1
|
Emad-Eldin M, Balata GF, Elshorbagy EA, Hamed MS, Attia MS. Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges. World J Diabetes 2024; 15:828-852. [DOI: 10.4239/wjd.v15.i5.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/01/2024] [Accepted: 03/20/2024] [Indexed: 05/10/2024] Open
Abstract
Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient’s perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.
Collapse
Affiliation(s)
- Mahmoud Emad-Eldin
- Department of Pharmacy Practice, Faculty of Pharmacy, Zagazig University, Zagazig HFQM+872, Al-Sharqia Governorate, Egypt
| | - Gehan F Balata
- Department of Pharmacy Practice, Faculty of Pharmacy, Heliopolis University, Cairo 44519, Egypt
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Eman A Elshorbagy
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mona S Hamed
- Department of Community at Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mohamed S Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| |
Collapse
|
2
|
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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
3
|
Studer CM, Linder M, Pazzagli L. A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes. J Health Popul Nutr 2023; 42:122. [PMID: 37936205 PMCID: PMC10631092 DOI: 10.1186/s41043-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Antidiabetic medication adherence is a key aspect for successful control of type 2 diabetes mellitus (T2DM). This systematic review aims to provide an overview of the associations between socioeconomic factors and antidiabetic medication adherence in individuals with T2DM. METHODS A study protocol was established using the PRISMA checklist. A primary literature search was conducted during March 2022, searching PubMed, Embase, Web of Science, as well as WorldCat and the Bielefeld Academic Search Engine. Studies were included if published between 1990 and 2022 and included individuals with T2DM. During primary screening, one reviewer screened titles and abstracts for eligibility, while in the secondary screening, two reviewers worked independently to extract the relevant data from the full-text articles. RESULTS A total of 15,128 studies were found in the primary search, and 102 were finally included in the review. Most studies found were cross-sectional (72) and many investigated multiple socioeconomic factors. Four subcategories of socioeconomic factors were identified: economic (70), social (74), ethnical/racial (19) and geographical (18). The majority of studies found an association with antidiabetic medication adherence for two specific factors, namely individuals' insurance status (10) and ethnicity or race (18). Other important factors were income and education. CONCLUSIONS A large heterogeneity between studies was observed, with many studies relying on subjective data from interviewed individuals with a potential for recall bias. Several socioeconomic groups influencing medication adherence were identified, suggesting potential areas of intervention for the improvement of diabetes treatment adherence and individuals' long-term well-being.
Collapse
Affiliation(s)
- Christian Ming Studer
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Laura Pazzagli
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
4
|
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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Che Aishah Nazariah Ismail
- Department of Physiology, School of Medical Sciences, University Sains Malaysia Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| |
Collapse
|
5
|
Yahaya JJ, Doya IF, Morgan ED, Ngaiza AI, Bintabara D. Poor glycemic control and associated factors among patients with type 2 diabetes mellitus: a cross-sectional study. Sci Rep 2023; 13:9673. [PMID: 37316565 DOI: 10.1038/s41598-023-36675-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
Glycemic control is of paramount importance in care and management for patients with type 2 diabetes mellitus (T2DM). Poor glycemic control is a major health problem that greatly contributes to the development of diabetes related complications. This study aims to assess the prevalence of poor glycemic control and associated factors among outpatients with T2DM attending diabetes clinic at Amana Regional Referral Hospital in Dar-es-salaam, Tanzania from December 2021 to September 2022. A face to face interviewer semi-structured questionnaire was administered during data collection. Binary logistic regression under multivariable analysis was used to determine the independent predictors of poor glycemic control. A total of 248 patients with T2DM were included in the analysis with mean age of 59.8 ± 12.1 years. The mean fasting blood glucose was 166.9 ± 60.8 mg/dL. The prevalence of poor glycemic control was 66.1% (fasting blood glucose > 130 mg/dL or < 70 mg/dL). Failure to adhere to regular follow-up (AOR = 7.53, 95% CI = 2.34-19.73, p < 0.001) and alcoholism (AOR = 4.71, 95% CI = 1.08-20.59, p = 0.040) were the independent predictors of poor glycemic control. The prevalence of poor glycemic control observed in this study was significantly high. Emphasis should be placed on ensuring that patients have regular follow-up for their diabetes clinics and they should also continue modifying some of lifestyle behaviors including refraining from alcoholism, this can help them to have good glycemic control.
Collapse
Affiliation(s)
- James J Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda.
| | - Irene F Doya
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - Emmanuel D Morgan
- Department of Pathology, School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda
| | - Advera I Ngaiza
- Deparment of Pathology, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
- Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Deogratius Bintabara
- Department of Community Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| |
Collapse
|
6
|
Ayeni OA, Chiwambutsa S, Chen WC, Kapungu N, Kanji C, Thelingwani R, Murugan N, Mathiba R, Phakathi B, Nietz S, Ramiah D, O'Neil DS, Jacobson JS, Ruff P, Cubasch H, Chirwa T, Joffe M, Masimirembwa C, Neugut AI. The impact of HIV on non-adherence for tamoxifen among women with breast cancer in South Africa. Breast Cancer Res Treat 2023; 197:647-659. [PMID: 36538247 PMCID: PMC10149344 DOI: 10.1007/s10549-022-06835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Women living with HIV (WLWH) and breast cancer (BC) have worse overall survival than HIV-negative women with BC, and poor adherence to prescribed tamoxifen is known to contribute to poor survival. We therefore investigated the association of HIV infection with adherence to adjuvant tamoxifen among women with localized hormone receptor (HR)-positive breast cancer in South Africa. METHODS Among 4,097 women diagnosed with breast cancer at six hospitals in the prospective South African Breast Cancer and HIV Outcomes (SABCHO) cohort study between July 2015 and December 2020, we focused on black women with stages I-III HR-positive breast cancer who were prescribed 20 mg of adjuvant tamoxifen daily. We collected venous blood once from each participant during a routine clinic visit, and analyzed concentrations of tamoxifen and its metabolites using a triple quadruple mass spectrometer. We defined non-adherence as a tamoxifen level < 60 ng/mL after 3 months of daily tamoxifen use. We compared tamoxifen-related side effects, and concurrent medication use among women with and without HIV and developed multivariable logistic regression models of tamoxifen non-adherence. RESULTS Among 369 subjects, 78 (21.1%) were WLWH and 291 (78.9%) were HIV-negative. After a median (interquartile range) time of 13.0 (6.2-25.2) months since tamoxifen initiation, the tamoxifen serum concentration ranged between 1.54 and 943.0 ng/mL and 208 (56.4%) women were non-adherent to tamoxifen. Women < 40 years of age were more likely to be non-adherent than women > 60 years (73.4% vs 52.6%, odds ratio (OR) = 2.49, 95% confidence interval (CI) = 1.26-4.94); likewise, WLWH (70.5% vs 52.6%, OR = 2.16, 95% CI = 1.26-3.70) than HIV-negative women. In an adjusted model WLWH had twice the odds of non-adherence to tamoxifen, compared to HIV-negative women (OR = 2.40, 95% CI = 1.11-5.20). CONCLUSION High rates of non-adherence to adjuvant tamoxifen may limit the overall survival of black South African women with HR-positive breast cancer, especially among WLWH.
Collapse
Affiliation(s)
- Oluwatosin A Ayeni
- MRC South Africa and the University of the Witwatersrand Centre for Common Epithelial Cancers Research Unit, Johannesburg, South Africa.
