediating role of psychological well-being in the relationship between the light triad of personality and sense of concordance with treatment adherence in patients with type 2 diabetes: A network analysis and structural equation modeling study. Acta Psychol (Amst) 2024; 248:104361. [PMID: 38878474 DOI: 10.1016/j.actpsy.2024.104361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND This study aimed to investigate the intricate relationship among treatment adherence, the light triad of personality, self-coherence, and psychological well-being in individuals diagnosed with Type 2 Diabetes Mellitus (T2DM). Structural equation modeling (SEM) was employed to elucidate the direct and mediated pathways linking these variables, while network analysis sought to identify and characterize the underlying factors of the light triad of personality within the context of T2DM management. METHOD A path analysis-network analysis study using convenience sampling was conducted, recruiting 412 T2DM patients from ten private practices and general hospitals in Gilan province, Iran. Data collection utilized Antonovsky's Self of Coherence scale (SOC), The Light Triad Rating Scale, and The Reef's Psychological Well-being Questionnaire. Structural equation modeling assessed model fitness and determined direct and indirect links between variables. Analysis was conducted using R-Studio software (Version 4.2.1), SPSS (V.26), and AMOS software (V.24). RESULTS Confirmatory factor analysis and network analysis confirmed the three-factor structure of the Light Triad of Personality scale. Direct impacts of Light Triad of Personality (β = 0.34, p < .001) and self-coherence (β = 0.32, p < .001) on treatment adherence were observed. Psychological well-being played an indirect role in this relationship, with significant effects from Light Triad of Personality (β = 0.25, p < .001) and self-coherence (β = 0.08, p < .001) on treatment adherence. Bootstrapped exploratory graph analysis revealed an average of 3 dimensions within the network, indicating community structures. CONCLUSION SEM analysis demonstrated good model fit, suggesting the importance of designing interventional programs incorporating self-coherence and psychological well-being frameworks to enhance treatment adherence in T2DM patients.
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Affiliation(s)
| | | | | | | | - Mozhdeh Azarian
- Department of Nursing and midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Seyedeh Maryam Mousavi
- Department of Nursing and midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran.
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Alfakhri A, Almadani O, Althunian T, Alrwisan A, Badreldin H, Albogami Y. Treatment modification patterns of glucose-lowering agents in Saudi Arabia: A retrospective real-world data analysis. Diabetes Res Clin Pract 2024; 214:111770. [PMID: 38971376 DOI: 10.1016/j.diabres.2024.111770] [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: 05/10/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
AIM The growing number of antidiabetics has broadened therapeutic options, leading to heterogeneity in prescribing patterns. Studies identifying antidiabetics modification patterns are lacking in Saudi Arabia. Therefore, the aim of this study is to describe modification patterns in Saudi patients. METHODS Patients ≥ 18 years old with at least one antidiabetic between 2016 and 2022 were included. Follow-up started from the earliest to the last prescription.Two modification types were evaluated: "add-on," prescribing new antidiabetics within a treatment episode, and "switching", starting a new treatment episode after the preceding ends. Descriptive statistics were used to characterize patients and estimate events proportions. RESULTS Of 122,291 patients, 47.2 % had treatment interruption or modification, totaling 303,781 events. Interruptions accounted for 54 %, add-on for 11 %, and switching for 35 %. The median time to first event was 159 days. The most add-on included dipeptidyl peptidase-4 inhibitor (DPP-4) inhibitors to biguanide and sulfonylurea (8 %), and sulfonylurea to biguanide (8 %). Among 106,405 switching events, 23 % shifted from dual to monotherapy and 17 % from monotherapy to dual therapy. CONCLUSION Nearly half of patients experienced modifications or interruptions, with notable shifts between monotherapies and dual therapies. These findings highlight the evolving landscape of treatment patterns in Saudi Arabia and guide future research and decision-making.
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Affiliation(s)
| | | | - Turki Althunian
- Saudi Food and Drug Authority, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Hisham Badreldin
- Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah Internatioanl Medical Research Center, Riyadh, Saudi Arabia; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yasser Albogami
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
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Alharbi S, Alhofaian A, Alaamri MM. Correlation between Illness Perception and Medication Adherence among Adult Patients with Type 2 Diabetes Mellitus in Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:244-251. [PMID: 39055074 PMCID: PMC11268541 DOI: 10.4103/sjmms.sjmms_511_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/13/2023] [Accepted: 03/26/2024] [Indexed: 07/27/2024]
Abstract
Objectives This study aimed to assess the level of illness perception and medication adherence among adult patients with type 2 diabetes mellitus (T2DM) in Jeddah, Saudi Arabia, with a specific focus on understanding how these two factors may be related. Materials and Methods This descriptive correlation study included all adult patients with T2DM attending the Jeddah Care Centre for Diabetes and Hypertension at King Abdulaziz Hospital between January and April 2022. Data were collected using a questionnaire that elicited sociodemographic and clinical information, and the Arabic versions of the Brief Illness Perception Questionnaire and the Morisky Medication Adherence Scale. Descriptive statistics and Pearson's correlation analysis were used for data analysis. Results A total of 365 patients were included (mean age: 50.9 ± 15.9 years), with the majority being female (53.4%). Overall, the level of medication adherence was moderate (mean score: 5.36 ± 1.73). Patients with lower medication adherence perceived the consequences of T2DM as more severe, had a stronger association with the illness identity, and experienced more intense emotional responses (for all, P < 0.001). Conversely, patients with higher adherence had a greater sense of personal control, a stronger belief in treatment effectiveness, and a better understanding of the illness (for all, P < 0.001). Conclusion The study found a correlation between illness perception and medication adherence in patients with T2DM. Addressing patients' perceptions may enhance their ability to manage the condition more effectively.
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Affiliation(s)
- Samaher Alharbi
- Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aisha Alhofaian
- Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marym M. Alaamri
- Department of Medical Surgical Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
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Chen SH, Lee MC, Pu C. Medication adherence in patients with type 2 diabetes after disability onset: a difference-in-differences analysis using nationwide data. BMC Med 2024; 22:102. [PMID: 38448936 PMCID: PMC10918964 DOI: 10.1186/s12916-024-03324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Effectively managing the coexistence of both diabetes and disability necessitates substantial effort. Whether disability onset affects adherence to type 2 diabetes medication remains unclear. This study investigated whether disability onset reduces such adherence and whether any reduction varies by disability type. METHODS This study used the National Disability Registry and National Health Insurance Research Database from Taiwan to identify patients with type 2 diabetes who subsequently developed a disability from 2013 to 2020; these patients were matched with patients with type 2 diabetes without disability onset during the study period. Type 2 diabetes medication adherence was measured using the medication possession ratio (MPR). A difference-in-differences analysis was performed to determine the effect of disability onset on the MPR. RESULTS The difference-in-differences analysis revealed that disability onset caused a reduction of 5.76% in the 1-year MPR (P < 0.001) and 13.21% in the 2-year MPR (P < 0.001). Among all disability types, organ disabilities, multiple disabilities, rare diseases, and a persistent vegetative state exhibited the largest reductions in 2-year MPR. CONCLUSIONS Policies aimed at improving medication adherence in individuals with disabilities should consider not only the specific disability type but also the distinct challenges and barriers these patients encounter in maintaining medication adherence.
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Affiliation(s)
- Szu-Han Chen
- Department of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Miaw-Chwen Lee
- Department of Social Welfare, National Chung Cheng University, Chia-Yi, Taiwan
- Center for Innovative Research on Aging Society, National Chung Cheng University, Chiayi, Taiwan
- Advanced Institute of Manufacturing with High-tech Innovations, National Chung Cheng University, Chiayi, Taiwan
| | - Christy Pu
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, 155 Li-Nong ST, Sec 2, Peitou, Taipei, Taiwan.
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10
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Doya IF, Yahaya JJ, Ngaiza AI, Bintabara D. Low medication adherence and its associated factors among patients with type 2 diabetes mellitus attending Amana Hospital in Dar es Salaam, Tanzania: a cross-sectional study. Int Health 2024; 16:200-207. [PMID: 37310004 PMCID: PMC10911532 DOI: 10.1093/inthealth/ihad042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Low medication adherence among patients with type 2 diabetes mellitus (T2DM) is associated with significant morbidity and mortality globally. We investigated the prevalence of low medication adherence and its associated factors among patients with T2DM. METHODS We used the Bengali version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in measuring medication adherence among patients with T2DM who were attending the diabetes clinic at Amana Regional Referral Hospital in Dar es Salaam, Tanzania, from December 2021 to May 2022. Binary logistic regression analysis under multivariate analysis was used to determine the predictors of low medication adherence after controlling for confounders. A two-tailed p-value <0.05 was considered significant. RESULTS The prevalence of low medication adherence was 36.7% (91/248) of the subjects included in the study. Lack of formal education (adjusted odds ratio [AOR] 5.3 [95% confidence interval {CI} 1.717 to 16.312], p=0.004), having comorbidities (AOR 2.1 [95% CI 1.134 to 3.949], p=0.019) and drinking alcohol (AOR 3.5 [95% CI 1.603 to 7.650], p=0.031) were the independent predictors of low medication adherence. CONCLUSION More than one-third of the patients with T2DM in this study had low medication adherence. Our study also showed that a lack of formal education, having comorbidities and drinking alcohol were significantly associated with low medication adherence.
