1
|
Rosenstock J, Juneja R, Beals JM, Moyers JS, Ilag L, McCrimmon RJ. The Basis for Weekly Insulin Therapy: Evolving Evidence With Insulin Icodec and Insulin Efsitora Alfa. Endocr Rev 2024; 45:379-413. [PMID: 38224978 PMCID: PMC11091825 DOI: 10.1210/endrev/bnad037] [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: 05/05/2023] [Indexed: 01/17/2024]
Abstract
Basal insulin continues to be a vital part of therapy for many people with diabetes. First attempts to prolong the duration of insulin formulations were through the development of suspensions that required homogenization prior to injection. These insulins, which required once- or twice-daily injections, introduced wide variations in insulin exposure contributing to unpredictable effects on glycemia. Advances over the last 2 decades have resulted in long-acting, soluble basal insulin analogues with prolonged and less variable pharmacokinetic exposure, improving their efficacy and safety, notably by reducing nocturnal hypoglycemia. However, adherence and persistence with once-daily basal insulin treatment remains low for many reasons including hypoglycemia concerns and treatment burden. A soluble basal insulin with a longer and flatter exposure profile could reduce pharmacodynamic variability, potentially reducing hypoglycemia, have similar efficacy to once-daily basal insulins, simplify dosing regimens, and improve treatment adherence. Insulin icodec (Novo Nordisk) and insulin efsitora alfa (basal insulin Fc [BIF], Eli Lilly and Company) are 2 such insulins designed for once-weekly administration, which have the potential to provide a further advance in basal insulin replacement. Icodec and efsitora phase 2 clinical trials, as well as data from the phase 3 icodec program indicate that once-weekly insulins provide comparable glycemic control to once-daily analogues, with a similar risk of hypoglycemia. This manuscript details the technology used in the development of once-weekly basal insulins. It highlights the clinical rationale and potential benefits of these weekly insulins while also discussing the limitations and challenges these molecules could pose in clinical practice.
Collapse
Affiliation(s)
- Julio Rosenstock
- Velocity Clinical Research at Medical City,
Dallas, TX 75230, USA
| | - Rattan Juneja
- Lilly Diabetes and Obesity, Eli Lilly and Company,
Indianapolis, IN 46225, USA
| | - John M Beals
- Lilly Diabetes and Obesity, Eli Lilly and Company,
Indianapolis, IN 46225, USA
| | - Julie S Moyers
- Lilly Diabetes and Obesity, Eli Lilly and Company,
Indianapolis, IN 46225, USA
| | - Liza Ilag
- Lilly Diabetes and Obesity, Eli Lilly and Company,
Indianapolis, IN 46225, USA
| | - Rory J McCrimmon
- School of Medicine, University of Dundee, Dundee
DD1 9SY, Scotland, UK
| |
Collapse
|
2
|
Akkuş Y, Kiliç SP. Feelings, Difficulties and Attitudes in relation to Fasting: A Qualitative Study on Spiritual Coping Among Turkish Patients with Type 2 Diabetes. JOURNAL OF RELIGION AND HEALTH 2023; 62:4382-4398. [PMID: 36495355 DOI: 10.1007/s10943-022-01713-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
This study aims to reveal the feelings, difficulties, attitudes, and spiritual coping status of Turkish patients with Type 2 diabetes mellitus toward fasting during Ramadan. The sample of this descriptive qualitative study consists of 14 patients diagnosed with Type 2 diabetes. We determined two main themes and relevant sub-themes. The first was "the feelings and difficulties experienced due to diabetes mellitus" with the sub-themes of "negative emotions" and "difficulties in fasting." The second theme was identified as "religious and spiritual coping" with the sub-themes of "believing the disease comes from God," "having difficulty in adhering to disease-specific practices while fasting," and "feeling that fasting facilitates coping and provides relief." In conclusion, it was determined that the patients continued to fast despite the difficulties and that fasting facilitated coping and provided relaxation.
Collapse
Affiliation(s)
- Yeliz Akkuş
- Nursing Department, Faculty of Health Science, Kafkas University, 36100, Kars, Turkey.