- Soweto Comprehensive Cancer Centre, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - Shingirai Chiwambutsa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong Carl Chen
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Nyasha Kapungu
- Department of Pharmaceutical Medicine, African Institute of Biomedical Science and Technology Block C Wilkins Hospital, Harare, Zimbabwe
| | - Comfort Kanji
- Department of Pharmaceutical Medicine, African Institute of Biomedical Science and Technology Block C Wilkins Hospital, Harare, Zimbabwe
| | - Roslyn Thelingwani
- Department of Pharmaceutical Medicine, African Institute of Biomedical Science and Technology Block C Wilkins Hospital, Harare, Zimbabwe
| | - Nivashni Murugan
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rofhiwa Mathiba
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Soweto Comprehensive Cancer Centre, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Boitumelo Phakathi
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Duvern Ramiah
- Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel S O'Neil
- Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Paul Ruff
- MRC South Africa and the University of the Witwatersrand Centre for Common Epithelial Cancers Research Unit, Johannesburg, South Africa
- Soweto Comprehensive Cancer Centre, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- MRC South Africa and the University of the Witwatersrand Centre for Common Epithelial Cancers Research Unit, Johannesburg, South Africa
| | - Collen Masimirembwa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Pharmaceutical Medicine, African Institute of Biomedical Science and Technology Block C Wilkins Hospital, Harare, Zimbabwe
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
7
|
Osetinsky B, Mhalu G, Mtenga S, Tediosi F. Care cascades for hypertension and diabetes: Cross-sectional evaluation of rural districts in Tanzania. PLoS Med 2022; 19:e1004140. [PMID: 36469527 PMCID: PMC9762578 DOI: 10.1371/journal.pmed.1004140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/19/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), especially hypertension and diabetes, are rapidly rising in sub-Saharan Africa, necessitating health systems transformations. In Tanzania, current policies aim to improve control of hypertension and diabetes, but information is still needed to assess the gaps in treatment. METHODS AND FINDINGS We conducted a cross-sectional household survey of 784 adults in two districts in Tanzania from December 2020 to January 2021, capturing the cascade-of-care for hypertension and diabetes. The ages of the respondents ranged from 18 to 89 years. Of those screened positive for these conditions, we measured the proportion in each step of the cascades: awareness, care engagement, treatment, and control. We conducted multivariable logistic regression analyses for all four steps along the hypertension care cascade with the independent variables of social health protection schemes, and prior diagnosis of comorbid diabetes, and demographic information. In our sample, of the 771 who had their blood pressure measured, 41% (95% confidence interval (CI): 38% to 44%) were screened positive for hypertension, and of the 707 who had their blood sugar measured, 6% (95% CI: 4% to 8%) were screened positive for diabetes. Of those with hypertension, 43% (95% CI: 38% to 49%) had a prior diagnosis, 25% (95% CI: 21% to 31%) were engaged in care, 21% (95% CI: 3% to 25%) were on treatment, and 11% (95% CI: 8% to 15%) were controlled. Of the 42 respondents with diabetes, 80% (95% CI: 69% to 93%) had a prior diagnosis. The diabetes care cascade had much less drop-off, so 66% of those with diabetes (95% CI: 52% to 82%) were engaged in care and on treatment, and 48% (95% CI: 32% to 63%) had their diabetes controlled at the point of testing. Healthcare fee exemptions were independently associated with higher odds of being previously diagnosed (OR 5.81; 95% CI [1.98 to 17.10] p < 0.005), engaged in care (OR 4.71; 95% CI [1.59 to 13.90] p 0.005), and retained in treatment (OR 2.93; 95% CI [1.03 to 8.35] p < 0.05). Prior diagnosis of comorbid diabetes was highly associated with higher odds of being engaged in care for hypertension (OR 3.26; 95% CI [1.39 to 7.63] p < 0.005). The two primary limitations of this study were reliance on screening at a single time point only of people available at the village at the time of the sample and dependence on self-report for to inform the three cascade steps of prior diagnosis, healthcare visits for engagement in care, and treatment use. CONCLUSIONS The high burden of hypertension and low levels of control in our study underscores the importance of improving the awareness and treatment of hypertension. The differences in the care cascades for hypertension and diabetes demonstrates that chronic NCD treatment is possible in this setting, but efforts will be needed across the entire care cascade to improve hypertension control.
Collapse
Affiliation(s)
- Brianna Osetinsky
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Sally Mtenga
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
8
|
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: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
9
|
Aravindakshan R, Abraham SB, Aiyappan R. Medication Adherence to Oral Hypoglycemic Drugs among Individuals with Type 2 Diabetes Mellitus - A Community Study. Indian J Community Med 2021; 46:503-507. [PMID: 34759497 PMCID: PMC8575238 DOI: 10.4103/ijcm.ijcm_985_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
Context Control of diabetes mellitus is a global challenge and nonadherence to diabetic medications is a public health concern. Factors related to patients, medications, and system can contribute to nonadherence. Aims We aimed to determine self-reported adherence to oral hypoglycemics and to understand the determinants of medication adherence in a group of adult diabetics in South Kerala. Methods A cross-sectional survey was conducted among 218 diabetic individuals. An eight-item questionnaire to assess the level of adherence and a structured interview schedule were administered to meet the objectives. Adherence was categorized as poor, moderate and high, based on k-means cluster analysis. Results The proportion of good adherence was 60.09%. Higher age, male gender, nonalcoholic, higher family income, higher frequency of blood glucose monitoring, and controlled blood sugar level were independent predictors of good adherence. Conclusion The proportion of individuals with poor medication adherence is low. Focus must be on determining factors influencing medication nonadherence.
Collapse
Affiliation(s)
- Rajeev Aravindakshan
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
| | - Sherin Billy Abraham
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Finland
| | | |
Collapse
|
10
|
Azharuddin M, Adil M, Sharma M, Gyawali B. A systematic review and meta-analysis of non-adherence to anti-diabetic medication: Evidence from low- and middle-income countries. Int J Clin Pract 2021; 75:e14717. [PMID: 34378293 DOI: 10.1111/ijcp.14717] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/17/2021] [Accepted: 08/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-adherence to anti-diabetic medication is an important cause of uncontrolled blood glucose that leads to complications of diabetes. However, there is a lack of evidence on the burden of and factors associated with non-adherence to anti-diabetic medication among individuals living with diabetes in low-and middle-income countries (LMICs). OBJECTIVES This systematic literature review and meta-analytic synthesis aims to estimate non-adherence to anti-diabetic medication reported among individuals in LMICs and explores factors affecting non-adherence. METHODS We systematically searched MEDLINE and Embase to identify studies investigating non-adherence to anti-diabetic medications published from January 2000 to May 2020. Two authors carried out study selection, screening, and data extraction independently. Cross-sectional studies that had been conducted among individuals with diabetes in LMICs were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Meta-analysis was carried out using Stata 14.2. Random effects model was used to compute the pooled proportion at a 95% confidence interval (CI). RESULTS Forty-three studies met the inclusion criteria, of which 13 studies were used in meta-analysis. The pooled proportion of non-adherence to anti-diabetic medications using the eight-item Morisky Medication Adherence Scale (MMAS-8) was 43.4% (95% CI: 17.5-69.4; P < 0.001) and 29.1% (95% CI: 19.8-38.4; P < 0.001) when using the cut-off at 80 or 90%. The pooled proportion of non-adherence was 29.5% (95% CI: 25.5-33.5; P = .098) when using the four-item Morisky Medication Adherence Scale (MMAS-4). Using the World Health Organization (WHO) five dimensions of medication adherence framework, the factors contributing to non-adherence were varied, including disease factors, therapy-related factors, healthcare system factor, patient-centred factors, and socio-economic factors. CONCLUSIONS Non-adherence to anti-diabetic medication remains an ongoing challenge in LMICs and several factors operating at different levels were cited as reasons. Comprehensive intervention strategies are urgently needed to address these factors in effectively tackling medication non-adherence in LMICs.
Collapse
Affiliation(s)
- Md Azharuddin
- Division of Pharmacology, Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, New Delhi, India
| | - Mohammad Adil
- Department of Pharmacology, School of Pharmaceutical Education and Research, New Delhi, India
| | - Manju Sharma
- Division of Pharmacology, Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, New Delhi, India
- Department of Pharmacology, School of Pharmaceutical Education and Research, New Delhi, India
| | - Bishal Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Olickal JJ, Chinnakali P, Suryanarayana B, Saya GK, Ganapathy K, Subrahmanyam D. Medication adherence and glycemic control status among people with diabetes seeking care from a tertiary care teaching hospital, south India. Clinical Epidemiology and Global Health 2021. [DOI: 10.1016/j.cegh.2021.100742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
12
|
Barasa Masaba B, Mmusi-Phetoe RM. Determinants of Non-Adherence to Treatment Among Patients with Type 2 Diabetes in Kenya: A Systematic Review. J Multidiscip Healthc 2021; 13:2069-2076. [PMID: 33447041 PMCID: PMC7801910 DOI: 10.2147/jmdh.s270137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Non-adherence to the prescribed treatment regimen in patients with type 2 diabetes mellitus is quite high. Furthermore, it has been associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs. The present systematic review study aimed to explore the determinants that contribute to non-adherence to treatment among patients with type 2 diabetes mellitus in Kenya. METHODS A systematic review of studies conducted in Kenya on the present research problem published in English between December 2013 and May 2020. The databases included Scopus, Web of Science, Science Direct, Cochrane Library, PUBMED, OVID and Google Scholar. The following were the key words used in the search: "Non-adherence Diabetes Patients", "Determinants of Non-adherence Diabetes Patients" AND "Health Facilities" AND "Kenya". Qualitative analysis was used to present data under thematic domains. RESULTS The search generated 17,094 articles of which only 15 met the inclusion criteria. The major determinants were presented under three thematic domains: 1) Cost - income, insurance, distance, bills of drugs and food; 2) Patient characteristics - perception of (efficacy, severity, effects of non-adherence), knowledge, co-morbidity, family support, self unfounded beliefs; and 3) Health system - health education, multiple drugs, evaluations and support, guidelines, poor perception of system. CONCLUSION A multitude of factors including unaffordable care, patient's poor knowledge on the disease process, less family support in patient's daily self-care management, complex drug regimen and unsatisfactory health messages from the health providers were observed to be associated with non-adherence. Implementing integrated care programs will help in reducing levels of non-adherence among type 2 diabetes mellitus patients.