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Affiliation(s)
- Irene F Doya
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - James J Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda
| | - Advera I Ngaiza
- Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Pathology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Deogratius Bintabara
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
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Boonpattharatthiti K, Saensook T, Neelapaijit N, Sakunrag I, Krass I, Dhippayom T. The prevalence of adherence to insulin therapy in patients with diabetes: A systematic review and meta-analysis. Res Social Adm Pharm 2024; 20:255-295. [PMID: 38104019 DOI: 10.1016/j.sapharm.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Adherence to insulin therapy is crucial to achieving good glycemic control for patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). A comprehensive estimation of adherence to insulin therapy in patients with diabetes is currently lacking. OBJECTIVE To explore the prevalence of adherence to insulin therapy in patients with both T1D and T2D. METHODS A systematic search was performed using the following databases: PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from the inception of each database to August 2023. Cross-sectional studies were included if they met the following criteria: (1) conducted in patients with T1D or T2D; (2) reported adherence to insulin therapy. The Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used to assess the quality of included studies. Pooled estimates of the prevalence of adherence to insulin were calculated as a percentage together with a 95 % confidence interval (95%CI) using a random-effect model. All analyses were conducted using STATA 15 (College Station, Texas, United States); PROSPERO (CRD42022322323). RESULTS Search results yielded 14,914 articles, of these 57 studies with a total of 125,241 patients met the inclusion criteria. The overall estimated prevalence of adherence to insulin therapy in both types of diabetes was 55.37 % (95%CI: 48.55 %-62.19 %). The adherence for T1D was 52.63 % (95 % CI: 37.37 %-67.87 %), whereas the adherence for T2D was 52.55 % (95 % CI: 43.08 %-62.01 %). The prevalence of adherence in lower middle-income countries was 56.79 % (95 % CI: 27.85 %-85.74 %). CONCLUSIONS The overall prevalence of adherence to insulin therapy was remarkably low. This requires attention from healthcare practitioners and policymakers to implement appropriate strategic approaches to improve adherence to insulin therapy.
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Affiliation(s)
- Kansak Boonpattharatthiti
- Faculty of Pharmaceutical Sciences, Burapha University, Chon Buri, Thailand; The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Thitinan Saensook
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Department of Pharmacy, Navamin 9 Hospital, Bangkok, Thailand.
| | - Nipaporn Neelapaijit
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Department of Pharmacy, Navamin 9 Hospital, Bangkok, Thailand.
| | - Itsarawan Sakunrag
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Ines Krass
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia.
| | - Teerapon Dhippayom
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
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Ali SA, Salih SM, Abdelmola A, Makeen AM, Solan YM, Mohammed Ali MM. Association of Anxiety and Depressive Symptoms and Treatment Adherence Among Patients With Type 2 Diabetes Mellitus in Jazan, Saudi Arabia: A Cross-Sectional Study. Cureus 2024; 16:e56068. [PMID: 38618389 PMCID: PMC11009697 DOI: 10.7759/cureus.56068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Diabetes mellitus is a serious public health concern. It is associated with many psychological problems, such as depression, anxiety, and eating disorders. These co-morbidities are associated with improper adherence to treatment, self-care, poor glycemic control, more complications, and worse outcomes. METHODS This study aimed to measure the level of medication adherence among type 2 diabetics in Jazan, Saudi Arabia, and to find its association with their psychological status (specifically, depression and anxiety). A cross-sectional descriptive design was used among adults with type 2 diabetes at the Diabetes and Endocrinology Center in Jazan, Saudi Arabia. The estimated sample size was 480 patients. The General Medication Adherence Scale and Patient Health Questionnaire-4 (PHQ-4) were used as tools to achieve the study objectives. RESULTS A total of 449 diabetic patients completed the survey (93.5% response rate). Patients with poor, low, and partial adherence account for 337 (75%) of patients and only 112 (25%) have good and high medication adherence. Employment and duration of illness were highly significant with a positive relationship to treatment adherence (p = 0.010 and 0.000, respectively). On the other hand, age and disease duration had a significant relationship with psychological disorders (p = 0.029 and 0.002, respectively). Of the patients, 64 (14.3%) had high scores on the PHQ-4, with depressive symptoms in 46 (10.24%) and anxiety symptoms in 75 (16.7%). Correlation analysis reveals that there is a highly significant negative correlation between psychological disorders and adherence to medications (r = -0.288, p = 0.000). CONCLUSION A negative correlation between psychological disorders and adherence to medications was found. The findings indicate the importance of psychological support for diabetic patients for better treatment adherence.
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Affiliation(s)
- Suhaila A Ali
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Sarah M Salih
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Amani Abdelmola
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Anwar M Makeen
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Yahia M Solan
- Department of Family Medicine, Jazan Diabetes and Endocrinology Center, Jazan, SAU
| | - Mona M Mohammed Ali
- Department of Pediatric Endocrinology, Jazan Diabetes and Endocrinology Center, Jazan, SAU
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Khardali A, Kashan Syed N, Alqahtani SS, Qadri M, Meraya AM, Rajeh N, Aqeely F, Alrajhi S, Zanoom A, Gunfuthi S, Basudan W, Hakami TK, Abdelgadir MA. Assessing medication adherence and their associated factors amongst type-2 diabetes mellitus patients of Jazan Province, Saudi Arabia: A single-center, cross-sectional study. Saudi Pharm J 2024; 32:101896. [PMID: 38178855 PMCID: PMC10764249 DOI: 10.1016/j.jsps.2023.101896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024] Open
Abstract
Background The prevalence of type 2 diabetes mellitus (T2DM) globally is reaching epidemic proportions. By 2035, it is projected to increase to 417 million, which is of significant concern as T2DM represents the most oversized budget item in many healthcare systems, primarily due to the high rates of morbidity and mortality associated with the disease. The worldwide cost burden of T2DM has been inexorably growing. A key contributor to the remarkably high morbidity and mortality rates is poor glycemic control potentially associated with medication non-adherence. Aim The present research's main objective included assessing medication adherence among patients with T2DM in a single center in Jazan Province. Methods Three hundred nine patients with T2DM participated in a cross-sectional survey over three months (September to November 2022). The study participants comprised 50.8 % (females) and 49.2 % (males), with a mean age of 44.12 years (SD ± 12.70). A 31-item self-report questionnaire was used for data collection. Results Sixty-six percent of the sample were found to be adherent to their T2DM therapy. A positive association was noticed between the GMAS score and the participant's age (r = 0.24; p < 0.01). The participants' medication adherence was significantly associated with having age above 50 years (χ2 = 13.62; p = 0.001), residing in urban localities (χ2 = 21.37; p < 0.001), being married (χ2 = 12.80; p = 0.002), having glycated hemoglobin level more than 8 % (χ2 = 6.99; p = 0.03) and taking between one to three medications per day (χ2 = 17.63; p < 0.001). Conclusion The majority of T2DM patients in the present study were found adherent to their anti-diabetic medications, particularly older patients. Future studies should focus on exploring the reasons for the reported high adherence among older patients and non-adherence among younger patients, as this could facilitate the development of a strategy to enhance adherence.
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Affiliation(s)
- Amani Khardali
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
| | - Nabeel Kashan Syed
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
| | - Saad S. Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Marwa Qadri
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan-45142, Saudi Arabia
- Inflammation Pharmacology and Drug Discovery Unit, Medical Research Center, Jazan University, Jazan-45142, Saudi Arabia
| | - Abdulkarim M. Meraya
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
| | - Norah Rajeh
- Jazan Endocrinology and Diabetes Centre, Jizan - 82723, Jazan, Saudi Arabia
| | - Fatimah Aqeely
- Jazan Endocrinology and Diabetes Centre, Jizan - 82723, Jazan, Saudi Arabia
| | - Sedan Alrajhi
- College of Pharmacy, Jazan University, Jizan - 45142, Saudi Arabia
| | - Amnah Zanoom
- College of Pharmacy, Jazan University, Jizan - 45142, Saudi Arabia
| | - Shahd Gunfuthi
- College of Pharmacy, Jazan University, Jizan - 45142, Saudi Arabia
| | - Wahhaj Basudan
- College of Pharmacy, Jazan University, Jizan - 45142, Saudi Arabia
| | - Thana K. Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mawada A. Abdelgadir
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan - 45142, Jazan, Saudi Arabia
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Suprapti B, Izzah Z, Anjani AG, Andarsari MR, Nilamsari WP, Nugroho CW. Prevalence of medication adherence and glycemic control among patients with type 2 diabetes and influencing factors: A cross-sectional study. GLOBAL EPIDEMIOLOGY 2023; 5:100113. [PMID: 37638377 PMCID: PMC10446000 DOI: 10.1016/j.gloepi.2023.100113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background This study aimed to assess medication adherence, glycemic control, and their influencing factors among outpatients at an Indonesian clinic with type 2 diabetes. Methods A cross-sectional study was conducted among patients with type 2 diabetes at a hospital-based clinic in Surabaya, Indonesia, from September to December 2018. A purposive sampling was used; patients aged 18 years and older, had diabetes and any comorbidity, received hypoglycemic agents, and provided written informed consent were included. The previously validated Brief Medication Questionnaire was used to measure medication adherence, while glycosylated hemoglobin (A1C) levels were used to evaluate glycemic control. Binary logistic regression was used to identify factors associated with medication adherence and glycemic control. Results Of 321 patients enrolled in the study, 268 (83.5%) patients were medication nonadherent. Patients who did not engage regularly in physical activity (aOR: 0.49, 95% CI: 0.26-0.93) was more likely to be medication adherent. Poor glycemic control (A1C: >7%) was observed in 106 (33.0%) of the patients. Patients who used a combination of oral hypoglycemic agents and insulin (aOR: 2.74, 95% CI: 1.09-6.86), did not take biguanide (aOR: 2.73, 95% CI: 1.16-6.43), reported hyperglycemia (aOR: 4.24, 95% CI: 1.53-11.81), and had comorbid diseases (aOR: 4.33, 95% CI: 1.08-17.34) increased the risk of having poor glycemic control. Patients who were more likely to achieve good glycemic control were male (aOR: 0.39, 95% CI: 0.20-0.74) and aged older (aOR: 0.95, 95% CI: 0.92-0.99). Conclusions The proportion of patients who were medication nonadherent was much higher than those with poor glycemic control. Whereas regular exercise was a predictor of nonadherence, age, sex, diabetes medication, not taking biguanide, acute complications, and comorbidity were predictors of poor glycemic control. Therefore, strategies are needed to improve medication adherence and glycemic control.