| | | |
Collapse
|
3
|
Alzahrani AM, Alshareef RJ, Balubaid MM, Alzahrani M, Alsoubhi M, Shaheen M. Perception and attitude of type 2 diabetic patients toward insulin therapy in the primary care of National Guard for Health Affairs (NGHA) in Jeddah, Saudi Arabia. J Family Med Prim Care 2023; 12:2768-2773. [PMID: 38186793 PMCID: PMC10771210 DOI: 10.4103/jfmpc.jfmpc_2484_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: 12/23/2022] [Revised: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose/Background Our study explores and determines the perception toward insulin among patients with diabetes in the National Guard for Health Affairs (NGHA), Jeddah, the Kingdom of Saudi Arabia (KSA), and aims to gain insight into the causes of refusal. Patients with type 2 diabetes (T2D) are likely to need the use of insulin to keep blood glucose levels within normal range and delay the onset of diabetes-related problems. Individuals with diabetes may be hesitant to begin insulin therapy if they have a negative attitude toward it, which might add to the delay in beginning treatment. Materials and Methods A cross-sectional study was conducted in the primary healthcare centers of the NGHA in Jeddah, Saudi Arabia. Data were collected through a validated self-administered questionnaire that was divided into three sections, with a total of 32 questions. The first section concerned demographic data, the second part was directed toward insulin users, and the last section was directed toward non-insulin patients. Results and Conclusion Our study collected 314 responses. Males constituted 54.8% of participants and insulin users resembled 45.7%. According to our study, important deterrents to starting insulin therapy among non-insulin users included the following: the cost of insulin, the pain associated with injections, the difficulty in maintaining food control while on insulin treatment, scarring at the injection site, and the weight gain impact. Factors that were found to influence compliance to insulin therapy among insulin users included fear of weight gain and self-administration of insulin.
Collapse
Affiliation(s)
- Abdullah M. Alzahrani
- Department of Family Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Reem J. Alshareef
- Department of Family Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Marwan M. Balubaid
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Alzahrani
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Alsoubhi
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mostafa Shaheen
- Department of Health Science, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| |
Collapse
|
4
|
Kuratli OA, Gross C, Laimer M, Melmer A. Analysis of diabetes attitudes, wishes and needs in Switzerland, the Swiss DAWN2™ Study. Swiss Med Wkly 2023; 153:40023. [PMID: 37233990 DOI: 10.57187/smw.2023.40023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
AIMS OF THE STUDY Swiss DAWN2™ aimed to evaluate the difficulties and unmet needs of individuals with diabetes and stakeholders, based on the assessments of diabetes care and self-management: the individual burden of disease, the perception of the quality of medical care, and the treatment satisfaction of individuals with diabetes living in the Canton of Bern. The results of the Swiss cohort were analysed and compared with the global DAWN2™ results. METHODS 239 adult individuals with diabetes were enrolled in a cross-sectional study at the Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism at the University Hospital of Bern between 2015 and 2017. The participants completed validated online questionnaires regarding health-related quality of life (EQ-5D-3L) and emotional distress (PAID-5), diabetes self-care activities (SDSCA-6), treatment satisfaction (PACIC-DSF), and health-related wellbeing (WHO-5). Eligibility criteria were as follows: participants were aged >18 years, had a diagnosis of diabetes type 1 or 2 since at least 12 months and gave written informed for the participation in the present study. RESULTS When compared globally, the Swiss cohort reported a higher quality of life (77.28 ± 16.73 vs. 69.3 ± 17.9 EQ-5D-3L score, p <0.001) and lower emotional distress (22.28 ± 20.94 vs. 35.2 ± 24.2 PAID-5 score, p = 0.027). Higher frequencies of self-measurement of blood glucose (6.43 ± 1.68 vs. 3.4 ± 2.8 SDSCA-6 score, p <0.001) and physical activity (4.40 ± 2.04 vs. 3.8 ± 2.7 SDSCA-6 score, p = 0.05) were reported. PACIC-DSF revealed higher satisfaction concerning organisational aspects of patient care (60.3 ± 1.51 vs. 47.3 ± 24.3, p<0.001) and higher health-related well-being as compared to the global score (71.38 ± 23.31 vs. 58 ± 13.8 WHO-5 Well-Being Index, p <0.001). HbA1c >7% correlated to emotional distress (PAID-5, 26.08 ± 23.37 vs. 18.80 ± 17.49, p = 0.024), unfavourable eating habits (4.28 ± 2.22 vs. 4.99 ± 2.15, p = 0.034) and decreased physical activity (3.95 ± 2.16 vs. 4.72 ± 1.92, p = 0.014). Sleeping problems were most commonly reported (35.6%). In total, 28.8% of respondents completed diabetes-related educational programs. CONCLUSION In global comparison, Swiss DAWN2™ showed a lower burden of disease and yet a higher level of treatment satisfaction in patients who were treated in Switzerland. Further studies are required to assess the quality of diabetes treatment and unmet needs in patients treated outside of a tertiary care center.