Collapse
|
13
|
Thapar R, Holla R, Kumar N, Aithal S, Karkera S, Rao C, Pujari N, Zahida A, Unnikrishnan B, Mithra P, Swamy DK, Kulkarni V, Bhagawan D, Kumar A. Factors influencing adherence to anti-diabetes medications among type 2 diabetes patients attending tertiary care hospitals in Mangaluru. Clinical Epidemiology and Global Health 2020. [DOI: 10.1016/j.cegh.2020.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
14
|
Fadare JO, Enwere OO, Adeoti AO, Desalu OO, Godman B. Knowledge and Attitude of Physicians Towards the Cost of Commonly Prescribed Medicines: A Case Study in Three Nigerian Healthcare Facilities. Value Health Reg Issues 2020; 22:68-74. [PMID: 32798837 DOI: 10.1016/j.vhri.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE One of the core principles of rational prescribing is consideration of the cost of the medicines prescribed, especially in countries with high patient copayments and low incomes such as Nigeria. Little is known about Nigerian physicians' knowledge about the cost of commonly prescribed medicines. The principal objective of the study was to assess the knowledge of Nigerian physicians about the cost of commonly prescribed medicines. METHODS Descriptive cross-sectional survey conducted among physicians in 3 tertiary institutions in Nigeria. Apart from socio-demographic and other information, questions about the estimated costs of branded and generic versions of 11 commonly prescribed medications were included in the questionnaire. RESULTS One hundred and seventy-nine (179; 95.7%) respondents agreed that costs of medicines were important when writing prescriptions, although only 7 (3.7%) of them had any formal training in the economics of healthcare. The median percentages of respondents with accurate estimated costs for generic and originator brands were 6.2% and 12%, respectively. Respondents were more knowledgeable about the cost of medicines used for the treatment of infectious diseases (malaria, bacterial infections) than noncommunicable diseases (diabetes mellitus, hypertension, and dyslipidemia). CONCLUSIONS The knowledge of Nigerian physicians in the 3 participating hospitals about the costs of commonly prescribed medicines was poor. This is despite their awareness about the importance of costs of medicines when prescribing.
Collapse
Affiliation(s)
- Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria.
| | - Okezie O Enwere
- Department of Medicine, Imo State University, Orlu, Imo State, Nigeria
| | - Adekunle O Adeoti
- Department of Medicine, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | - Olufemi O Desalu
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| |
Collapse
|
15
|
Munyogwa MJ, William R, Kibusi SM, Gibore NS. Clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania: a cross-sectional study. BMC Health Serv Res 2020; 20:527. [PMID: 32522187 PMCID: PMC7288541 DOI: 10.1186/s12913-020-05407-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 06/05/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tanzania is among the sub-Saharan African countries facing a tremendous increase in the burden of type 2 diabetes mellitus. In order to provide diabetes health care services, the government has established diabetes care clinics in secondary and tertiary healthcare facilities. However, previous studies have demonstrated a disparity in availability of supplies and equipment for provision of diabetes health care services at these healthcare facilities. This study aims to assess the clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania. METHODS A cross-sectional study was conducted in Mwanza Region from June to September, 2018.Three hundred and thirty patients were selected by systematic random sampling from three healthcare facilities. A structured questionnaire was utilized to collect information on patient characteristics, health care received and patient perception of care. Patient blood pressure, blood glucose, weight and height were measured during the study. Percentages, chi-square tests and multivariable analysis were conducted to obtain the proportions, make comparisons and determining the correlates of tertiary-level healthcare facility. RESULTS Approximately half of respondents (54.5%) were from secondary healthcare facilities. The prevalence of hypertension (63.3%), hyperglycemia (95.8%) and obesity (93.3%) were high. The prevalence of hyperglycemia was slightly higher at secondary-level healthcare facility (p = 0.005). The proportion of respondents recently diagnosed with diabetes (≤ 10 years) was significantly higher at tertiary-level healthcare facility (p = 0.000). The prevalence of diabetes related complications was higher at tertiary-level healthcare facility (80.7% versus 53.3%, p = 0.000). Assessments of body weight, blood pressure, blood glucose, feet and eye examination were conducted on a monthly basis at all facilities. None of the respondents had undergone lipid profile testing. All of the respondents (100%) received care from a nurse during diabetes clinic visits and half of the respondents (49.7%) also received care from a clinician. Relatively young patients, married and recently diagnosed patients were more likely to attend clinic at tertiary facilities. Tertiary-level healthcare facilities were more likely to have patients with complications and to have a dietitian available at the clinic.
Collapse
Affiliation(s)
- Mariam J Munyogwa
- Department of Public Health, University of Dodoma, P. O. Box 395, Dodoma, Tanzania.
| | - Reuben William
- Department of Research, Sumve School of Nursing, P. O. O. Box 7, Mantare, Mwanza, Tanzania
| | - Stephen M Kibusi
- Department of Public Health, University of Dodoma, P. O. Box 395, Dodoma, Tanzania
| | - Nyasiro S Gibore
- Department of Public Health, University of Dodoma, P. O. Box 395, Dodoma, Tanzania
| |
Collapse
|
16
|
Gouveia BDLA, Sousa MMD, Almeida TDCFD, Sousa VAGD, Oliveira SHDS. Beliefs related to insulin use in people with Type 2 Diabetes Mellitus. Rev Bras Enferm 2020; 73:e20190029. [PMID: 32321140 DOI: 10.1590/0034-7167-2019-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/10/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the beliefs of people with Type 2 Diabetes Mellitus related to insulin use. METHODS a descriptive, cross-sectional, quantitative-qualitative study based on Theory of Planned Behavior and performed with 32 participants using insulin. The data were analyzed and grouped into categories by beliefs similarity, counted from the frequencies. RESULTS 118 behavioral, 60 normative and 97 control beliefs were issued. Among the behavioral beliefs, there was an advantage in keeping the diabetes under control and disadvantage, the pain of being pierced by the application of insulin. Regulations highlighted the children as referents who support the treatment. In control beliefs, it was observed that the application of insulin appears as easiness and difficulty to the treatment.Conclusions: the study will support the construction of a psychometric scale to measure the determinants of insulin use, revealing particularities for the structuring of educational interventions that contribute to adherence of the treatment verified in adequate glycemic control.
Collapse
|
17
|
Sefah IA, Okotah A, Afriyie DK, Amponsah SK. Adherence to Oral Hypoglycemic Drugs among Type 2 Diabetic Patients in a Resource-Poor Setting. Int J Appl Basic Med Res 2020; 10:102-109. [PMID: 32566526 PMCID: PMC7289204 DOI: 10.4103/ijabmr.ijabmr_270_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/02/2019] [Accepted: 01/10/2020] [Indexed: 01/09/2023] Open
Abstract
Objective: Diabetes mellitus is a growing public health problem in many countries including Ghana. Adherence to drugs, especially among patients with type 2 diabetes mellitus (T2DM) is often poor is some resource-poor settings. The objective of this study was to assess adherence to oral hypoglycemic drugs and factors that affect adherence among patients with T2DM in the Volta Region of Ghana. Methods: The study was cross-sectional and conducted among 400 patients with T2DM attending diabetic clinics at 4 randomly selected hospitals in the Volta Region of Ghana between January 10 and March 30, 2015. Patients were interviewed using a structured questionnaire and other data collection tools to determine the commonest self-reported reason(s) for nonadherence. Adherence was assessed using the 8-item Morisky Medication Adherence Scale. Multivariate analysis was performed between adherence and statistically significant patient variables. Results: Adherence to oral hypoglycemic drugs among T2DM patients was 47.75%. The odds of adherence with fasting blood glucose between 1 and 6 mmol/L was approximately two-fold (adjusted odd ratio [aOR] =1.92, confidence interval [CI]: 1.11–3.32) versus the odds of having fasting blood glucose of above 10 mmol/L. The odds of adherence among patients with tertiary education was approximately three-fold (aOR = 3.01 CI: 1.44–6.269) versus patients with no formal education. The commonest self-reported reason for nonadherence was forgetfulness. Conclusion: Adherence to oral hypoglycemic drugs among T2DM patients in the current study was sub-optimal. Therefore, in such settings, management of T2DM must include strategies to identify nonadherent patients, and regular patient education and counseling.