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Affiliation(s)
- Budi Suprapti
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Zamrotul Izzah
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
| | - Ade Giriayu Anjani
- Master of Clinical Pharmacy Program, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Mareta Rindang Andarsari
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Wenny Putri Nilamsari
- Department of Pharmacy Practice, Faculty of Pharmacy Universitas Airlangga, Nanizar Zaman Joenoes Building, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
| | - Cahyo Wibisono Nugroho
- Department of Internal Medicine, Faculty of Medicine Universitas Airlangga, Mayjen Prof. Dr. Moestopo 47, Surabaya 60131, Indonesia
- Department of Internal Medicine, Universitas Airlangga Hospital, Campus C Unair Mulyorejo, Surabaya 60115, Indonesia
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15
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Al-Azayzih A, Kanaan RJ, Altawalbeh SM, Al-Qerem W, Smadi S. Medication Adherence and Its Associated Determinants in Older Adults with Type 2 Diabetes and Cardiovascular Comorbidities. Patient Prefer Adherence 2023; 17:3107-3118. [PMID: 38050627 PMCID: PMC10693756 DOI: 10.2147/ppa.s437013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
Aims of the Study To evaluate medication adherence level and identify predictors of poor medication adherence in elderly patients with Cardiovascular (CVS) diseases and type 2 diabetes in Jordan. Methods This cross-sectional study was conducted on elderly patients who attended King Abdullah University Hospital (KAUH) outpatient diabetes and cardiology clinics from March 6, 2023, to July 6, 2023. Data on age, sex, socio-demographics, biological variables, medication characteristics, and chronic comorbidities were obtained from electronic patients' medical records and a validated questionnaire. Medication adherence levels (low, moderate, and high) were assessed using the Arabic version of the 4-item Morisky, Green, and Levine Medication Adherence Scale-Medication Assessment Questionnaire. Results Data from 506 elderly patients were analyzed. The average age of the participants was 67.93 years (SD = 6.22). 7.9% of patients showed low adherence levels, 33.6% showed moderate adherence level, and 58.5% of patients showed a high level of adherence toward their prescribed medications. Multivariable ordinal logistic regression analysis revealed that single/currently unmarried patients and patients who were living with others were more likely to have a higher adherence level; Odd Ratios (ORs) were 4.75 and 4.10, respectively. Patients who took their medications ≥ 3 and 2 times a day showed higher adherence to their medications than those who only took them once a day.; ORs were 2.15 and 2.36, respectively. Conclusion This study indicated an inadequate level of adherence among patients with type 2 diabetes and cardiovascular comorbidities. This study revealed the necessity of implementing programs to help in raising the awareness among elderly patients with type 2 diabetes and CVDs of the importance of adherence to prescribed long-term medication regimens.
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Affiliation(s)
- Ahmad Al-Azayzih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Roaa J Kanaan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Saja Smadi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Mousavi SM, Bagheri SM, Jalali Heris N, Matbouraftar P, Azarian M, Kordbagheri M. Structural equation modeling to estimate treatment adherence based on the light triad of personality and sense of coherence in patients with type-2 diabetes: examining the mediating role of psychological well-being. Front Psychol 2023; 14:1285808. [PMID: 38090178 PMCID: PMC10711286 DOI: 10.3389/fpsyg.2023.1285808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024] Open
Abstract
Background The current study investigated the relationship between the light triad of personality and self-coherence with treatment adherence in patients with Type 2 Diabetes Mellitus (T2DM) using Structural Equation Modeling (SEM). Psychological well-being was considered a mediator variable in this SEM assessment. Method A cross-sectional study by convenience sampling was conducted, and 368 patients with T2DM were recruited from 10 private practice and general hospitals from May to November 2021 in Gilan province, Iran. The Reef's Psychological Well-being Questionnaire, the Light Triad Rating Scale, and Antonovsky's Sense of Coherence Scale were used for data collection. Structural equation modeling was used to examine the model fitness and identify direct/indirect relationships among variables. Data were analyzed by the SPSS (Version 26) and AMOS software (Version 24). Results The average score of light triads, sense of coherence, psychological well-being, and treatment adherence were 70.36 ± 25.55, 108.25 ± 37.68, 57.03 ± 23.84, and 106.81 ± 39.61, respectively. Model fit statistics suggest that the measurement model fits the data well: χ2 (146, N = 368) = 314.011 (p < 0.001). The SEM results showed that the light triad of personality (β = 0.12) and self-coherence (β = 0.14) were positively associated with treatment adherence. Anxiety, the light triad of personality (β = 0.12), and self-coherence (β = 0.14) affect treatment adherence indirectly through psychological well-being. Conclusion The analysis of the SEM revealed that the suggested model had a suitable goodness of fit. So, using self-coherence and psychological well-being structures in designing interventional programs is recommended to optimize treatment adherence in patients with T2DM.
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Affiliation(s)
| | | | | | | | - Mozhdeh Azarian
- Department of Nursing and Midwifery, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Mohammadreza Kordbagheri
- Department of Statistics, Faculty of Mathematical Sciences, Shahid Beheshti University, Tehran, Iran
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Battelino T, Brosius F, Ceriello A, Cosentino F, Green J, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Rydén L, Rodbard HW, Ji L, Sheu WHH, Standl E, Parkin CG, Schnell O. Guideline Development for Medical Device Technology: Issues for Consideration. J Diabetes Sci Technol 2023; 17:1698-1710. [PMID: 35531901 PMCID: PMC10658688 DOI: 10.1177/19322968221093355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in the development of innovative medical devices and telehealth technologies create the potential to improve the quality and efficiency of diabetes care through collecting, aggregating, and interpreting relevant health data in ways that facilitate more informed decisions among all stakeholder groups. Although many medical societies publish guidelines for utilizing these technologies in clinical practice, we believe that the methodologies used for the selection and grading of the evidence should be revised. In this article, we discuss the strengths and limitations of the various types of research commonly used for evidence selection and grading and present recommendations for modifying the process to more effectively address the rapid pace of device and technology innovation and new product development.
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Affiliation(s)
- Tadej Battelino
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine–Tucson, AZ, USA
| | | | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | | | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Linong Ji
- Peking University People’s Hospital, Beijing, China
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
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Jarrar Y, Abdul-Wahab G, Mosleh R, Abudahab S, Jarrar Q, Hamdan A, Qadous SG, Balasmeh R, Abed AF, Ibrahim Y, Al-Doaiss AA, AlShehri MA. Does Ramadan Intermittent Fasting Affect the Fasting Blood Glucose Level among Type II Diabetic Patients? J Clin Med 2023; 12:6604. [PMID: 37892742 PMCID: PMC10607677 DOI: 10.3390/jcm12206604] [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: 09/11/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The level of fasting blood glucose (FBG) is influenced by several factors, including health status, genetics, and diet. Some studies have reported a beneficial effect of Ramadan Intermittent Fasting (RIF) on diabetic patients. However, clinical observations have shown that diabetes is exacerbated in some patients. AIM This study aims to investigate the influence of RIF on the FBG level, a biomarker of hyperglycemia and diabetes, and to identify factors associated with variations in FBG levels during RIF among diabetic patients. METHODS This study is a cross-sectional study. We monitored the FBG levels of 181 type II diabetic patients over a two-month period, from 20 February to 20 April 2023, which represents the Islamic lunar months of Shaban (8th month) and Ramadan (9th month). Ramadan provides a prominent month of intermittent fasting practice for studying its physiological effects on diabetes. We collected clinical data from each participant, including demographic information, co-morbidities, and medications used during this period. RESULTS Based on our findings, diabetic patients were classified into three groups depending on the influence of RIF on FBG levels: the positively affected group (44%), whose average FBG levels were reduced; the neutrally affected group (24%), whose average FBG levels did not change; and the negatively affected group (32%), whose average FBG levels increased during the fasting month of Ramadan compared to the previous month. Furthermore, we found that the positive effect of RIF was more frequent among obese, non-geriatric, and male diabetic patients, while the negative effect of RIF was more frequent among patients who were not adhering to the medication. CONCLUSIONS This study concludes that RIF affects FBG levels differently among diabetic patients. These findings should be taken into consideration when treating diabetic patients during the fasting month of Ramadan, and further studies are needed to identify (1) factors associated with inter-individual variation in the response to RIF and (2) those who are great candidates for RIF.
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Affiliation(s)
- Yazun Jarrar
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt 19117, Jordan
| | - Ghasaq Abdul-Wahab
- Department of Oral Surgery and Periodontology, College of Dentistry, Al-Mustansiryia University, Baghdad 10052, Iraq;
| | - Rami Mosleh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus 00970, Palestine;
| | - Sara Abudahab
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Qais Jarrar
- Department of Pharmaceutical Science, Al-Isra’a University, Amman 11622, Jordan;
| | - Anas Hamdan
- Department of Anesthesia and Resuscitation Technology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus 00970, Palestine;
| | - Shurouq Ghalib Qadous
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus 00970, Palestine;
| | - Ruba Balasmeh
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan;
| | | | - Yasmeen Ibrahim
- AlSaidaly Scientific Bureau, Baghdad 10542, Iraq; (A.F.A.); (Y.I.)
| | - Amin A. Al-Doaiss
- Biology Department, College of Science, King Khalid University, Abha 61413, Saudi Arabia; (A.A.A.-D.); (M.A.A.)
| | - Mohammed Ali AlShehri
- Biology Department, College of Science, King Khalid University, Abha 61413, Saudi Arabia; (A.A.A.-D.); (M.A.A.)