Collapse
Affiliation(s)
- Oliver Andreas Kuratli
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Carolina Gross
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Melmer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Li H, Wang L, Huang J, Li B, Qiu T. The relationship between the knowledge of diabetes mellitus and the mental, psychological and emotional status of T2DM patients based on a structural equation model. Sci Rep 2022; 12:20714. [PMID: 36456701 PMCID: PMC9715717 DOI: 10.1038/s41598-022-25211-4] [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: 03/15/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
To explore diabetes-related knowledge levels among patients with type 2 diabetes mellitus (T2DM) and the influencing factors, correlations and paths of patients' mental and emotional status based on a structural equation model. A total of 1512 patients with T2DM in 18 tertiary general hospitals in Hunan Province. A descriptive correlational study. The study was conducted and surveyed with the general information questionnaires, including the Audit of Diabetes Knowledge (AD knowl), the Problem Areas in Diabetes 5 scale (PAID-5) and the World Health Organization Five-Item Well-Being Index (WHO-5). The structural equation model showed that PAID-5 and WHO-5 scores (P < 0.05) were affected by diabetes self-management, medical history/treatment and knowledge. According to the model, the common risk factors affecting the mental and emotional status of diabetic patients were general demographic characteristics (less exercise time and greater economic burden), medical history/treatment of diabetes (longer course of disease, more hospitalizations due to diabetes, and more acute or chronic complications), and lower levels of diabetes-related knowledge. In addition, solitude was also a risk factor for low levels of happiness. The diabetes-related knowledge levels of T2DM patients are very low, and these patients generally experience emotional disorders, which deserves close attention. The structural equation model can be used to explore the influencing factors and correlations of the psychological and emotional status of diabetic patients.
Collapse
Affiliation(s)
- Haiyang Li
- grid.452708.c0000 0004 1803 0208Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Liping Wang
- grid.452708.c0000 0004 1803 0208Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Jin Huang
- grid.452708.c0000 0004 1803 0208Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Bei Li
- grid.452708.c0000 0004 1803 0208Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Tieying Qiu
- grid.452708.c0000 0004 1803 0208Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011 China
| |
Collapse
|
6
|
Pilv L, Vermeire EIJJ, Rätsep A, Moreau A, Petek D, Yaman H, Oona M, Kalda R. Diabetes-related quality of life in six European countries measured with the DOQ-30. Eur J Gen Pract 2021; 27:191-197. [PMID: 34338125 PMCID: PMC8330755 DOI: 10.1080/13814788.2021.1954615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The quantification of diabetes-related quality of life (DR-QoL) is an essential step in making Type 2 Diabetes (T2DM) self-management arrangements. The European General Practitioners Research Network (EGPRN) initiated the EUROBSTACLE study to develop a broadly conceptualised DR-QoL instrument for diverse cultural and ethnic groups; high and low-income countries. In 2016 the Diabetes Obstacles Questionnaire-30 (DOQ-30) was introduced. Objectives The research aimed to study obstacles a patient with diabetes (PWD) may face in everyday life. First, we assessed how descriptive and clinical characteristics and the residential country were associated with the obstacles. Secondly, we calculated the proportion of respondents who expressed obstacles. Methods Data were collected in 2009 in a cross-sectional survey in Belgium, France, Estonia, Serbia, Slovenia, and Turkey. Multiple linear regressions were computed to detect associations between descriptive and clinical characteristics, residential country, and obstacles. Percentages of respondents who perceived obstacles were calculated. Results We found that although descriptive and clinical characteristics varied to quite a great extent, they were weakly associated with the perception of obstacles. The residential country was most often associated with the existence of some obstacle. The highest percent (48%) of all respondents perceived ‘Uncertainty about Insulin Use’ as an obstacle. Conclusion Descriptive and clinical characteristics were weakly associated with perceived obstacles. However, the residential country plays an essential role in the decline of the QoL of PWDs. Education of both PWDs and healthcare professionals (HCPs) plays an essential role in countering the fear of insulin.
Collapse
Affiliation(s)
- Liina Pilv
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Anneli Rätsep
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Alain Moreau
- Department of Family Medicine, University Claude Bernard Lyon, Lyon, France
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Marje Oona
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| |
Collapse
|
7
|
Adé A, Debroucker F, Delporte L, De Monclin C, Fayet E, Legendre P, Radoszycki L, Chekroun M. Chronic patients' satisfaction and priorities regarding medical care, information and services and quality of life: a French online patient community survey. BMC Health Serv Res 2020; 20:511. [PMID: 32503523 PMCID: PMC7275411 DOI: 10.1186/s12913-020-05373-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The French healthcare system is evolving to meet the challenges of an aging population, the growing prevalence of chronic diseases, the development of new technologies and the increasing involvement of patients in the management of their disease. The aim of this study is to assess the satisfaction and priorities of chronic patients regarding medical care, information and services and their quality of life. METHODS A cross-sectional study was conducted from February to March 2018 via the French Carenity platform. Adult patients enrolled in type 1 diabetes, heart failure or obesity communities were invited to answer an online questionnaire. A numeric scale from 0 (meaning not satisfied) to 5 was used to evaluate patients' satisfaction. Patients' priorities were assessed using a ranking question. Patients' satisfaction and priorities have been combined in a matrix to identify patients' expectations. RESULTS Sixty-seven respondents of each condition answered a questionnaire. The most important and least satisfactory items about medical care are availability and active listening from healthcare providers, as well as access to coordinated and multidisciplinary care. Regarding information and services, respondents mostly expect connected medical devices, in addition to lifestyle and dietary measures. As for the quality of life, respondents fear that their chronic condition will keep impacting their daily mood and ability to do physical activities. CONCLUSIONS This study shows that chronic patients want to be more actively involved in their care pathway. Patient training and therapeutic patient education programs could help them manage their chronic conditions within a patient-centred healthcare system.