Collapse
Affiliation(s)
| | - Archibald Okotah
- Department of Pharmacy, Ho Municipal Hospital, Ghana Health Service, Ho, Accra, Ghana
| | | | - Seth Kwabena Amponsah
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Accra, Ghana
| |
Collapse
|
18
|
Mwita JC, Godman B, Esterhuizen TM. Statin prescription among patients with type 2 diabetes in Botswana: findings and implications. BMC Endocr Disord 2020; 20:36. [PMID: 32151249 PMCID: PMC7063760 DOI: 10.1186/s12902-020-0516-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is evidence of statin benefit among patients with diabetes regardless of cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana. METHODS The study was a secondary data analysis of 500 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone, Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescriptions. RESULTS Overall, 477 (95.4%) participants were eligible for a statin prescription. Clinicians prescribed statins in 217 (45.5%) of eligible participants, and only one (4.4%) ineligible participant. The probability of a statin prescription was higher in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17-1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00-1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06-1.74). CONCLUSION A large proportion with type 2 diabetes in Gaborone is not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescriptions. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations.
Collapse
Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag, 00713 Gaborone, Botswana
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Tonya M. Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
19
|
Alluhayyan OB, Alsahly RJ, Aldawsari AA, Alghabawy KA, Alqaan RS, Almutairi AF, Alharbi SA. Illness Perception and Medication Adherence Among Patients with Primary Hypothyroidism in Al Qassim, Saudi Arabia. Patient Prefer Adherence 2020; 14:1111-1117. [PMID: 32753851 PMCID: PMC7352375 DOI: 10.2147/ppa.s257703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Poor adherence to levothyroxine is a potential risk factor for treatment failure that ultimately leads to increased healthcare costs and serious health outcomes. This study aimed to investigate the correlation between illness perception and medication adherence among primary hypothyroidism patients. PATIENTS AND METHODS We conducted a cross-sectional survey among primary hypothyroidism patients who met the inclusion criteria in the Qassim region of Saudi Arabia using a questionnaire with demographic characteristics, clinical factors, the 12-Item Medication Adherence Scale, and the Brief Illness Perception Questionnaire (BIPQ). We included 400 patients in the analysis. RESULTS We found a significant positive correlation between BIPQ subscales - personal control, treatment control, and understanding - with all domains of the 12-Item Medication Adherence Scale. The other dimensions of BIPQ subscales did not significantly correlate with medication adherence. However, a high BIPQ overall score was significantly correlated with poor medication adherence. CONCLUSION This study found a significant correlation between a high BIPQ overall score and poor medication adherence. This finding suggests the need to consider the emotional and cognitive representation of hypothyroidism in hypothyroid patients to improve their treatment adherence.
Collapse
Affiliation(s)
- Omar Buraykan Alluhayyan
- College of Medicine, Qassim University, Al Qassim, Saudi Arabia
- Correspondence: Omar Buraykan Alluhayyan Qassim University, Al Qassim, Saudi ArabiaTel +966 594474177 Email
| | | | | | | | | | | | - Saleh Ali Alharbi
- Department of Family and Community Medicine, King Saud Hospital, Al Qassim, Saudi Arabia
| |
Collapse
|
20
|
Gao L, Yu S, Cipriani A, Wu S, Huang Y, Zhang Z, Yang J, Sun Y, Yang Z, Chai S, Zhang Y, Ji L, Zhan S, Sun F. Neurological Manifestation of Incretin-Based Therapies in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis. Aging Dis 2019; 10:1311-1319. [PMID: 31788342 PMCID: PMC6844583 DOI: 10.14336/ad.2019.0303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/03/2019] [Indexed: 01/02/2023] Open
Abstract
As a new class of antidiabetic drug, incretin-based therapies, which include dipeptidyl peptidase-4 inhibitors (DPP-4Is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have raised concerns about symptoms of withdrawal in patients with type 2 diabetes mellitus (T2DM), such as dizziness and headache. To systematically evaluate whether incretin-based therapies may lead to dizziness and headache in patients with T2DM compared to other traditional antidiabetic drugs or placebo. We searched Medline, Embase, the Cochrane library, and clinicaltrials.gov from inception through June 23, 2017, to identify randomized controlled trials of the safety of DPP-4Is or GLP-1 RAs versus placebo or other antidiabetic drugs in T2DM patients. We used the network meta-analysis under the frequentist framework to compare the association between multiple antidiabetic drugs and dizziness and headache. A total of 233 clinical trials with nine treatments and 147,710 patients were included: two incretin-based therapies, one placebo, and six traditional antidiabetic drugs (metformin, insulin, sulfonylurea, thiazolidinediones, alpha-glucosidase inhibitor, and sodium-glucose co-transporter 2). Compared to insulin, thiazolidinediones, or placebo, GLP-1 RAs statistically significantly increased the risk of dizziness (odds ratios [ORs]: 1.92, 1.57, and 1.40, respectively) and headache (ORs: 1.34, 1.41, and 1.18, respectively). DPP-4Is increased the risk of headache (OR: 1.22, 95% confidence interval [CI]: 1.02 to 1.46; moderate quality) and dizziness (OR: 1.46, 95% CI: 1.05 to 2.03; moderate quality) compared to insulin. Of the incretin-based therapies, DPP-4Is had a lower risk of dizziness than GLP-1 RAs (OR: 0.76, 95% CI: 0.67 to 0.87; high quality). Ranking probability analysis indicated that GLP-1 RAs may have the greatest risk of both dizziness and headache among the nine treatments (22.5% and 23.4%, respectively), whereas DPP-4Is were in the middle (46.2% and 45.0%, respectively). Incretin-based therapies increase the risk of dizziness and headache compared to insulin, thiazolidinediones, and placebo.
Collapse
Affiliation(s)
- Le Gao
- 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shuqing Yu
- 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Andrea Cipriani
- 2Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Shanshan Wu
- 3National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi Huang
- 4Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, MD 21250, USA
| | - Zilu Zhang
- 5Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Jun Yang
- 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yixin Sun
- 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhirong Yang
- 6Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Sanbao Chai
- 7Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, China
| | - Yuan Zhang
- 8Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Linong Ji
- 9Department of Endocrinology and Metabolism, People's Hospital, Peking University, Beijing, China
| | - Siyan Zhan
- 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Feng Sun
- 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
21
|
Kefale AT, Biru TT, Addo HA. Appropriateness of insulin commencement and adequacy of glycemic control among ambulatory patients with type 2 diabetes in Ethiopia. J Diabetes Metab Disord 2019; 18:461-469. [PMID: 31890672 DOI: 10.1007/s40200-019-00448-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
Background Knowing when to start insulin is central to optimal management of Type 2 diabetes mellitus (T2DM) but a real clinical challenge. Poor glycemic control is critical for development of the deadly diabetic complications. Objective The aim of the study was to assess the appropriateness of insulin commencement, adequacy of glycemic control and associated factors among patients with T2DM. Settings The study was conducted at three public hospitals in Southwest Ethiopia. Methods Cross sectional study was conducted using structured questionnaire and data abstraction format. All patients with T2DM who were available during the data collection period and fulfilling study criteria were included. Main outcome measure Multivariable binary logistic regression analysis was done for identifying factors associated with poor glycemic control by taking statistical significance at p value ≤0.05. Results One hundred sixty nine patient data was considered for analysis. Insulin was initiated in 28 patients, but only 10(35.7%) insulin commencements were appropriate. More than two third (70.4%) of the studied population had poor glycemic control. Addition of second antidiabetic medication (Adjusted Odds Ratio (AOR) = 2.5, 95% CI = 1.3-6.2) and living in urban areas (AOR = 2.5, 95% CI = 1.1-5.7) were associated with poor glycemic control while having regular diabetic care follow up of every >1 month (AOR = 0.4, 95% CI = 0.2-0.9) was negatively associated with poor glycemic control. Conclusions About two third of insulin commencements were inappropriate and majority of patients could not stay on optimal glycemic control. Addition of second antidiabetic medication and living in urban areas were found to be associated with poor glycemic control. Impact of findings on practice statements • Initiation of insulin before optimization of oral agents increase cost of care.• Proper titration of the first oral agent is important prior to adding other antidiabetic agents.• Emphasis should be given to improve glycemic control, and hence halt subsequent complications.