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Alhilali MY, Alhilaly YS, Alkalash S. Knowledge and Attitude of School Students About Diabetes Mellitus in the Western Region of Saudi Arabia. Cureus 2023; 15:e47514. [PMID: 38022000 PMCID: PMC10663975 DOI: 10.7759/cureus.47514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a worldwide public health issue. Diabetes has been developing dramatically among young individuals, and childhood onset is now becoming a global epidemic. Data on DM knowledge and attitude among Saudi school pupils in the western region of the country are few. Therefore, this study has been undertaken to assess the level of knowledge and attitude of school students toward DM in the western region of Saudi Arabia. METHODS A cross-sectional study was conducted on a sample of 850 school students in the western region of Saudi Arabia from October to December 2022. The data were collected using an online questionnaire and analyzed using Statistical Product and Service Solutions (SPSS) (version 23.0; IBM SPSS Statistics for Windows, Armonk, NY). RESULTS This study included 850 pupils in total. Females represented most of them (82.1%). The participants' ages ranged from 10 to 18 years, with the majority of them between the ages of 16 and 18. Self-reported diabetes among students was 9.5%, and the most prevalent type was type 1 diabetes. Regarding the physical activity of the participants, 22.6% of them conduct physical exercise for a duration of more than 30 minutes per day, with a significantly higher percentage among non-diabetics, while 34.6% of the diabetics do not exceed 20 minutes of daily exercise, with a P value of 0.017. School students showed a lack of information about symptoms and complications of DM where only diabetics could mention them when compared with non-diabetic students, with P values of <0.001 for each of them. Diabetic students listed DM risk factors, such as genetics, obesity, and smoking, more frequently than non-diabetics; the corresponding P values were 0.004, 0.001, and 0.041. Unfortunately, more than 32% of diabetic students had the misconception that DM is not a controllable disease. According to the majority of diabetic students, soft drinks raise blood sugar levels. The Internet was the main source of information about DM. CONCLUSION The school students' understanding of DM was generally suboptimal. Their understanding of the symptoms, effects, and management of diabetes was low. Most school students in this cohort perceived that DM could not be controlled. Given the high rate of self-reported diabetes in the western region of Saudi Arabia, it is strongly advised to educate children about DM at an early age. Every student at school should adopt a healthy lifestyle that includes a balanced diet and regular exercise, and they should be closely observed by their teachers and parents. Family physicians should regularly check the adherence of diabetic children to their antidiabetic medications and ensure this important point with their caregivers. Psychological assessment and counseling are highly recommended for all diabetic children.
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Affiliation(s)
- Mohamed Y Alhilali
- College of Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | - Safa Alkalash
- College of Community Medicine and Healthcare, Umm Al-Qura University, Al-Qunfudah, SAU
- College of Family Medicine, Menoufia University, Shebin Elkom, EGY
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20
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Sharma D, Goel NK, Cheema YS, Garg K. Medication Adherence and its Predictors among Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study. Indian J Community Med 2023; 48:781-785. [PMID: 37970170 PMCID: PMC10637603 DOI: 10.4103/ijcm.ijcm_744_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/02/2023] [Indexed: 11/17/2023] Open
Abstract
Medication adherence is vital in managing noncommunicable diseases like diabetes. Illness perception and an individual's knowledge regarding the disease may influence medication adherence. The present study aimed to assess the prevalence and predictors of medication adherence among type 2 diabetic patients. A cross-sectional study was conducted among 400 diabetes mellitus patients attending an outdoor patient department (OPD) of a tertiary care hospital in North India. Brief Medication Questionnaire (BMQ) and Brief Illness Perception Questionnaire (B-IPQ) were used to study medication adherence and illness perception, respectively. Descriptive and analytic statistics were computed using Epi Info software for Windows (CDC, Atlanta, GA, USA). The prevalence of medication adherence was 79.5% (82/400). The odds of medication adherence increased with higher age (odds ratio [OR] = 1.8 [1.1-2.9]) and more duration of illness (OR = 1.8 [1.0-3.2]) Patients having good knowledge of diabetes were more likely to adhere to medications. [OR=1.8(1.1-3.1). Diabetes medicine-adherent patients had a higher perceived understanding of the disease, felt having lesser negative consequences, and were less concerned about the illness than their counterparts. A high proportion adhered to diabetes medication. The guiding factors to further improve medication adherence are age, duration of illness, illness perception, and knowledge regarding the disease.
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Affiliation(s)
- Deepak Sharma
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Naveen Krishan Goel
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Yuvraj Singh Cheema
- General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Keshav Garg
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
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21
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Kaur P, Gomra R, Girdhar S, Sharma S, Chaudhary A. A qualitative study on factors affecting adherence to antidiabetic medication in patients approaching a health center in an urban area. J Family Med Prim Care 2023; 12:1602-1608. [PMID: 37767450 PMCID: PMC10521832 DOI: 10.4103/jfmpc.jfmpc_2107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/01/2023] [Accepted: 04/18/2023] [Indexed: 09/29/2023] Open
Abstract
Aim The aim of this study was to evaluate the factors affecting adherence to antidiabetic medication among diabetic patients in India. Setting and Design A qualitative study was conducted among 40 diabetic patients aged >30 years, on treatment for more than a year without any complications in the Urban Health Centre of Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Materials and Methods A semistructured questionnaire was harnessed to congregate data by interviewing the patients for 30-40 min in person. The interviews were recorded in the form of audios by acquiring informed consent and transcribed verbatim. The factors were then divided into barriers and enablers which were further subdivided into themes and subthemes as a result of which four major themes were built including individual, social, organizational, and community levels. These major themes were further categorized into several subthemes to assess the nonadherence to antidiabetic medications. Results The results of the interviews depicted that the lack of knowledge, financial problems, familial issues, misconceptions regarding the disease, and side effects of taking medications daily were the major altruist for nonadherence, whereas on the other hand, positive perception about the disease, family support, and getting medications on affordable prices by some health-care institutes played an important role in enabling medication adherence as about 50% patients were adherent to the medications. Moreover, various interventions were used to escort the patients regarding medication compliance and blood glucose level monitoring such as lifestyle modifications (diet and exercise), use of reminders for medication intake on time, encouraging them to visit health-care centers, or hospitals on time for regular check-ups and by educating them regarding the long-term effects of diabetes and its prevention.
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Affiliation(s)
- Paawanjot Kaur
- Intern, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rozy Gomra
- Extern, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sangeeta Girdhar
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sarit Sharma
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Anurag Chaudhary
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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22
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Ismail CAN. Issues and challenges in diabetic neuropathy management: A narrative review. World J Diabetes 2023; 14:741-757. [PMID: 37383599 PMCID: PMC10294062 DOI: 10.4239/wjd.v14.i6.741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 04/11/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetic neuropathy (DN) is a devastating disorder with an increasing prevalence globally. This epidemic can pose a critical burden on individuals and com-munities, subsequently affecting the productivity and economic output of a country. With more people living a sedentary lifestyle, the incidence of DN is escalating worldwide. Many researchers have relentlessly worked on ways to combat this devastating disease. Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN. Unfortunately, most of these therapies are only partially effective. Worse still, some are associated with unfavorable side effects. This narrative review aims to highlight current issues and challenges in the management of DN, especially from the perspective of molecular mechanisms that lead to its progression, with the hope of providing future direction in the management of DN. To improve the approaches to diabetic management, the suggested resolutions in the literature are also discussed in this review. This review will provide an in-depth understanding of the causative mechanisms of DN, apart from the insights to improve the quality and strategic approaches to DN management.
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Affiliation(s)
- Che Aishah Nazariah Ismail
- Department of Physiology, School of Medical Sciences, University Sains Malaysia Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
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23
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Sarraf DP, Gupta PP. A hospital-based assessment of glycemic control and medication adherence in type 2 diabetes mellitus in Eastern Nepal. J Family Med Prim Care 2023; 12:1190-1196. [PMID: 37636174 PMCID: PMC10451609 DOI: 10.4103/jfmpc.jfmpc_90_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 03/02/2023] [Indexed: 08/29/2023] Open
Abstract
Background Poor glycemic control in type 2 diabetes mellitus (T2DM) causes damage to various organs and leads to the development of disabling and life-threatening complications. Objectives To find out the prevalence of glycemic control and medication adherence (MA) and the factors affecting them. Methods A cross-sectional study was conducted among patients with T2DM. The patients were categorized as good glycemic control (HbA1c <7.0%) and poor glycemic control (HbA1c ≥7.0%). MA was categorized as low (score <6), medium (score 6 or 7), and high (score 8). The Statistical Package for Social Science (version 11.5) was used for statistical analysis at a P value less than 0.05. Results Of 129 patients, 65 (50.39%) were females. The mean age was 48.33 ± 12.86 years. The combination of metformin and glimepiride was prescribed to 37 (28.68%) patients. Diabetic knowledge was poor in 84 (65.12%) patients. Glycemic control was good in 108 (83.72%) patients. MA was medium in 72 (55.81%) patients. Patients taking regular fruit, having shorter duration of drug therapy, and having good diabetic knowledge had good glycemic control and were statistically significant (P value < 0.05). Patients having family support, nonalcoholic, taking regular fruit, being involved in daily jogging, having shorter duration of drug therapy, and having good diabetic knowledge had high MA and were statistically significant (P value < 0.05). Conclusion The majority of the diabetic patients had good glycemic control and medium MA. Patients taking regular fruit, being involved in daily jogging, having a shorter duration of drug therapy, and having good diabetic knowledge were identified as factors that affect both glycemic control and MA.