Collapse
|
8
|
Guerci B, Charbonnel B, Gourdy P, Hadjadj S, Hanaire H, Marre M, Vergès B. Efficacy and adherence of glucagon-like peptide-1 receptor agonist treatment in patients with type 2 diabetes mellitus in real-life settings. DIABETES & METABOLISM 2019; 45:528-535. [DOI: 10.1016/j.diabet.2019.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/05/2019] [Accepted: 01/14/2019] [Indexed: 12/25/2022]
|
9
|
Lognos B, Carbonnel F, Boulze Launay I, Bringay S, Guerdoux-Ninot E, Mollevi C, Senesse P, Ninot G. Complementary and Alternative Medicine in Patients With Breast Cancer: Exploratory Study of Social Network Forum Data. JMIR Cancer 2019; 5:e12536. [PMID: 31774404 PMCID: PMC6906617 DOI: 10.2196/12536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 05/24/2019] [Accepted: 08/31/2019] [Indexed: 12/12/2022] Open
Abstract
Background Patients and health care professionals are becoming increasingly preoccupied in complementary and alternative medicine (CAM) that can also be called nonpharmacological interventions (NPIs). In just a few years, this supportive care has gone from solutions aimed at improving the quality of life to solutions intended to reduce symptoms, supplement oncological treatments, and prevent recurrences. Digital social networks are a major vector for disseminating these practices that are not always disclosed to doctors by patients. An exploration of the content of exchanges on social networks by patients suffering from breast cancer can help to better identify the extent and diversity of these practices. Objective This study aimed to explore the interest of patients with breast cancer in CAM from posts published in health forums and French-language social media groups. Methods The retrospective study was based on a French database of 2 forums and 4 Facebook groups between June 3, 2006, and November 17, 2015. The extracted, anonymized, and compiled data (264,249 posts) were analyzed according to the occurrences associated with the NPI categories and NPI subcategories, their synonyms, and their related terms. Results The results showed that patients with breast cancer use mainly physical (37.6%) and nutritional (31.3%) interventions. Herbal medicine is a subcategory that was cited frequently. However, the patients did not mention digital interventions. Conclusions This exploratory study of the main French forums and discussion groups indicates a significant interest in CAM during and after treatments for breast cancer, with primarily physical and nutritional interventions complementing approved treatments. This study highlights the importance of accurate information (vs fake medicine), prescription and monitoring of these interventions, and the mediating role that health professionals must play in this regard.
Collapse
Affiliation(s)
- Béatrice Lognos
- Research Unit EA4556 Epsylon, University of Montpellier, University Paul Valéry, Montpellier, France.,Plateforme universitaire Collaborative d'Evaluation des programmes de Prévention et de Soins de support, University of Montpellier, University Paul Valéry, Montpellier, France.,University Department of General Practice, University of Montpellier, Montpellier, France
| | - François Carbonnel
- Research Unit EA4556 Epsylon, University of Montpellier, University Paul Valéry, Montpellier, France.,Plateforme universitaire Collaborative d'Evaluation des programmes de Prévention et de Soins de support, University of Montpellier, University Paul Valéry, Montpellier, France.,University Department of General Practice, University of Montpellier, Montpellier, France.,University Multiprofessional Health Center Avicenne, Cabestany, France
| | - Isabelle Boulze Launay
- Research Unit EA4556 Epsylon, University of Montpellier, University Paul Valéry, Montpellier, France.,Plateforme universitaire Collaborative d'Evaluation des programmes de Prévention et de Soins de support, University of Montpellier, University Paul Valéry, Montpellier, France
| | - Sandra Bringay
- Research Unit 5506, Laboratoire d'informatique, de Robotique et de Microélectronique de Montpellier, Unité Mixte de Recherche, University of Montpellier, Montpellier, France
| | - Estelle Guerdoux-Ninot
- Plateforme universitaire Collaborative d'Evaluation des programmes de Prévention et de Soins de support, University of Montpellier, University Paul Valéry, Montpellier, France.,Institut du Cancer de Montpellier, Montpellier, France
| | - Caroline Mollevi
- Plateforme universitaire Collaborative d'Evaluation des programmes de Prévention et de Soins de support, University of Montpellier, University Paul Valéry, Montpellier, France.,Institut du Cancer de Montpellier, Montpellier, France
| | - Pierre Senesse
- Research Unit EA4556 Epsylon, University of Montpellier, University Paul Valéry, Montpellier, France.,Plateforme universitaire Collaborative d'Evaluation des programmes de Prévention et de Soins de support, University of Montpellier, University Paul Valéry, Montpellier, France.,Institut du Cancer de Montpellier, Montpellier, France