Collapse
|
22
|
Abstract
The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013–2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27–1.43) and 1.41 (95% CI: 1.30–1.54); females: 1.17 (95% CI: 1.11–1.23) and 1.24 (95% CI: 1.13–1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80–0.96) and 0.88 (95% CI: 0.79–0.99); females: 1.00 (95% CI: 0.93–1.07) and 0.95 (95% CI: 0.83–1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75–0.91) and 0.62 (95% CI: 0.54–0.70); females: 0.94 (95% CI: 0.87–1.02) and 0.77 (95% CI: 0.65–0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes).
Collapse
Affiliation(s)
- Peng Jiang
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
23
|
Mallah Z, Hammoud Y, Awada S, Rachidi S, Zein S, Ballout H, Al-Hajje A. Validation of diabetes medication adherence scale in the Lebanese population. Diabetes Res Clin Pract 2019; 156:107837. [PMID: 31479705 DOI: 10.1016/j.diabres.2019.107837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/25/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
AIM To validate the Diabetes Medication Adherence Scale (DMAS-7), determine its concordance with another validated scales and to assess factors affecting medication adherence. METHODS A cross-sectional study was conducted on a sample of Lebanese patients with diabetes using a questionnaire. The level of adherence was measured using the DMAS-7 and the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted, and the scale was validated in terms of reliability, predictive ability, and construct validity using SPSS version 19. RESULTS Out of 300 eligible patients, the rate of adherence was 33.7%. Measures of validity showed good reliability (Cronbach alpha = 0.627), and good construct validity with LMAS-14 (Spearman's rho = 0.846; Cohen's kappa = 0.711). DMAS-7 was found to be both correlated with LMAS-14 (ICC average measure = 0.675; p-value <0.001) in addition to possessing a better predictive value. Thus, DMAS-7 showed to have good concordance and increased validity compared to LMAS-14. Having an optimal glycated hemoglobin (HbA1C) (OR = 0.779; p = 0.001) and performing regular physical activity (OR 2.328; p = 0.002) increased medication adherence. CONCLUSION The DMAS-7 showed to be reliable and valid instrument superior to LMAS-14 in predicting adherence levels to oral anti-diabetic medications, and thus can be used to achieve better glycemic outcomes.
Collapse
Affiliation(s)
- Zahraa Mallah
- Research Clinical Pharmacy and Pharmaco-epidemiology, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Yasmin Hammoud
- Research Clinical Pharmacy and Pharmaco-epidemiology, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Sanaa Awada
- Pharmacokinetics, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Samar Rachidi
- Clinical Pharmacy, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Salam Zein
- Clinical Pharmacy, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Hajar Ballout
- Saint Georges Hospital, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical Pharmacy, Lebanon; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon.
| |
Collapse
|
24
|
Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self‐care behaviours: Evidence from low‐ and middle‐income countries. J Adv Nurs 2019; 75:3374-3389. [DOI: 10.1111/jan.14190] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Victor Mogre
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Department of Health Professions Education School of Medicine and Health Sciences University for Development Studies Tamale Ghana
| | - Natalie A. Johnson
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
| | - Flora Tzelepis
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
- Hunter New England Population Health Hunter New England Local Health District Wallsend New South Wales Australia
| | | | - Christine Paul
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
| |
Collapse
|
25
|
Rwegerera GM, Moshomo T, Gaenamong M, Oyewo TA, Gollakota S, Mhimbira FA, Fadare J, Godman B, Meyer JC, Rivera YP. RETRACTED ARTICLE: Antidiabetic medication adherence and associated factors among patients in Botswana; implications for the future. Alexandria Journal of Medicine 2019. [DOI: 10.1016/j.ajme.2017.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaFaculty of Medicine, Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Thato Moshomo
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Marea Gaenamong
- Department of Accident and Emergency, Princess Marina Hospital, Gaborone, BotswanaDepartment of Accident and Emergency, Princess Marina Hospital, Gaborone, Botswana
| | - Taibat Aderonke Oyewo
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Sivasomnath Gollakota
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Joseph Fadare
- Department of Pharmacology and Therapeutics College of Medicine, Ekiti State University, Ado-Ekiti, NigeriaDepartment of Pharmacology and Therapeutics College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, SwedenDepartment of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United KingdomStrathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Johanna C. Meyer
- Department of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, Sefako Makgatho Health Sciences University, South AfricaDepartment of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, Sefako Makgatho Health Sciences University, South Africa
| | - Yordanka Piña Rivera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaFaculty of Medicine, Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| |
Collapse
|
26
|
Aminde LN, Tindong M, Ngwasiri CA, Aminde JA, Njim T, Fondong AA, Takah NF. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr Disord 2019; 19:35. [PMID: 30943969 PMCID: PMC6446302 DOI: 10.1186/s12902-019-0360-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a growing cause of disease burden globally. Its management is multifaceted, and adherence to pharmacotherapy is known to play a significant role in glycaemic control. Data on medication adherence among affected patients is unknown in Cameroon. In this study, the level of adherence and factors influencing non-adherence to antidiabetic medication among patients with type-2 diabetes was assessed. METHODS A hospital-based cross-sectional study among adult patients receiving care in the diabetic clinics of the Limbe and Bamenda Regional Hospitals in Cameroon was conducted. Medication adherence was assessed using the Medication Compliance Questionnaire (MCQ). Factors associated with non-adherence to medication were determined using basic and adjusted multivariable logistic regression models. RESULTS A total of 195 patients with type 2 diabetes were recruited. The prevalence of non-adherence to medication was 54.4% [95% confidence interval (CI): 47.1-61.5%]. In multivariable analysis, age > 60 years (aO.R. = 0.48, 95% CI: 0.25-0.94), alcohol consumption (aO.R. = 2.13, 95% CI: 1.10-4.14) and insulin alone therapy (aO.R. = 2.85, 95% CI: 1.01-8.08) were associated with non-adherence. Patients attributed their non-adherence to forgetfulness (55.6%), lack of finances (38.2%) and disappearance of symptoms (14.2%). CONCLUSIONS Adherence to anti-diabetic medication is poor in this study with more than half of participants being non-adherent. Urgent interventions are required to tackle this problem in combined efforts to stem this looming diabetes epidemic.
Collapse
Affiliation(s)
- Leopold Ndemnge Aminde
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia
- Non-communicable diseases Unit, Clinical Research Education, Networking and Consultancy, Douala, Cameroon
| | - Maxime Tindong
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Calypse A. Ngwasiri
- Non-communicable diseases Unit, Clinical Research Education, Networking and Consultancy, Douala, Cameroon
- Bamendjou District Hospital, Bamendjou, Cameroon
| | - Jeannine A. Aminde
- Etoug-Ebe Baptist Hospital Yaounde (EBHY), Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Tsi Njim
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA UK
- Health and Human Development Research Group (2HD), Douala, Cameroon
| | | | - Noah Fongwen Takah
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
27
|
Badi S, Abdalla A, Altayeb L, Noma M, Ahmed MH. Adherence to Antidiabetic Medications Among Sudanese Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Survey. J Patient Exp 2019; 7:163-168. [PMID: 32851136 PMCID: PMC7427351 DOI: 10.1177/2374373519831073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Adherence to antidiabetic medications is crucial for optimum glycemic control and decreasing complications. This study aimed to assess adherence to antidiabetic medications and the associated factors among individuals with type 2 diabetes attending Jabir Abu Eliz Diabetes Centre in Khartoum state, Sudan. Methods: This was a descriptive cross-sectional study, recruited 213 individuals with type 2 diabetes, and used a pretested questionnaire. Data were analyzed using the Statistical Package of Social Sciences version 21. Logistic regression analysis was used to check for factors that linked to poor adherence to diabetes medication. Results: The median duration of antidiabetic medications use was 8 years; 15.0% were highly adherent to diabetes medications, 44.6% were medium adherent, and 40.4% showed low adherence. Main factors and barriers were medication side effects (18.3%), use of herbal medicine (12.3%), and unavailability of medication (7%). Predictors to nonadherence were gender, and housing status (0.043 and 0.042, respectively). Conclusion: Level of adherence to diabetes medication was unsatisfactory as only 15% showed high adherence. Predictors of nonadherence were gender, and housing status. Effective interventions should be implemented to improve medication adherence, like appropriate patient education and involvement in the treatment plan.