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Affiliation(s)
- Deependra Prasad Sarraf
- Department of Clinical Pharmacology and Therapeutics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pramendra Prasad Gupta
- Department of General Practice and Emergency Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Yosef T, Nureye D, Tekalign E, Assefa E, Shifera N. Medication Adherence and Contributing Factors Among Type 2 Diabetes Patients at Adama Hospital Medical College in Eastern Ethiopia. SAGE Open Nurs 2023; 9:23779608231158975. [PMID: 36844422 PMCID: PMC9944187 DOI: 10.1177/23779608231158975] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/28/2022] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Good glycemic control and preventing early complications are the ultimate targets of diabetes management, which depends on patients' adherence to regimens. Even though highly potent and effective medications have been developed and manufactured with astonishing advancement over the past few decades, excellent glycemic control has remained elusive. Objective This study aimed to assess the magnitude and factors associated with medication adherence among type 2 diabetes (T2D) patients on follow-up at Adama Hospital Medical College (AHMC) in East Ethiopia. Methods A hospital-based cross-sectional study was conducted among 245 T2D patients on follow-up at AHMC from March 1 to March 30, 2020. Medication adherence reporting scale-5 (MARS-5) was utilized to collect information regarding patients' medication adherence. The data were entered and analyzed using SPSS (Statistical Package for Social Sciences) version 21. The level of significance was declared at a p-value of < .05. Results Of the 245 respondents, the proportion of respondents who adhere to diabetes medication was 29.4%, 95% CI [confidence interval] (23.7%-35.1%). After adjusting for khat chewing and adherence to blood glucose testing as confounding factors, being married (AOR [adjusted odds ratio] = 3.43, 95%CI [1.27-4.86]), government employee (AOR = 3.75, 95%CI [2.12-7.37]), no alcohol drinking (AOR = 2.25, 95%CI [1.32-3.45]), absence of comorbidity (AOR = 1.49, 95%CI [1.16-4.32]), and having diabetes health education at health institution (AOR = 3.43, 95%CI [1.27-4.86]) were the factors associated with good medication adherence. Conclusion The proportion of T2D patients who adhere to medication in the study area was remarkably low. The study also found that being married, government employee, no alcohol drinking, absence of comorbidity, and having diabetes health education at a health institution were the factors associated with good medication adherence. Therefore, imparting health education on the importance of diabetes medication adherence by health professionals at each follow-up visit should be considered. Besides, awareness creation programs regarding diabetes medication adherence should be considered using mass media (radio and television).
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Affiliation(s)
- Tewodros Yosef
- School of Public Health, College of Medicine and Health Sciences,
Mizan-Tepi
University, Mizan Teferi, Ethiopia,Tewodros Yosef, School of Public Health,
College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi,
Ethiopia.
| | - Dejen Nureye
- School of Pharmacy, College of Medicine and Health Sciences,
Mizan-Tepi
University, Mizan Teferi, Ethiopia
| | - Eyob Tekalign
- Department of Medical Laboratory Science, College of Medicine and
Health Sciences, Mizan-Tepi
University, Mizan Teferi, Ethiopia
| | - Elias Assefa
- School of Public Health, College of Medicine and Health Sciences,
Mizan-Tepi
University, Mizan Teferi, Ethiopia
| | - Nigusie Shifera
- School of Public Health, College of Medicine and Health Sciences,
Mizan-Tepi
University, Mizan Teferi, Ethiopia
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Alfulayw MR, Almansour RA, Aljamri SK, Ghawas AH, Alhussain SS, Althumairi AA, Almuthaffar AA, Alhuwayji KA, Almajed AA, Al-Yateem SS, Alamri AS, Alhussaini NH, Almutairi MA, Alali AO, Alkhateeb AF. Factors Contributing to Noncompliance With Diabetic Medications and Lifestyle Modifications in Patients With Type 2 Diabetes Mellitus in the Eastern Province of Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e31965. [PMID: 36582555 PMCID: PMC9795535 DOI: 10.7759/cureus.31965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is defined as a chronic medical condition in which the blood glucose level remains high. The risk factors of T2DM are high body mass index due to obesity or being overweight, genetics, and certain medical conditions. Lifestyle modification plays a crucial role in T2DM regulation and prevention, and if it is not controlled well by either lifestyle modification or DM regulatory medications, it may lead to medical complications ranging from mild to life-threatening complications. AIM The purpose of this study is to find the contributory factors of noncompliance with oral antidiabetic drugs and lifestyle modifications in patients with T2DM in the eastern province of Saudi Arabia. This will help control one of the most widespread comorbidities that might otherwise be a significant burden on patients' health and financial status as well as on the government. METHODOLOGY A cross-sectional questionnaire study was conducted on T2DM patients in the eastern province of Saudi Arabia through a link distributed on social media, and the contributory factors of noncompliance to diabetes medication and lifestyle modification were evaluated. RESULTS A total of 426 participants were included in the study. Regarding compliance with DM medications, 199 (46.7%) participants were adherent to their medications, 148 (34.7%) were not adherent to their medication, 42 (9.9%) were sometimes adherent, and 37 (8.7%) were mostly adherent to their medication. Regarding lifestyle modification, the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. According to the participants, the most reported factors contributing to noncompliance with DM medications and lifestyle modifications were forgetfulness, lack of knowledge about diabetes and the importance of controlling it, side effects of the medications, and difficulty in following a healthy diet. Regarding the influence of sociodemographic variables on the level of adherence in T2DM patients, factors such as age, marital status, occupation, comorbidities, diagnosis period, and previous complaints of DM complications showed significant associations with compliance with DM medication. CONCLUSION The findings of this study revealed that the level of adherence to DM medications among T2DM patients in the eastern province was suboptimal. Although free medicines were available with a high level of healthcare access through government primary healthcare centers (PHCCs), poor adherence was observed. This study highlighted that medication adherence might be affected by age, marital status, occupation, chronic diseases, diagnosis period, and previous complaints of DM complications. Regarding lifestyle modification, this study showed that the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. Our recommendation is to measure the presence of dietician clinics, patient relationships with their healthcare providers, and their effect on patient compliance with DM medications. Further research is needed to include other factors that could influence adherence, such as patient-healthcare provider communication. Moreover, it is suggested that PHCCs discuss with noncompliant patients the reasons that prevent them from adhering to their medication and lifestyle modifications as part of their care plan.
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Affiliation(s)
| | | | - Sarah K Aljamri
- Medical School, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Asia H Ghawas
- General Practice, Dhurma General Hospital Riyadh Cluster 3, Riyadh, SAU
| | - Sarah S Alhussain
- Medical School, Arabian Gulf University College of Medicine, Manama, BHR
| | | | | | | | | | | | | | | | | | - Abdulrahman O Alali
- General Practice, King Abdulaziz Hospital, Ministry of National Guard Health Affairs (MNGHA), Al-Ahsa, SAU
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Alanazi M, Alatawi AM. Adherence to Diabetes Mellitus Treatment Regimen Among Patients With Diabetes in the Tabuk Region of Saudi Arabia. Cureus 2022; 14:e30688. [DOI: 10.7759/cureus.30688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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Awwad O, AlMuhaissen S, Al-Nashwan A, AbuRuz S. Translation and validation of the Arabic version of the Morisky, Green and Levine (MGL) adherence scale. PLoS One 2022; 17:e0275778. [PMID: 36206237 PMCID: PMC9543961 DOI: 10.1371/journal.pone.0275778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
The Morisky Green Levine (MGL) adherence scale is a 4-item tool used for the detection of medication nonadherence among patients with chronic health conditions. Despite being widely used in Arabic-speaking research contexts, it has never been validated in Arabic language. The aim of this study was to translate and validate the MGL tool into Arabic. A standard forward-backward process was used to translate the questionnaire. Cronbach’s alpha coefficient was measured to assess internal consistency of the scale. The test-retest reliability measured the consistency of participants’ responses over time. Construct validity was evaluated by Explanatory factor analysis (EFA); Kaiser-Meyer-Olkin value and Bartlett’s test of sphericity were determined. Convergent validity was assessed using a preexisting medications Arabic Adherence Assessment Tool (AAAT). The model fit was evaluated using confirmatory factor analysis (CFA). Associations between the MGL scale scores and the patient demographic/clinical characteristics were tested by linear regressions. A total of 201 participants were included into the study. The MGL scale categorization revealed that 20.9%, 59.2% and 19.9% of the participants had high, moderate and low levels of adherence respectively. Adequate internal consistency (alpha = 0.593) was observed. A significant strong ICC and Pearson’s correlations were generated between responses at time 1 and time 2. EFA results elucidated the suitability of the data for factor analysis. Pearson’s coefficient (r) revealed a significant strong correlation between MGL scale and AAAT. CFA results confirmed a good fit for the suggested model. Linear regression revealed higher number of medications, more frequent outpatient clinic visits and not experiencing medication adverse effect factors significantly associated with better adherence. The Arabic version of MLG scale is a reliable valid tool to assess adherence among Arabic-speaking communities. Implementing interventions targeting patients not compliant to regular clinic visits and those at higher risk of experiencing medication side effects can greatly enhance medication adherence.
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Affiliation(s)
- Oriana Awwad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
- * E-mail:
| | - Suha AlMuhaissen
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, University of Jordan, Amman, Jordan
| | - Ayat Al-Nashwan
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
| | - Salahdein AbuRuz
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Chefik FH, Tadesse TA, Quisido BJE, Roba AE. Adherence to insulin therapy and associated factors among type 1 and type 2 diabetic patients on follow up in Madda Walabu University Goba Referral Hospital, South East Ethiopia. PLoS One 2022; 17:e0269919. [PMID: 35704654 PMCID: PMC9200331 DOI: 10.1371/journal.pone.0269919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Non-adherence to insulin therapy is a major global public health issue that has a causal relationship with increased diabetic complications that leads to further increase in the health care cost. However, adherence to insulin therapy and associated factors among diabetic mellitus (DM) patients are still not studied adequately in Ethiopia.
Objective
To assess the adherence to insulin therapy and associated factors among type 1 and type 2 diabetic patients on follow-up at Madda Walabu University—Goba Referral Hospital, South East Ethiopia.
Method
An institution-based, cross-sectional study was employed among 311 both type 1 and type 2 diabetic patients, Madda Walabu University—Goba Referral Hospital from March 4 to April 30, 2020. Study participants were recruited with simple random sampling method. Adherence to insulin therapy was measured by 8-item Morisky medication adherence scale. Therefore from these 8-items, those who score 6 or more are considered as adherent to insulin therapy. The data were collected through interviewer administered questionnaires by trained graduating class nurse students. The data were entered to Epidata version 3.1, and analyzed with SPSS version 25. Bivariate and multivariable logistic regression analyses were used to identify factors associated with adherence to insulin therapy. Statistical significance were declared at p <0.05.