| | - Gregory Ninot
- Research Unit EA4556 Epsylon, University of Montpellier, University Paul Valéry, Montpellier, France.,Plateforme universitaire Collaborative d'Evaluation des programmes de Prévention et de Soins de support, University of Montpellier, University Paul Valéry, Montpellier, France.,Institut du Cancer de Montpellier, Montpellier, France
| |
Collapse
|
10
|
Guerci B, Chanan N, Kaur S, Jasso-Mosqueda JG, Lew E. Lack of Treatment Persistence and Treatment Nonadherence as Barriers to Glycaemic Control in Patients with Type 2 Diabetes. Diabetes Ther 2019; 10:437-449. [PMID: 30850934 PMCID: PMC6437240 DOI: 10.1007/s13300-019-0590-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 01/01/2023] Open
Abstract
Treatment persistence (continuing to take medication for the prescribed period) and treatment adherence (complying with the prescription in terms of drug schedules and dosage) are both important when treating chronic diseases such as type 2 diabetes (T2D). They can be indicators of patient satisfaction with treatment. In T2D, the achievement of optimal outcomes requires both persistence with and adherence to prescribed therapy. Poor persistence with and adherence to T2D medication can have profound consequences for the patient, including non-achievement of glycaemic goals and an increased risk of long-term complications and mortality. Therefore, poor treatment persistence and adherence may also have economic consequences, including increased healthcare resource utilization and healthcare costs. Treatment persistence and adherence are affected by several factors, including the mode of administration, administration frequency/regimen complexity, and patient expectations. The aims of this review are as follows: to provide an overview of persistence with and adherence to different antidiabetes therapies for patients with T2D in the real-world setting; examine factors contributing to poor treatment persistence and adherence; and assess available data on the impact of poor treatment persistence and/or adherence on clinical and economic outcomes. Numerous potential targets for improving treatment persistence and/or adherence are identified, including developing less complex treatment regimens with lower pill burdens or less frequent injections, improving the convenience of drug-delivery systems, such as the use of insulin pen devices rather than the conventional vial and syringe, and developing therapies with an improved safety profile to alleviate patient fears of adverse effects, such as weight gain and risk of hypoglycaemia.Funding: Sanofi.
Collapse
Affiliation(s)
- Bruno Guerci
- Brabois Hospital and CIC INSERM ILCV, University Hospital of Nancy, Vandoeuvre Lès Nancy, France.
| | | | | | | | | |
Collapse
|
11
|
Cosson E, Mauchant C, Benabbad I, Le Pape G, Le Bleis M, Bailleul F, Lalau JD. Perceptions of insulin therapy in people with type 2 diabetes and physicians: a cross-sectional survey conducted in France. Patient Prefer Adherence 2019; 13:251-260. [PMID: 30804666 PMCID: PMC6375534 DOI: 10.2147/ppa.s181363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate perceptions of people with type 2 diabetes (T2D) and treating physicians living in France toward insulin therapy. METHODS Adults with T2D receiving oral glucose-lowering treatment alone (INS-) or basal insulin for ≥2 months (INS+) completed an online cross-sectional survey comprising 39 questions, including some regarding perceptions and fears of insulin therapy. Physicians were interviewed by telephone using eleven similar questions. The survey was designed by French clinicians experienced in treating diabetes and conducted under the auspices of an independent market-research agency. RESULTS The questionnaire was completed by 590 adults with T2D (two-thirds INS+) and 130 physicians (65 diabetologists/endocrinologists, 65 general practitioners). INS+ adults reported fewer negative feelings and more positive feelings than INS- adults. Two-thirds of INS+ adults reported that transitioning to insulin therapy was less difficult than expected. Overall, 44% of INS+ adults and 26% of physicians reported a fear of diabetic complications as being important, and 80% of physicians and 21% of INS+ adults considered injections to be a major patient fear. CONCLUSION Most people with T2D reported that transitioning to insulin therapy was less difficult than they had feared. People with T2D and physicians exhibited differing perceptions regarding the transition. Reasons for the apprehension surrounding the transition to insulin therapy in people with T2D need to be better identified. Support from insulin-treated peers may enable this transition to occur with fewer anxieties in insulin-naïve people with T2D.