Collapse
Affiliation(s)
- Safaa Badi
- Department of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Ali Abdalla
- Department of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Lina Altayeb
- Department of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Mounkaila Noma
- Faculty of Pharmacy, Department of Pharmacology, University of Medical Sciences & Technology, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV metabolic clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, United Kingdom
| |
Collapse
|
28
|
Rathish D, Hemachandra R, Premadasa T, Ramanayake S, Rasangika C, Roshiban R, Jayasumana C. Comparison of medication adherence between type 2 diabetes mellitus patients who pay for their medications and those who receive it free: a rural Asian experience. J Health Popul Nutr 2019; 38:4. [PMID: 30678724 PMCID: PMC6346564 DOI: 10.1186/s41043-019-0161-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Treatment plans fail if patients have poor medication adherence. Our aim was to compare medication adherence, reasons for non-adherence, and satisfaction with community support among type 2 diabetes mellitus patients who pay for their medications and those who receive it free. METHODS A descriptive cross-sectional study was conducted at Anuradhapura, Sri Lanka, among patients who were on oral anti-diabetic drugs for at least 3 months. They were grouped into two: universal-free group and fee-paying group. Three different scales were used to score medication adherence, reasons for non-adherence, and satisfaction with community support. Fisher's exact test was performed to determine if there was a significant difference between the two groups (p < 0.05) concerning medication adherence and satisfaction with community support. RESULTS The median (IQR) medication adherence scores for fee-paying group and universal-free group were 3 (2-3) and 3 (3-3), respectively; the median (IQR) scores for satisfaction with community support were 5 (2-6) and 4 (4-6), respectively. Both the adherence and the satisfaction failed to show a significant difference between the two groups. Forgetfulness, being away from home, complex drug regime, and willingness to avoid side effects were common reasons of non-adherence for both the groups. CONCLUSIONS There was no significant difference in medication adherence between the universal-free group and fee-paying group, despite of having a significantly different income. The universal-free health service would be a probable reason.
Collapse
Affiliation(s)
- Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Ruvini Hemachandra
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thilini Premadasa
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Sasini Ramanayake
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chathuri Rasangika
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Ravi Roshiban
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| |
Collapse
|
29
|
Tapela NM, Tshisimogo G, Shatera BP, Letsatsi V, Gaborone M, Madidimalo T, Ovberedjo M, Jibril HB, Tsima B, Nkomazana O, Dryden-Peterson S, Lockman S, Masupe T, Hirschhorn LR, El Halabi S. Integrating noncommunicable disease services into primary health care, Botswana. Bull World Health Organ 2019; 97:142-153. [PMID: 30728620 PMCID: PMC6357568 DOI: 10.2471/blt.18.221424] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Despite the rising burden of noncommunicable diseases, access to quality decentralized noncommunicable disease services remain limited in many low- and middle-income countries. Here we describe the strategies we employed to drive the process from adaptation to national endorsement and implementation of the 2016 Botswana primary healthcare guidelines for adults. The strategies included detailed multilevel assessment with broad stakeholder inputs and in-depth analysis of local data; leveraging academic partnerships; facilitating development of supporting policy instruments; and embedding noncommunicable disease guidelines within broader primary health-care guidelines in keeping with the health ministry strategic direction. At facility level, strategies included developing a multimethod training programme for health-care providers, leveraging on the experience of provision of human immunodeficiency virus care and engaging health-care implementers early in the process. Through the strategies employed, the country’s first national primary health-care guidelines were endorsed in 2016 and a phased three-year implementation started in August 2017. In addition, provision of primary health-care delivery of noncommunicable disease services was included in the country’s 11th national development plan (2017–2023). During the guideline development process, we learnt that strong interdisciplinary skills in communication, organization, coalition building and systems thinking, and technical grasp of best-practices in low- and middle-income countries were important. Furthermore, misaligned agendas of stakeholders, exaggerated by a siloed approach to guideline development, underestimation of the importance of having policy instruments in place and coordination of the processes initially being led outside the health ministry caused delays. Our experience is relevant to other countries interested in developing and implementing guidelines for evidence-based noncommunicable disease services.
Collapse
Affiliation(s)
- Neo M Tapela
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Moagi Gaborone
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, United States of America (USA)
| | - Tebogo Madidimalo
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, United States of America (USA)
| | - Martins Ovberedjo
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, United States of America (USA)
| | | | - Billy Tsima
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Scott Dryden-Peterson
- Division of Infectious Diseases, Harvard University, Brigham and Women's Hospital, Boston, USA
| | - Shahin Lockman
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Tiny Masupe
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, USA
| | | |
Collapse
|
30
|
Moosa A, Bezuidenhout S, Meyer JC, Godman B. Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa. Journal of Pharmaceutical Health Services Research 2019. [DOI: 10.1111/jphs.12283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
Objective
The prevalence of type 2 diabetes mellitus (T2DM) is growing in Sub-Saharan countries including South Africa. This is a concern given its appreciable impact on morbidity, mortality and costs with the recent introduction of universal health care in South Africa. The purpose of the study was to assess the knowledge of patients with T2DM attending a typical community health centre (CHC) regarding the management of their disease including risk factors and prevention to guide future initiatives. Typically, patients with T2DM in South Africa are managed in ambulatory care including CHCs.
Method
A quantitative, descriptive study in a CHC. The sample included 217 adults with T2DM who have visited a physician as well as the pharmacy. Face-to-face patient exit interviews were conducted using a structured questionnaire.
Key findings
Females predominated (65%), with the majority of patients >60 years (38.2%) and more than half from the Indian racial category. Most patients did not know how their medication controls their diabetes (79.3%) or did not know any of the side effects (83.9%) from their medication. Less than half of the patients knew how to take their medication, and more than a third of patients indicated that they were not practicing any form of self-care.
Conclusion
The results indicate that these T2DM patients lacked sufficient knowledge regarding the management of their disease. Healthcare managers should consider instigating programmes to improve patients’ knowledge about the management of their disease as part of general initiatives within South Africa to improve the management of patients with chronic diseases in the public sector.
Collapse
Affiliation(s)
- Afsana Moosa
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Selente Bezuidenhout
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
| |
Collapse
|
31
|
Alqarni AM, Alrahbeni T, Qarni AA, Qarni HMA. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia - a cross-sectional survey. Patient Prefer Adherence 2019; 13:63-71. [PMID: 30636871 PMCID: PMC6309134 DOI: 10.2147/ppa.s176355] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients' non-adherence to diabetes medication is associated with poor glycemic control and suboptimal benefits from their prescribed medication, which can lead to worsening of medical condition, development of comorbidities, reduced quality of life, elevated health care costs, and increased mortality. OBJECTIVE This study aimed to assess medication adherence among patients with diabetes and associated factors in Bisha primary health care centers (PHCCs) in Saudi Arabia. PATIENTS AND METHODS A cross-sectional study was conducted with a sample of 375 type 1 and 2 Saudi diabetic patients attending PHCCs under the Health Affairs of the Bisha governorate. The participants were aged 18 years and above, and had been taking diabetes medications for at least 3 months. Pregnant women, patients with mental illnesses, and those who were not willing to participate were excluded. Adherence to diabetes medications was measured using the four-item Morisky Green Levine Medication Adherence Scale (MGLS). All participants completed a self-report questionnaire including sociodemographic and clinical variables. Univariate and multivariate analyses were carried out using SPSS version 22. RESULTS Of all the respondents, 134 (35.7%), 161 (42.9%), and 80 (21.4%), patients had high (MGLS score 0), intermediate (MGLS score 1 or 2), and low adherence (MGLS score ≥3), respectively. Factors associated with the level of adherence in univariate analysis were occupational status (P=0.037), current medication (P<0.001), glycated hemoglobin (A1c) (P<0.001), and number of associated comorbidities (P<0.001). In multivariable analyses, A1c <7 (P<0.001) and no associated comorbidities (P<0.003) variables remained significantly associated with adherence. CONCLUSION The level of adherence to medication in diabetes mellitus patients in the Bisha PHCCs was found to be suboptimal. The findings point toward the need for better management of primary health care providers' approaches to individual patients, by taking into account their medication adherence levels. Better identification of patients' level of adherence remains essential for successful diabetes treatment.