Result
A total of 311 patients participate in the study with response rate of 100%. Among these only 38.9% of them were adherent to insulin therapy with a CI of [33.5, 44.3]. Having glucometer (AOR = 3.88; 95% CI [1.46, 10.35]), regular hospital follow-up (AOR = 3.13; 95% CI [1.12, 8.70]), being knowledgeable (AOR = 3.36; 95% CI [1.53, 7.37]), and favorable attitudes (AOR = 4.55; 95%CI [1.68, 12.34]) were the factor associated with adherence to insulin therapy.
Conclusion
This study concluded that adherence to insulin therapy was low in the study area. Having glucometer, regular hospital follow-up, being knowledgeable, and favorable attitudes were the factor associated with adherence to insulin therapy. Attention should be paid to help diabetic patients on acquiring knowledge regarding the need of consistent adherence to insulin therapy and its complications.
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Affiliation(s)
- Feleke Hailu Chefik
- Department of Nursing, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
- * E-mail:
| | - Tesfaye Assefa Tadesse
- Department of Nursing, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Bruce John Edward Quisido
- Department of Nursing, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Adem Esmael Roba
- Department of Nursing, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
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Lailaturrahmi L, Araswati F, Armenia A, Yosmar R. Effect of Drug Information Service on Clinical Outcome of Patients with Type 2 Diabetes Mellitus in Padang, Indonesia. BORNEO JOURNAL OF PHARMACY 2022. [DOI: 10.33084/bjop.v5i2.3301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) has been a health burden worldwide, including Indonesia. However, T2DM therapy needs a long and complex process, which patients often do not favor, thus making them does not take medications as instructed and negatively affecting clinical outcomes. This study aimed to understand the effect of Drug Information Service provision on the clinical outcome of T2DM patients. This quasi-experimental study was conducted using one group pre-post-test design. As the clinical outcome, the fasting blood glucose levels were measured before and after the intervention. A drug information service was provided through direct explanation to the patients. Sociodemographic data were analyzed descriptively. The difference in fasting blood glucose before and after the intervention was assessed using Wilcoxon signed-rank test. Forty patients participated in this study. Most participants are female (N=34; 85%) and receive two-drugs combination therapy of metformin and sulfonylureas (N=32; 77.5%). Although there is a decrease in mean fasting blood glucose level after intervention (174.92±59.561 vs. 184.20±49.768), there is no significant difference between fasting blood glucose levels pre-intervention and post-intervention (p>0.05). It is concluded that despite the noticeable decline of blood glucose level after drug information service, its effect on blood glucose control is not significant.
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Knowledge about the Risk of Cardiovascular Disease among Adults with Type 2 Diabetes Visiting the Outpatient Clinics at Tertiary Hospital in Riyadh, Saudi Arabia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094996. [PMID: 35564389 PMCID: PMC9103839 DOI: 10.3390/ijerph19094996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/06/2023]
Abstract
Background: One of the primary goals of diabetes management is to prevent cardiovascular events. The rate of cardiovascular diseases (CVDs) is significantly high in the diabetic population. Inadequate knowledge of CVDs risk in diabetes may result in the failure of its early prevention, causing increased morbidity and mortality. The objectives of this study were to assess the CVD risk knowledge and determine the predictors of the knowledge among adults with type 2 diabetes. Methods: A cross-sectional study was conducted to examine the study objectives. Convenience sampling was used to recruit adults with type 2 diabetes mellitus (DM) who visited the King Saud University Medical City (KSUMC) outpatient clinics. Data were collected using the Heart Disease Fact Questionnaire. SPSS software (version 24.0) was used for data analysis. Results: A total of 383 patients were recruited. The level of CVD risk knowledge was high among all participants (19.04 ± 3.47). There were significant differences in knowledge scores between different groups, including age (p = 0.01), marital status (p = 0.01), and type of residence (p = 0.04). Participants who were older than 40 years, married, and lived in traditional houses had higher knowledge scores. Conclusion: The study findings indicated a high level of CVD risk knowledge in our study population. The presence of multidisciplinary intensive education programmes targeting type 2 DM patients, such as that conducted at KSUMC, might be responsible for the higher levels of knowledge among our study population. Thus, increasing the efforts towards the education of patients will improve the level of knowledge, including CVD risk knowledge.
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Fayed A, AlRadini F, Alzuhairi RM, Aljuhani AE, Alrashid HR, Alwazae MM, Alghamdi NR. Relation between diabetes related distress and glycemic control: The mediating effect of adherence to treatment. Prim Care Diabetes 2022; 16:293-300. [PMID: 34922848 DOI: 10.1016/j.pcd.2021.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/19/2022]
Abstract
AIMS Diabetes related distress (DRD) is a negative emotional reaction to stresses associated with diabetes mellitus (DM) and its management. This study estimated the burden of DRD and self-reported adherence to treatment (SRAT) among patients with DM and investigated their relationship with glycemic control. METHODS A cross sectional study of consented 157 diabetics was conducted using the17-item Diabetes Distress Scale (DDS). It measures distress at four subscales: Emotional Burden (EB), Physician-related (PD), Regimen-related (RD) and Interpersonal Distress (ID). SRAT was assessed using Morisky's scale. Glycemic control was assessed using the most recent HbA1c results. Multivariable linear regression analysis was used for adjustment of confounders and bootstrap Confidence Interval was used to test for the occurrence of mediating effect. RESULTS Average age was 44.5 ± 16.0 years, 65% were females, 79% had type 2 DM and nearly 55% has had DM for more than 7 years and the average HbA1c was 8.9 ± 2.2%. Clinically significant DRD was reported by 37% of the participants, EB and RD in 40.8%, PD in 46.5%, and ID among 32.5%. Younger patients showed higher level of stress compared to older participants and patients with type 1 DM showed higher level of stress in all DRD domains. Only 46% of patients were defined as having satisfactory SRAT and improvement of SRAT significantly enhanced the glycemic control (r = -0.32, p < 0.01). DRD and low SRAT negatively correlated with HbA1c; increasing the DRD by one point may increase the HbA1c on average by 0.41 (C.I. 0.02-0.80) and will indirectly raise the HbA1c by 0.24 (C.I. 0.04-0.47) through the mediating effect of low SRAT. CONCLUSION DRD and low SRAT are commonly reported among DM patients and both are indirectly correlated. The mediating effect of low SRAT highlights the clinical role of DRD and clarifies the process by which distress affect the outcome of DM management.
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Affiliation(s)
- Amel Fayed
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, PO Box 84428, Saudi Arabia
| | - Faten AlRadini
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, PO Box 84428, Saudi Arabia.
| | - Ruba Mohammed Alzuhairi
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, PO Box 84428, Saudi Arabia
| | - Afrah Eid Aljuhani
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, PO Box 84428, Saudi Arabia
| | - Hana Rashid Alrashid
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, PO Box 84428, Saudi Arabia
| | - Manal Mohsen Alwazae
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, PO Box 84428, Saudi Arabia
| | - Nuha Ramadan Alghamdi
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, PO Box 84428, Saudi Arabia
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Singh R, Kumari P, Prashar A, Sardana O, Singh V. Assessment of medication adherence among type-2 diabetes mellitus in a tertiary care hospital of North India. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:24951-24955. [PMID: 34826085 DOI: 10.1007/s11356-021-17434-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Study was conducted utilizing a confirmed medication adherence scale to measure the socio-demographic profile, self-care, and medication adherence among Type-2 Diabetes Mellitus (T2DM) patients. The Fisher exact test was used to calculate the level of significance (P) using SPSS (Statistical Package for Social Sciences) Version 21.0. The research presented in this paper uses statistical evidence to assess the numerous aspects that may be linked to medication adherence. A prospective observational study was undertaken on participants visiting the outpatient department for 6 months at a North Indian tertiary care hospital to investigate the pattern and quality of life associated with T2DM. The study examined those who had T2DM for more than 2 years. At the time of the visit, subjects were interviewed using socio demographic information and a structured verified questionnaire. Fisher exact test was used to identify the parameters that were linked to medication adherence, with P0.05 being regarded statistically significant. A total of 350 T2DM outpatients were followed up on, with a male-to-female ratio of 1:0.95. A 13-item medication adherence scale was created and tested, revealing that approximately 32% of participants demonstrated high adherence to anti-diabetic drugs (score = 13). The P value was obtained using Fisher exact test for educational status, occupation, marital status, and the quantity and kind of anti-diabetic drugs was found to be 0.05. Only 32% of the respondents took their diabetes medication as prescribed, indicating the need to improve adherence among T2DM patients. The quantity and kind of anti-diabetic drugs, as well as the patients' educational status, occupation, and marital status, all demonstrated a statistically significant relationship with medication adherence.
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Affiliation(s)
- Ravinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Pratima Kumari
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | | | - Ojus Sardana
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Varinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
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Khayyat YA, Alshamrani RM, Bintalib DM, Alzahrani NA, Alqutub S. Adherence to Hypoglycemic Agents in Type 2 Diabetes Mellitus: A Cross-Sectional Study. Cureus 2022; 14:e22626. [PMID: 35371760 PMCID: PMC8960541 DOI: 10.7759/cureus.22626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/18/2022] Open
Abstract
Aims This study aimed to elucidate the level and determinants of adherence to oral hypoglycemic agents (OHAs) among type 2 diabetes mellitus patients and to employ patient interview as a prediction tool for suboptimal adherence, for preventing and reducing complications. Methods In this analytical, cross-sectional study, 383 patients with type 2 diabetes mellitus were interviewed using an electronic, self-constructed, validated questionnaire. Patients were recruited from all Ministry of Health centers across Jeddah, through stratified random sampling. Univariate and multivariate logistic regression analyses were used to evaluate the significance of the results. Results Suboptimal levels of adherence were reported by 74.9% of the participants. Predictors of suboptimal adherence are as follows: younger age (P = 0.003), employment [odd ratio (OR), 1.7; 95% confidence interval (CI), 1.1-3.0], unavailability of reminder (OR, 1.9; 95% CI, 1.1-3.1), and non-commitment to appointments (OR, 6.1; 95% CI, 1.1-3.1). Conclusion The level of adherence to OHAs was found to be suboptimal. Encountering any of the predictors of suboptimal adherence while interviewing the patient should prompt extra vigilance in the approach. Furthermore, utilizing methods to augment adherence might be prudent.