Collapse
Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, Paris, France,
- Nutritional Epidemiology Research Unit, UMR U1153 INSERM/U11125 INRA/CNAM/Paris 13 University, Bobigny, Paris, France,
| | | | | | | | | | | | - Jean-Daniel Lalau
- Department of Endocrinology-Diabetology-Nutrition, Amiens University Medical Center, Amiens, France
- PériTox Laboratory (UMR-I 01), Jules Verne University of Picardy, Amiens, France
| |
Collapse
|
12
|
Yazla E, Karadere ME, Küçükler FK, Karşıdağ Ç, İnanç L, Kankoç E, Dönertaş M, Demir E. The Effect of Religious Belief and Forgiveness on Coping with Diabetes. JOURNAL OF RELIGION AND HEALTH 2018; 57:1010-1019. [PMID: 29022162 DOI: 10.1007/s10943-017-0504-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We aimed to investigate the relationship of religious beliefs and forgiveness in diabetic patients with various sociodemographic characteristics, emotional problems and glycaemic control. The study comprises 100 patients diagnosed with type 2 DM. We used a data collection form, the Scale of Forgiveness and Religiosity (SFR), Problem Areas in Diabetes Scale (PAID), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and the Audit of Diabetes-Dependent Quality of Life (ADDQoL). We also recorded blood glucose and HbA1c test results. A statistically significant relationship was determined only between the scores of the STAI-I and the religious belief scales (r = 0.198, p = 0.049). A statistically significant negative relationship was determined between the forgiveness scale points and the BDI (r = 0.326, p = 0.001), the STAI-II (r = 0.308, p = 0.002) and PAID (r = 0.313, p = 0.001) and a positive correlation with ADDQoL (r = 0.284, p = 0.004). To conclude, forgiveness by patient himself or others reduced the emotional problems which were experienced related to diabetes by reducing stress levels and could increase quality of life.
Collapse
Affiliation(s)
- Ece Yazla
- Department of Psychiatry, Hitit University Çorum Education and Research Hospital, Çorum, Turkey.
| | - Mehmet Emrah Karadere
- Department of Psychiatry, Hitit University Çorum Education and Research Hospital, Çorum, Turkey
| | - Ferit Kerim Küçükler
- Department of Internal Medicine Endocrinology, Hitit University Çorum Education and Research Hospital, Çorum, Turkey
| | - Çağatay Karşıdağ
- Department of Psychiatry, Acıbadem Altunizade Hastanesi, Istanbul, Turkey
| | - Leman İnanç
- Department of Psychiatry, Faculty of Medicine, Sıtkı Kocaman University, Muğla, Turkey
| | - Elif Kankoç
- Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Melda Dönertaş
- Dr. Kamil Furtun Samsun Pulmonary Diseases and Surgery Hospital, Samsun, Turkey
| | - Emre Demir
- Department of Biostatistics, Hitit University, Çorum, Turkey
| |
Collapse
|
13
|
Pétré B, Ketterer F, Vanmeerbeek M, Scheen A, Lair ML, Ziegler O, Böhme P, Guillaume M. [Cross-border evaluation of needs for training in therapeutic education of the patient for the management in type 2 diabetes and obesity: Survey by method of nominal group with healthcare professionals]. Presse Med 2016; 45:e351-e361. [PMID: 27242212 DOI: 10.1016/j.lpm.2016.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 11/27/2015] [Accepted: 02/23/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The design of continuous training programs in therapeutic patient education (ETP) should be inspired by needs shown by the professionals concerned in terms of mobilization or acquisition of skills in this domain. The objective of this study is to analyze needs expressed by healthcare professionals (HP) involved in patients' management presenting a type 2 diabetes (T2D) and/or obesity and to compare them with the existing recommendations. METHODS One hundred and five PS (general practitioners, dietitians and nurses) of 3 frontier regions of French-speaking European countries (France, Belgium and Grand duchy of Luxembourg) were questioned in 12 monodisciplinary groups according to the technique of the nominal group. Needs expressed by the participants were classified in the categories of the reference table of skills to dispense TPE (National Institute for Health Prevention and Education [INPES], 2013). RESULTS/DISCUSSION Among needs expressed by HP, 52 % of the votes targeted relational skills, 10 % of the skills relative to the biomedical techniques, 20 % of the skills relative to the educational techniques and 11 %, those of organization and the coordination. Seven percent of the proposals were out of the categories of the INPES. Results do not allow to establish profiles of skills according to the studied region or profession. The recognition of the TPE by the French legislation does not seem to influence in a major way the data. CONCLUSION The needs expressed by PS in the context of this study are focused on the relation HP/patient that is the heart of the TPE. It would however be necessary to raise awareness among HP in the acquisition of the other skills which concern in particular the animation of group, the interprofessional coordination, the consideration of the environment or more generally the procedures.