Collapse
Affiliation(s)
- Abdullah M Alqarni
- Clinical Pharmacy Department, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia,
- Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh, Saudi Arabia,
| | - Tahani Alrahbeni
- Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh, Saudi Arabia,
| | - Ayidh Al Qarni
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Physical Therapy, King Abdullah Hospital, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia
| | - Hassan M Al Qarni
- Clinical Pharmacy Department, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia,
- Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh, Saudi Arabia,
| |
Collapse
|
32
|
Kilonzo SB, Gunda DW, Bakshi FA, Kalokola F, Mayala HA, Dadi H. Control of Hypertension among Diabetic Patients in a Referral Hospital in Tanzania: A Cross-Sectional Study. Ethiop J Health Sci 2018; 27:473-480. [PMID: 29217952 PMCID: PMC5615008 DOI: 10.4314/ejhs.v27i5.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Hypertension is common among diabetic patients. The co-existence of two conditions carries an excessive risk of severe complications and mortalities. Limited information exists on the determinants of poor hypertension control among these patients. We aimed at determining the prevalence and factors associated with poor hypertension control in these patients. Methods Data of diabetic patients who were also hypertensive attending an outpatient clinic from 1 August 2015 to 31 December 2015 at Bugando Medical Centre were retrospectively analyzed. Uncontrolled hypertension was defined as a blood pressure of ≥130mmHg and/or ≥80mmHg systolic and diastolic respectively. A designed questionnaire was used to collect data of patients. Continuous variables were summarized by median and interquartile ranges (IQR) and categorical variables were summarized by frequency and percentage. Logistic regression was used to find the predictors of uncontrolled hypertension. Results The majority of our study population were females, 161/295 (54.6%), and the median age was 57 years (IQR 50–64). The prevalence of hypertension was 206/295 (69.8%). A total of 174/206 (84.5%) patients had uncontrolled hypertension. This poor control was significantly associated with poor adherence to anti-hypertensives (OR 1.73[1.26–2.38] p=0.002), presence of any long-term complication (OR 3.19 [1.65–6.18] p=0.03) and overweight (BMI>24.9 Vs <24.9) (OR 1.68 [0.98–2.88], p=0.04). Under-prescription and ambiguous drugs combination was also observed. Conclusion The prevalence of poor hypertension control among diabetic patients in Tanzania is alarming. Most of the factors associated with this situation can be modified. The clinicians should advocate individualized management, continuous health education and adherence to the available guidelines.
Collapse
Affiliation(s)
- Semvua B Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Daniel W Gunda
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Fatma A Bakshi
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza-Tanzania.,Department of Internal Medicine, Bugando Medical Centre, Mwanza-Tanzania
| | - Henry A Mayala
- Cardiovascular department, Jakaya Kikwete Cardiac Institute, Dar es Salaam-Tanzania
| | - Hollo Dadi
- Faculty of Undergraduate Studies, Weill School of Medicine, Mwanza-Tanzania
| |
Collapse
|
33
|
Waari G, Mutai J, Gikunju J. Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. Pan Afr Med J 2018; 29:82. [PMID: 29875963 PMCID: PMC5987072 DOI: 10.11604/pamj.2018.29.82.12639] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 01/08/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Medication non-adherence is a common problem facing health care providers treating adult type 2 diabetes mellitus patients. Poor glycaemic control associated with increased morbidity and mortality are resulting consequences. The objective of this study was to assess medication adherence among Type 2 diabetes mellitus patients. METHODS This is a cross-sectional study conducted at Kenyatta National Hospital from November 2015 to January 2016. 290 Type 2 diabetic patients were enrolled. A questionnaire was used for data collection. Adherence levels were determined by patient scores on Morisky Medication Adherence Scale-8 and glycaemic control by blood assay for glycosylated haemoglobin. Ordinal logistic regression modelling was done using STATA software to determine factors associated with poor medication adherence. RESULTS The prevalence of medication adherence low for 28.3 % [95% CI: 23.1, 33.5], medium for 26.2% (95% CI: 21.1, 31.3) and high for 45.5% (95% CI: 39.6, 51.3) of study participants. Glycaemic control was good (HbA1c < 7%) for 107 (36.9 %) of study participants. Dissatisfaction with family members support (OR = 2.99, CI = 1.12-7.98), patients with 2-10 years duration of disease (OR = 2.07, CI = 1.01-4.22), ever being admitted for diabetes mellitus (OR = 2.94, CI = 1.60-5.41), challenge in drug access (OR = 1.76, CI = 1.01-3.05) and dissatisfaction with attending clinicians (OR = 3.58, CI= 1.36 - 9.43) were factors found associated with poor medication adherence. CONCLUSION A majority of type 2 diabetes mellitus patients have suboptimal medication adherence. Family support, affordability of medications and good healthcare provider-patient communication are important in ensuring medication adherence.
Collapse
Affiliation(s)
- Gabriel Waari
- School of Public Health, Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute
| | - Joseph Gikunju
- Department of Medical Laboratory Science, Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Kenya
| |
Collapse
|
34
|
Trevisan DD, São-João TM, Cornélio ME, Jannuzzi FF, Rodrigues RCM, Lima MHM. A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol. Contemp Nurse 2018; 53:658-668. [PMID: 29281941 DOI: 10.1080/10376178.2017.1421862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Non-adherence to oral antidiabetics drugs (OADs) has been a common problem and may contribute to poor glycemic control. AIM To describe an experimental study protocol that aims at implementing and evaluating the effect of the "action planning and coping planning" interventions on medication adherence to OADs in patients with type 2 diabetes mellitus (T2DM) in follow-up at primary care services. DESIGN A randomized controlled trial. METHODS Two groups (intervention and control) will be followed over a period of 105 days. The intervention group will receive a combination of the "action planning" and "coping planning" intervention strategies. There will be in-person meetings and phone calls to reinforce the intervention. The control group will receive the usual care from the health unit. CONCLUSIONS It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence.
Collapse
Affiliation(s)
| | - Thaís M São-João
- a School of Nursing , University of Campinas , Campinas , Brazil
| | | | | | | | | |
Collapse
|
35
|
Elsous A, Radwan M, Al-Sharif H, Abu Mustafa A. Medications Adherence and Associated Factors among Patients with Type 2 Diabetes Mellitus in the Gaza Strip, Palestine. Front Endocrinol (Lausanne) 2017; 8:100. [PMID: 28649231 PMCID: PMC5465265 DOI: 10.3389/fendo.2017.00100] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/01/2017] [Indexed: 01/04/2023] Open
Abstract
AIM The aim of this study was to evaluate the adherence to anti-diabetic medications among patients with type 2 diabetes mellitus (DM) seeking medical care in the Gaza Strip, Palestine. METHODS A cross-sectional study was conducted among 369 primary care patients with type 2 DM from October to December 2016. Adherence to medications was measured using the Morisky Medication Adherence Scale (MMAS-4). Socio-demographic and clinical variables, provider-patient relationship, health literacy, and health belief were examined for each patient. Univariate, binary logistic regression and multiple linear regression were applied to determine the independent factors influencing adherence to anti-diabetic medications using SPSS version 22. RESULTS Of all the respondents, 214 (58%), 146 (39.5%), and nine (2.5%) had high (MMAS score = 0), medium (MMAS score = 1 + 2), and low (MMAS score ≥ 3) adherence to anti-diabetic medications, respectively. Factors that were independently associated with adherence to anti-diabetic medications were as follows: female gender [odds ratio (OR): 1.657, 95% confidence interval (CI): 1.065-2.578] and perception of disease's severity (OR: 1.510, 95% CI: 0.410-5.560). Elderly (t = 1.345) and longer duration of DM (t = 0.899) were also predictors of adherence but showed no statistical significance (p > 0.05). CONCLUSION The level of complete adherence to anti-diabetic medications was sub-optimal. New strategies that aim to improve patients' adherence to their therapies are necessary taking into consideration the influencing factors and the importance of having diabetes educators in the primary care centers.
Collapse
Affiliation(s)
- Aymen Elsous
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences – International campus, Tehran, Iran
- Quality Improvement and Infection Control Office, Shifa Medical Complex, Gaza Strip, Palestine
| | - Mahmoud Radwan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences – International campus, Tehran, Iran
- Directorate General of International Cooperation, Ministry of Health, Gaza Strip, Palestine
| | - Hasnaa Al-Sharif
- Director of Chronic Diseases Department, Al Rimal Martyrs Health Center, Ministry of Health, Gaza Strip, Palestine
| | - Ayman Abu Mustafa
- Department of Research, Directorate General of Human Resources Development, Ministry of Health, Gaza Strip, Palestine
| |
Collapse
|
36
|
Jande M, Katabalo DM, Sravanam P, Marwa C, Madlan B, Burger J, Godman B, Oluka M, Massele A, Mwita S. Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania. J Comp Eff Res 2017; 6:185-193. [PMID: 28485175 DOI: 10.2217/cer-2016-0060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM Hypertension is a leading global health problem requiring lifelong treatment. However, adherence to antihypertensive medicines is a problem, greater among developing countries. Consequently, there is a need to determine current adherence rates and their associations among developing countries to plan future initiatives. MATERIALS & METHODS Cross-sectional study among adult outpatients with essential hypertension in Tanzania. Predesigned questionnaires were used to gather information on adherence rates and patient-related beliefs. The main outcome measure was adherence. RESULTS A total of 180 participants were included, with females making up 65%. High-adherence rates were seen in 54% of the patients. Patients' belief about their medication and its necessity was higher in the high adherent group and concerns about their medicines and their necessity were higher in the low adherent group. Conclusion & recommendations: Adherence rates were low compared with a suggested level ≥80%. Educational initiatives are needed to address knowledge and concerns with hypertension to improve future outcomes.