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Aleppo G, Parkin CG, Carlson AL, Galindo RJ, Kruger DF, Levy CJ, Umpierrez GE, Forlenza GP, McGill JB. Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion. Diabetes Technol Ther 2021; 23:715-725. [PMID: 34077674 PMCID: PMC8573795 DOI: 10.1089/dia.2021.0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Numerous studies have demonstrated the clinical value and safety of insulin pump therapy in type 1 diabetes and type 2 diabetes populations. However, the eligibility criteria for insulin pump coverage required by the Centers for Medicare & Medicaid Services (CMS) discount conclusive evidence that supports insulin pump use in diabetes populations that are currently deemed ineligible. This article discusses the limitations and inconsistencies of the insulin pump eligibility criteria relative to current scientific evidence and proposes workable solutions to address this issue and improve the safety and care of all individuals with diabetes.
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Affiliation(s)
- Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christopher G. Parkin
- Clinical Research, CGParkin Communications, Inc., Henderson, Nevada, USA
- Address correspondence to: Christopher G. Parkin, MS, Clinical Research, CGParkin Communications, Inc., 2352 Martinique Avenue, Henderson, NV 89044, USA.
| | - Anders L. Carlson
- International Diabetes Center, Endocrinologist, Regions Hospital & HealthPartners Clinics, Minneapolis, Minnesota, USA
- Diabetes Education Programs, HealthPartners and Stillwater Medical Group, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Rodolfo J. Galindo
- Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Diabetes Metabolism Research Emory University Hospital Midtown, Atlanta, Georgia, USA
- Hospital Diabetes Taskforce, Emory Healthcare System, Atlanta, Georgia, USA
| | - Davida F. Kruger
- Division of Endocrinology, Diabetes, Bone & Mineral, Henry Ford Health System, Detroit, Michigan, USA
| | - Carol J. Levy
- Division of Endocrinology, Diabetes, and Metabolism, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Mount Sinai Diabetes Center and T1D Clinical Research, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Guillermo E. Umpierrez
- Division of Endocrinology, Metabolism Emory University School of Medicine, Atlanta, Georgia, USA
- Diabetes and Endocrinology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Gregory P. Forlenza
- Barbara Davis Center, Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Denver, Denver, Colorado, USA
| | - Janet B. McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
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Al-Qerem W, Jarab AS, Badinjki M, Hyassat D, Qarqaz R. Exploring variables associated with medication non-adherence in patients with type 2 diabetes mellitus. PLoS One 2021; 16:e0256666. [PMID: 34424940 PMCID: PMC8382191 DOI: 10.1371/journal.pone.0256666] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aims to assess medication adherence and explore its predictors in outpatients with type 2 diabetes. METHOD This cross-sectional study collected socio-demographics, disease-related information, and different biomedical variables for type 2 diabetes patients attending a Jordanian Diabetes center. The four-item medication adherence scale (4-IMAS) and the beliefs about medications questionnaire (BMQ) which includes necessity and concerns were used. Stepwise backward quartile regression models were conducted to evaluate variables associated with the Necessity and Concerns scores. Stepwise ordinal regression was conducted to evaluate variables associated with adherence. RESULTS 287 diabetic patients participated in the study. Almost half of the participants (46.5%) reported moderate adherence and 12.2% reported low adherence. Significant predictors of the adherence were necessity score (OR = 14.86, p <0.01), concern score (OR = 0.36, p <0.05), and frequency of medication administration (OR = 0.88, p- <0.01). Education was a significant predictor of Necessity and Concerns scores (β = 0.48, -0.2, respectively). CONCLUSION Simplifying the medication regimen, emphasizing medication necessity and overcoming medication concerns should be targeted in future diabetes intervention programs to improve medication adherence and hence glycemic control among diabetic patients.
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Affiliation(s)
- Walid Al-Qerem
- Department of pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Anan S. Jarab
- Faculty of Pharmacy, Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Badinjki
- Department of pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Dana Hyassat
- National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
| | - Raghda Qarqaz
- Department of pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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Bonikowska I, Szwamel K, Uchmanowicz I. Analysis of the Impact of Disease Acceptance, Demographic, and Clinical Variables on Adherence to Treatment Recommendations in Elderly Type 2 Diabetes Mellitus Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8658. [PMID: 34444407 PMCID: PMC8391118 DOI: 10.3390/ijerph18168658] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023]
Abstract
This project aimed to analyze the impact of disease acceptance and selected demographic and clinical factors on the adherence to treatment recommendations in elderly type 2 diabetes mellitus patients. The observational study was performed using standardized research questionnaires: the Acceptance of Illness Scale (AIS), the Self-Care of Diabetes Inventory (SCODI), and the Adherence in Chronic Diseases Scale (ACDS). Two hundred patients with T2DM were studied (age M = 70.21 years, SD = 6.63 years). The median degree of disease acceptance was 29 (min-max = 8-40) and the median level of adherence was 24 (min-max = 13-28). Disease acceptance was a significant (p = 0.002) independent predictor of the odds of qualifying for non-adherence OR = 0.903, 95% CI = 0.846-0.963. The respondents gave the lowest scores for glycemic control (Mdn = 38.99, min-max = 8.33-150), and health control (Mdn = 55.88, min-max = 11.76-100). A one-way ANOVA showed that the non-adhering patients were significantly older compared to the adherence group and were taking significantly more diabetes pills per day. The level of disease acceptance was average, but it turned out to be an independent predictor of adherence. Therefore, it is justified to use psychological and behavioral interventions that are aimed at increasing the level of diabetes acceptance in elderly people with T2DM. It is important to have a holistic approach to the patient and to take actions that consider the patient's deficits in the entire biopsychosocial sphere. The obtained result confirmed the legitimacy of interventions aimed at increasing the level of disease acceptance in this group of patients.
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Affiliation(s)
- Iwona Bonikowska
- Institute of Health Sciences, Department Nursing, University of Zielona Góra, 2 Energetyków Street, 65-00 Zielona Góra, Poland
| | - Katarzyna Szwamel
- Institute of Health Sciences, University of Opole, Katowicka Street 68, 45-060 Opole, Poland;
| | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wrocław Medical University, K. Bartla 5, 51-618 Wroclaw, Poland;
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ALquadeib BT, Aloudah NM, Almurshedi AS, ALfagih IM, ALdosari BN, ALmeleky AS, Almubyedh NM. Development and Validation of a Simple and Sensitive LC-MS/MS Method for Quantification of Metformin in Dried Blood Spot Its Application as an Indicator for Medication Adherence. Int J Gen Med 2021; 14:3225-3233. [PMID: 34267540 PMCID: PMC8275188 DOI: 10.2147/ijgm.s312633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Metformin (MET), an oral biguanide agent, can improve insulin resistance and decrease hepatic glucose production, leading to a reduction in blood-sugar levels. The objective of the present study was to develop and validate simple and rapid LC-MS/MS method for analysis of MET in dried blood spot (DBS) sample for patient monitoring studies purposes (drug adherence). METHODS The chromatographic separation was achieved with Waters HSS-T3 column using gradient elution of mobile phases of two solvents: 1) solvent A, consisted of 10mM ammonium formate, 0.2% formic acid 1%; and 2) acetonitrile solvent B, contained 0.2% formic acid in acetonitrile at a flow rate of 0.2 mL/min. The total run time was 3.0 min. The effectiveness of chromatographic conditions was optimized, and afatinib was used as the internal standard. The assay method was validated using USP 26 and the ICH guidelines. RESULTS The method showed good linearity in the range 8-48 ng/mL for MET with correlation coefficient (r) >0.9907. The intra- and inter‑day precision values for MET met the acceptance criteria as per regulatory guidelines. MET was stable during the stability studies at ambient temperature 25 °C, at refrigerator 4 °C, at 10 °C autosampler, freeze/thaw cycles and 30 days storage in a freezer at -30 ± 0.5 °C. CONCLUSION This method has successfully fulfilled all validation requirements referring to EMA and FDA guidelines, and successfully can be applied for MET adherence study. All the six studied patients were approved to metformin adherence.
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Affiliation(s)
- Bushra T ALquadeib
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11671, Saudi Arabia
| | - Nouf M Aloudah
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11671, Saudi Arabia
| | - Alanood S Almurshedi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11671, Saudi Arabia
| | - Iman M ALfagih
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11671, Saudi Arabia
| | - Basmah N ALdosari
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11671, Saudi Arabia
| | - Adim S ALmeleky
- College of Pharmacy, King Saud University, Riyadh, 11671, Saudi Arabia
| | - Nour M Almubyedh
- College of Pharmacy, King Saud University, Riyadh, 11671, Saudi Arabia
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Widayanti AW, Sigalingging KK, Dewi FP, Widyakusuma NN. Issues Affecting Medication-Taking Behavior of People with Type 2 Diabetes in Indonesia: A Qualitative Study. Patient Prefer Adherence 2021; 15:989-998. [PMID: 34040353 PMCID: PMC8139640 DOI: 10.2147/ppa.s301501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE It has been widely acknowledged that non-adherence to medication among people with type 2 diabetes is a significant problem worldwide. Studies have suggested that non-adherence to medication may be caused by the complexity of issues surrounding medication use which further created burdens related to medication. However, studies on this topic in the Indonesian context were still limited. This study aimed to understand the experiences of people with type 2 diabetes in medication-taking and explore any practical issues that potentially affect their behavior when taking medication. METHODS Qualitative phenomenological study with semi-structured interviews was applied. The participants were purposefully recruited and selected from some primary healthcare facilities in Yogyakarta Province. The eligibility criteria included: diagnosed with type 2 diabetes by healthcare professionals for at least six months and were able to comprehend information. Information about the study was explained, and written informed consent was collected. The interviews were recorded, transcribed verbatim, and analyzed with a deductive qualitative content analysis method. RESULTS Fifty-one people with type 2 diabetes were involved in this study. Most of the participants were between 40 and 59 years old, and many of them were female and housewives. The thematic analysis found some practical issues that affected people's behavior in taking type 2 diabetes medication. These included individual's mealtime, characteristics of the medications, accessibility of healthcare services, experiences of side effects and social activities. CONCLUSION The practical issues identified in this study can be resolved by improving the role of healthcare providers in managing people with diabetes. Future research needs to be conducted to evaluate the effectiveness of interventions developed based on understanding of the practical factors identified.