Collapse
Affiliation(s)
- Benoît Pétré
- Université de Liège, département des sciences de la santé publique, bâtiment B23, 4000 Liège, Belgique.
| | - Frédéric Ketterer
- Université de Liège, département de médecine générale, 4000 Liège, Belgique
| | - Marc Vanmeerbeek
- Université de Liège, département de médecine générale, 4000 Liège, Belgique
| | - André Scheen
- Centre hospitalier universitaire de Liège, service de diabétologie, nutrition et maladies métaboliques, Liège, Belgique
| | - Marie-Lise Lair
- Centre d'études en santé, centre de recherche public de la santé, 1445 Strassen, Luxembourg
| | - Olivier Ziegler
- CHRU de Nancy, université de Lorraine, hôpital Brabois-Adultes, service de diabétologie, maladies métaboliques, nutrition, Vandœuvre-lès-Nancy, France
| | - Philip Böhme
- CHRU de Nancy, université de Lorraine, hôpital Brabois-Adultes, service de diabétologie, maladies métaboliques, nutrition, Vandœuvre-lès-Nancy, France
| | - Michèle Guillaume
- Université de Liège, département des sciences de la santé publique, bâtiment B23, 4000 Liège, Belgique
| |
Collapse
|
14
|
Breaking Barriers to Effective Type 2 Diabetes Management: Findings from the use of the OPTIMA© Questionnaire in Clinical Practice. Adv Ther 2016; 33:1033-48. [PMID: 27193870 PMCID: PMC4920846 DOI: 10.1007/s12325-016-0341-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 11/15/2022]
Abstract
Background The OPTIMA© (MSD, Courbevoie, France) questionnaire was developed to promote shared decisions and the set-up of specific micro-objectives in clinical practice by optimizing communication between type 2 diabetes (T2DM) patients and their physicians. The present study aimed to assess OPTIMA in clinical practice. Methods A cross-sectional multicenter observational study was conducted in France from 2012 to 2014. During routine consultation, patients completed one of the five modules of the OPTIMA questionnaire (Physical activity, Diet, Treatment, Knowledge of the disease or Self-monitoring of blood glucose). The rate of SMART (specific, measurable, acceptable, realistic, timely) micro-objective set-up following the use of the questionnaire was assessed. Data on how patients felt about their diabetes management (beliefs concerning actions, how easy they were to do and how often they were done in practice) were gathered. Finally, patients’ and physicians’ opinions on OPTIMA were assessed using the PRAgmatic Content and face validity Test (PRAC-Test© (Mapi, Lyon, France) evaluation questionnaire. Results Overall, 807 patients were included by 186 physicians. While 92.7 % of consultations led to the set-up of a micro-objective, only 22.3 % were SMART micro-objectives: Physical activity module (34.3 %), Diet module (9.6 %), Treatment module (16.4 %), Knowledge of the disease module (25.2 %), and self-monitoring of blood glucose module (29.5 %). Among patients completing the Physical activity module, 79.0 % reported that they believed physical activity was useful, 35.0 % that it was easy, and 25.8 % that they regularly practised it. PRAC-Test results showed that OPTIMA was a useful and easy-to-use questionnaire that promotes communication between physicians and their patients according to 92.8 % of patients and 69.4 % of physicians. Conclusion The OPTIMA questionnaire facilitates communication between patients and their physicians and promotes the set-up of micro-objectives concerning T2DM management. The Physical activity module was the most likely of the five modules in the questionnaire to lead to the set-up of SMART micro-objectives. Funding MSD France. Electronic supplementary material The online version of this article (doi:10.1007/s12325-016-0341-6) contains supplementary material, which is available to authorized users.
Collapse
|
15
|
Perception et vécu émotionnel de la maladie et de ses traitements par des patients ayant un diabète de type 2 et en population générale. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1957-2557(16)30132-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
|
17
|
Triplitt C, Solis-Herrera C. GLP-1 Receptor Agonists: Practical Considerations for Clinical Practice. DIABETES EDUCATOR 2015; 41:32S-46S. [PMID: 26450217 DOI: 10.1177/0145721715607981] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Type 2 diabetes (T2D) imparts an increased risk of adverse health outcomes in patients unable to achieve glycemic control. Patient education and individualization of treatment are important for effective management of T2D. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of injectable glucose-lowering agents that lower A1C with added benefits of weight loss and improved cardiovascular risk markers. This review discusses the role of GLP-1RAs currently approved in the United States (exenatide, liraglutide, albiglutide, dulaglutide) for T2D management and characterizes the efficacy and safety profiles of individual GLP-1RAs. CONCLUSIONS GLP-1RAs are recommended as a preferred add-on agent to existing metformin monotherapy, as first-line therapy if metformin is contraindicated or poorly tolerated, and for use in combination with other oral glucose-lowering agents or basal insulin. Shorter-acting GLP-1RAs (exenatide and liraglutide) offer improved coverage of postprandial hyperglycemia, while longer-acting GLP-1RA formulations (exenatide extended-release, dulaglutide, and albiglutide) further improve fasting plasma glucose, which can result in additional A1C lowering. Reductions in body weight and blood pressure appear similar among individual agents, and small increases in heart rate are of unknown clinical relevance. Gastrointestinal adverse events abate over time with continued treatment and are less frequent with longer-acting GLP-1RAs. Hypoglycemia incidence is low but increased when GLP-1RAs are used with insulin secretagogues or insulin. GLP-1RAs target multiple pathophysiologic mechanisms in patients with T2D and improve glycemic control, although there are some differences within this drug class that may be relevant in clinical practice. Therefore, selection of the most appropriate treatment for individual patients is important.