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Affiliation(s)
- Anna Wahyuni Widayanti
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Furi Patriana Dewi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Niken Nur Widyakusuma
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Salama HM, Saudi RA. Effect of patients beliefs about medications on adherence to drugs in diabetic patients attending family medicine outpatient clinic in Ismailia, Egypt. J Diabetes Metab Disord 2021; 19:951-958. [PMID: 33553017 DOI: 10.1007/s40200-020-00587-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022]
Abstract
Background Adherence affected by many factors in the patient or in the treatment. One of these factors is beliefs about medicine, which is modifiable. This study aimed to assess the effect of beliefs about medicines on adherence to medications in diabetic patients. Methods It is a cross-sectional descriptive-analytic study, conducted between March 2019 and June 2019, in Family medicine outpatient clinic, Suez Canal University, Egypt. A consecutive sample of diabetic patients presented to the clinic in the period of study was included until fulfilling sample size (82 patients). They filled validated questionnaires of the Morisky Medication Adherence Scale, Beliefs about Medicine, and socio-demographic characteristics. Results About half of the patients were non-adherent (54.9%). The necessity beliefs mean was 18.6, while the median was 20, concerns beliefs mean was 14.2, while the median was 14, overuse beliefs mean was 12.2, while the median was 13, finally mean and median of harm score was 11.0. There was a statistically significant relationship between age, education, concern, and harm score with adherence (p = 0.04, 0.02, < 0.001, and 0.03). Age was a positive predictor of adherence; and concern beliefs score was a negative predictor of adherence. Conclusions Physicians should inquire about their patient medication beliefs and its effect on patient adherence to discover and solve concerns of diabetic patients to improve non-adherence.
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Affiliation(s)
- Hend Mikhail Salama
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Rabab Atta Saudi
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Siraj J, Abateka T, Kebede O. Patients’ Adherence to Anti-diabetic Medications and Associated Factors in Mizan-Tepi University Teaching Hospital: A Cross-Sectional Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211067477. [PMID: 34932417 PMCID: PMC8721716 DOI: 10.1177/00469580211067477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction: A number of medications have been demonstrated to lower blood glucose. However, current-day management has failed to achieve and maintain the optimal glycemic level for diabetic patients. Patients’ non-adherence is among the most contributing factors. Therefore, the aim of this study was to explore the prevalence of non-adherence to anti-diabetic medications and associated factors. Methods: A hospital based cross-sectional study was conducted from November 2020 to January 2021. A systematic random sampling technique was used. Data were collected by structured questionnaire adapted from different literatures. Then, data were entered into SPSS version 25 and analyzed. To determine the association of dependent and independent variables, multiple logistic regression was done. P-value <.05 was considered statistically significant. Results: A total of 275 study participants were interviewed with a response rate of 100%. From this 53.8% were females, 59.3% were in the age group of 41-60 years, 35.3% were college/university graduates and 79.3% were not using social drugs. One hundred eighty-seven (68%) of them were adherent to their anti-diabetic medication. Factors found to be significantly associated with anti-diabetic medication adherence were age >60 years (AOR = .276, 95% CI = .124-.611) attending higher education (AOR = 6.203, 95% CI = 1.775-21.93), retired (AOR = 7.771, 95% CI = 1.458-41.427), housewife (AOR = 7.023, 95% CI = 1.485-33.215), average monthly income 1001birr-2000 birr (AOR = .246, 95% CI = .067-.911) and social drug use (AOR = 3.695, 95% CI = 1.599-8.542). Forgetfulness, not affording, side effects, misunderstanding of instructions, and poly-pharmacy were identified reasons for non-adherence. Conclusions and Recommendations: Patients’ adherence to anti-diabetic medications in the current study is sub-optimal. Age, monthly income, level of education, occupational status, and social drug use were associated with adherence. Forgetfulness, not affording, and side effects were reasons identified to contribute to non-adherence. Therefore, adherence counseling, use of alarms, and the way to mitigate non-affordability, including anti-diabetic medications into a program drug should be considered.
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Affiliation(s)
- Jafer Siraj
- Department of Pharmacology and Pharmaceutical chemistry, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Turi Abateka
- Mizan-Tepi University students’ clinic, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Oliyad Kebede
- Department of Social Pharmacy and Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Prabahar K, Albalawi MA, Almani L, Alenizy S. Assessment of Medication Adherence in Patients with Chronic Diseases in Tabuk, Kingdom of Saudi Arabia. J Res Pharm Pract 2020; 9:196-201. [PMID: 33912502 PMCID: PMC8067897 DOI: 10.4103/jrpp.jrpp_20_97] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/17/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Uncontrolled chronic diseases such as hypertension and diabetes mellitus can lead to severe complications. Poor adherence to medication is one of the important reasons, leading to complications for chronically diseased patients. We aimed to assess the trend toward medication adherence and the reasons for medication nonadherence in chronic disease patients in Tabuk city in Saudi Arabia. METHODS A cross-sectional study was conducted at a tertiary care hospital in Tabuk, Saudi Arabia. Participants were selected and interviewed for information regarding their medication adherence. A medication adherence rating scale questionnaire was used to measure the level of adherence in study participants. The data were analyzed by the statistical package for the social sciences (SPSS) database 24. FINDINGS Overall, 208 participants were involved in this study. Among these, 134 (64.4%) were female, and 74 (35.6%) were male. This study showed that 159 (76.44%) participants were adherent to their medications and nearly one-quarter of patients were nonadherent to their medications. No statistically significant differences were found between male and female patients toward their medication adherence. The primary intentional and nonintentional reason for nonadherence was side effects and forgetfulness, respectively. CONCLUSION Tailoring the therapy according to the individual need of the patients will maximize the patient's adherence toward medications.
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Affiliation(s)
- Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Lama Almani
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Sarah Alenizy
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
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Naqvi AA, Mahmoud MA, AlShayban DM, Alharbi FA, Alolayan SO, Althagfan S, Iqbal MS, Farooqui M, Ishaqui AA, Elrggal ME, Haseeb A, Hassali MA. Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses. Saudi Pharm J 2020; 28:1055-1061. [PMID: 32922135 PMCID: PMC7474165 DOI: 10.1016/j.jsps.2020.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/24/2020] [Indexed: 02/09/2023] Open
Abstract
PURPOSE The study aimed to translate and validate the Arabic version of General Medication Adherence Scale (GMAS) in Saudi patients with chronic diseases. METHODS A multi-center cross sectional study was conducted for a month in out-patient wards of hospitals in Khobar, Dammam, Makkah, and Madinah, Saudi Arabia. Patients were randomly selected from a registered patient pools at hospitals and the item-subject ratio was kept at 1:20. The tool was assessed for factorial, construct, convergent, known group and predictive validities as well as, reliability and internal consistency of scale were also evaluated. Sensitivity, specificity, and accuracy were also evaluated. Data were analyzed using SPSS v24 and MedCalc v19.2. The study was approved by concerned ethics committees (IRB-129-25/6/1439) and (IRB-2019-05-002). RESULTS A total of 282 responses were received. The values for normed fit index (NFI), comparative fit index (CFI), Tucker Lewis index (TLI) and incremental fit index (IFI) were 0.960, 0.979, 0.954 and 0.980. All values were >0.95. The value for root mean square error of approximation (RMSEA) was 0.059, i.e., <0.06. Hence, factorial validity was established. The average factor loading of the scale was 0.725, i.e., >0.7, that established convergent validity. Known group validity was established by obtaining significant p-value <0.05, for the associations based on hypotheses. Cronbach's α was 0.865, i.e., >0.7. Predictive validity was established by evaluating odds ratios (OR) of demographic factors with adherence score using logistic regression. Sensitivity was 78.16%, specificity was 76.85% and, accuracy of the tool was 77.66%, i.e., >70%. CONCLUSION The Arabic version of GMAS achieved all required statistical parameters and was validated in Saudi patients with chronic diseases.
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Affiliation(s)
- Atta Abbas Naqvi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mansour Adam Mahmoud
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Dhfer Mahdi AlShayban
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fawaz Abdullah Alharbi
- Drug Information and Poison Center, Alansar Hospital, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Sultan Othman Alolayan
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Sultan Althagfan
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Azfar Athar Ishaqui
- Department of Pharmacy, King Abdulaziz Hospital, National Guard Health Authority, Alahsa, Saudi Arabia
| | - Mahmoud E. Elrggal
- Pharmaceutical Research Center, Deanship of Scientific Research, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Mansour AA, Alibrahim NTY, Alidrisi HA, Alhamza AH, Almomin AM, Zaboon IA, Kadhim MB, Hussein RN, Nwayyir HA, Mohammed AG, Al-Waeli DKJ, Hussein IH. Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period. Diabetes Metab Syndr 2020; 14:265-272. [PMID: 32272433 DOI: 10.1016/j.dsx.2020.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period. METHODS A total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3-12 months. RESULTS Patients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m2 and presence of hypertension were associated with a decreased risk of poor glycemic control. CONCLUSION Using data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.
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Affiliation(s)
- Abbas Ali Mansour
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq.
| | - Nassar T Y Alibrahim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Haider A Alidrisi
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ali H Alhamza
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ammar M Almomin
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ibrahim Abbood Zaboon
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Muayad Baheer Kadhim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Rudha Naser Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Hussein Ali Nwayyir
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Adel Gassab Mohammed
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Dheyaa K J Al-Waeli
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
| | - Ibrahim Hani Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah Health Directorate, University of Basrah, Basrah, Iraq
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