Collapse
Affiliation(s)
- Curtis Triplitt
- University of Texas Health Science Center, Texas Diabetes Institute, San Antonio, Texas (Dr Triplitt, Dr Solis-Herrera)
| | - Carolina Solis-Herrera
- University of Texas Health Science Center, Texas Diabetes Institute, San Antonio, Texas (Dr Triplitt, Dr Solis-Herrera)
| |
Collapse
|
18
|
Halimi S, Potier L, Mosnier-Pudar H, Penfornis A, Roussel R, Boultif Z, Monguillon P, Renard E, Serusclat P, Marre M, Charbonnel B. Programme L&Vous : premiers enseignements de l’Observatoire National de l’Utilisation, en vie réelle, de l’Insuline Basale par les patients diabétiques de Type 2. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1957-2557(15)30221-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Duclos M, Dejager S, Postel-Vinay N, di Nicola S, Quéré S, Fiquet B. Physical activity in patients with type 2 diabetes and hypertension--insights into motivations and barriers from the MOBILE study. Vasc Health Risk Manag 2015; 11:361-71. [PMID: 26170686 PMCID: PMC4492639 DOI: 10.2147/vhrm.s84832] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Although physical activity (PA) is key in the management of type 2 diabetes (T2DM) and hypertension, it is difficult to implement in practice. Methods Cross-sectional, observational study. Participating physicians were asked to recruit two active and four inactive patients, screened with the Ricci-Gagnon (RG) self-questionnaire (active if score ≥16). Patients subsequently completed the International Physical Activity Questionnaire. The objective was to assess the achievement of individualized glycated hemoglobin and blood pressure goals (<140/90 mmHg) in the active vs inactive cohort, to explore the correlates for meeting both targets by multivariate analysis, and to examine the barriers and motivations to engage in PA. Results About 1,766 patients were analyzed. Active (n=628) vs inactive (n=1,138) patients were more often male, younger, less obese, had shorter durations of diabetes, fewer complications and other health issues, such as osteoarticular disorders (P<0.001 for all). Their diabetes and hypertension control was better and obtained despite a lower treatment burden. The biggest difference in PA between the active vs inactive patients was the percentage who declared engaging in regular leisure-type PA (97.9% vs 9.6%), also reflected in the percentage with vigorous activities in International Physical Activity Questionnaire (59.5% vs 9.6%). Target control was achieved by 33% of active and 19% of inactive patients (P<0.001). Active patients, those with fewer barriers to PA, with lower treatment burden, and with an active physician, were more likely to reach targets. The physician’s role emerged in the motivations (reassurance on health issues, training on hypoglycemia risk, and prescription/monitoring of the PA by the physician). A negative self-image was the highest ranked barrier for the inactive patients, followed by lack of support and medical concerns. Conclusion Physicians should consider PA prescription as seriously as any drug prescription, and take into account motivations and barriers to PA to tailor advice to patients’ specific needs and reduce their perceived constraints.
Collapse
Affiliation(s)
- Martine Duclos
- Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), G Montpied Hospital; INRA, UNH, CRNH Auvergne, France ; Nutrition Department, University of Auvergne, Clermont-Ferrand, Auvergne, France
| | - Sylvie Dejager
- Department of Endocrinology and Metabolism, La Pitié-Salpétrière Hospital, Paris, France ; Clinical and Scientific Affairs, Novartis Pharma SAS, Rueil-Malmaison, France
| | | | | | - Stéphane Quéré
- Biostatistics, Novartis Pharma SAS, Rueil-Malmaison, France
| | - Béatrice Fiquet
- Clinical and Scientific Affairs, Novartis Pharma SAS, Rueil-Malmaison, France ; Department of Hypertension, Georges Pompidou European Hospital, Paris, France
| |
Collapse
|