Collapse
Affiliation(s)
- Mary Jande
- School of Pharmacy, Catholic University of Health & Allied Science, PO Box 1464 Mwanza, Tanzania
| | - Deogratias M Katabalo
- School of Pharmacy, Catholic University of Health & Allied Science, PO Box 1464 Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | | | - Carol Marwa
- School of Pharmacy, Catholic University of Health & Allied Science, PO Box 1464 Mwanza, Tanzania
| | - Bijal Madlan
- School of Pharmacy, Catholic University of Health & Allied Science, PO Box 1464 Mwanza, Tanzania
| | - Johanita Burger
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, Strathclyde University, Glasgow, UK
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Amos Massele
- Department of Clinical Pharmacology, School of Medicine, University of Botswana, Gaborone, Botswana
| | - Stanley Mwita
- School of Pharmacy, Catholic University of Health & Allied Science, PO Box 1464 Mwanza, Tanzania
| |
Collapse
|
37
|
Kassahun A, Gashe F, Mulisa E, Rike WA. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia. J Pharm Bioallied Sci 2016; 8:124-9. [PMID: 27134464 PMCID: PMC4832902 DOI: 10.4103/0975-7406.171696] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Diabetes mellitus is a major global health problem covering approximately 347 million persons worldwide. Glycemic control has a main role in its management which mainly depends upon patient adherence to the treatment plan. Accurate assessment of medication adherence is necessary for effective management of diabetes. Objective: To assess nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital (AGH), Oromia Region, Ethiopia. Materials and Methods: A descriptive cross-sectional study was conducted on patients seeking anti-diabetic drug treatment and follow-up at AGH using structured questionnaire and reviewing the patient record card using check list from January 24, 2014 to February 7, 2014. Descriptive analysis was used to describe the percentages and number of distributions of the variables in the study; and association was identified for categorical data. P ≤ 0.05 was considered as statistically significant. Result: Of all respondents, 149 (52.3%) and 136 (47.7%) were female and male, respectively. The majority of the study participants 189 (66.3%) were in the age group of 30–60 years. Two-hundred nineteen (76.8%) of respondents were married currently. The majority, 237 (83.2%) of respondents did not have blood glucose self-monitoring equipment (glucometer). A total of 196 (68.8%) respondents were adhered to anti-diabetic medication. There was a significant association between adherence to the medication and side effect, level of education, monthly income and presence of glucometer at home (P < 0.05). Conclusion: The participants in the area of study were moderately adherent to their anti-diabetic medications with nonadherence rate of 31.2%. Different factors of medication nonadherence were identified such as side effect and complexity of regimen, failure to remember, and sociodemographic factors such as educational level and monthly income.
Collapse
Affiliation(s)
| | - Fanta Gashe
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Eshetu Mulisa
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Wote Amelo Rike
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
38
|
Pathania M, Dutt HK, Gogoi JB, Rathaur V, Singh G, Singh P. Study the Impact of Diabetes Camps on Adherence to Medication and Glycaemic Control in Uttarakhand. J Clin Diagn Res 2016; 10:OC22-6. [PMID: 27042497 PMCID: PMC4800563 DOI: 10.7860/jcdr/2016/16053.7271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diabetes is a major public health problem which needs to be addressed with outmost planning in resource poor settings. Good glycaemic control and medication adherence patterns can play an important role in reducing disease related complications thereby reducing morbidity and mortality among diabetics. Disease specific camps can act as a stepping stone in providing limited care to the patients. AIM The study was planned to study the impact of diabetes camp on glycaemic control and adherence to antidiabetic medication among diabetic patients at a Government Teaching Hospital, Srinagar, Garhwal, Uttarakhand, India. MATERIALS AND METHODS A cross-sectional study using a medication adherence questionnaire collected from the patients participating in diabetic camps and measuring their HbA1C levels before and after the camps along with spreading awareness about the disease. Two diabetes awareness camps were organized, three month apart and the participants were imparted knowledge about the disease. A total of 50 patients with type 2 DM who had self reported history of diabetes and were on some form of oral anti diabetics confirmed by their prescriptions. The patients were called for monthly follow up in outpatient department. A six question preformed questionnaire - the Girerd's instrument was used to assess the level of adherence to the prescribed anti-diabetic drugs in 50 patients with type 2 diabetes mellitus, their HbA1C levels were estimated and the results were analysed using standard statistical methods. RESULTS A total of 50 type 2 diabetic, 48 were studied comprising 23 (47.9%) women and 25 (52.1%) men with a mean age of 57.43 years. The average duration of diabetes among participants was 7.02 years. Poor medication adherence score was recorded in 27 participants and only 7 participants had good adherence to medication before the camp. After the camp, 19 participants had good adherence and 7 had poor medication adherence scores. As a result of improved adherence, improvement in glycaemic control was noticed by a decrease of 0.5 units in the mean HbA1C value by the end of the study. CONCLUSION The results clearly showed that group intervention in the form of camp combined with monthly follow-ups could improve adherence as well as glycaemic control at a government teaching hospital in a resource poor setting. This could also involve and encourage society as well as young trainees to participate collectively in the care of diabetics.
Collapse
Affiliation(s)
- Monika Pathania
- Associate Professor, Department of Medicine, VCSGGMS&RI, Srikot, Srinagar, Uttarakhand, India
| | - Hemant Kumar Dutt
- Assistant Professor, Department of Pharmacology, Kannur Medical College, Anjarakandy, Kannur, Kerala, India
| | - Javin Bisnu Gogoi
- Professor, Department of Biochemistry, VCSGGMS&RI, Srikot, Srinagar, Uttrakhand, India
| | - Vyas Rathaur
- Associate Professor, Department of Pediatrics,Government Doon Medical college, Dehradun, Uttrakhand, India
| | - Ganesh Singh
- Assistant Professor, Statistics, Department of Community Medicine, Lala Lajpat Rai Memorial Medical College and S.V.B.P. Hospital, Meerut, India
| | - Parul Singh
- Assistant Professor, Department of Ophthalmology, VCSGGMS&RI, Srinagar, Uttarakhand, India
| |
Collapse
|
39
|
Musenge EM, Michelo C, Mudenda B, Manankov A. Glycaemic Control and Associated Self-Management Behaviours in Diabetic Outpatients: A Hospital Based Observation Study in Lusaka, Zambia. J Diabetes Res 2016; 2016:7934654. [PMID: 26798654 PMCID: PMC4699008 DOI: 10.1155/2016/7934654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The control of diabetes mellitus depends on several factors that also include individual lifestyles. We assessed glycaemic control status and self-management behaviours that may influence glycaemic control among diabetic outpatients. METHODS This cross-sectional study among 198 consenting randomly selected patients was conducted at the University Teaching Hospital diabetic clinic between September and December 2013 in Lusaka, Zambia. A structured interview schedule was used to collect data on demographic characteristics, self-management behaviours, and laboratory measurements. Binary logistic regression analysis using IBM SPSS for Windows version 20.0 was carried out to predict behaviours that were associated with glycaemic control status. RESULTS The proportion of patients that had good glycaemic control status (HbA1c≤ 48 mmol/mol) was 38.7% compared to 61.3% that had poor glycaemic control status (HbA1c≥ 49 mmol/mol). Adherence to antidiabetic treatment and fasting plasma glucose predicted glycaemic control status of the patients. However, self-blood glucose monitoring, self-blood glucose monitoring means and exercise did not predict glycaemic control status of the patients. CONCLUSION We find evidence of poor glycaemic control status among most diabetic patients suggesting that health promotion messages need to take into account both individual and community factors to promote behaviours likely to reduce nonadherence.
Collapse
Affiliation(s)
- Emmanuel Mwila Musenge
- Department of Physiological Sciences, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
- *Emmanuel Mwila Musenge:
| | - Charles Michelo
- Department of Public Health, Section for Epidemiology and Biostatistics, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
| | - Boyd Mudenda
- Department of Public Health, Section for Epidemiology and Biostatistics, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
| | - Alexey Manankov
- Department of Physiological Sciences, School of Medicine, University of Zambia, Ridgeway Campus, P.O. Box 50110, 10101 Lusaka, Zambia
| |
Collapse
|
40
|
Pihau-Tulo ST, Parsons RW, Hughes JD. An evaluation of patients' adherence with hypoglycemic medications among Papua New Guineans with type 2 diabetes: influencing factors. Patient Prefer Adherence 2014; 8:1229-37. [PMID: 25258517 PMCID: PMC4172082 DOI: 10.2147/ppa.s66655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aims of this study were to evaluate the extent of adherence to hypoglycemic medications, assess the relationship between adherence and glycemic control, and evaluate factors affecting adherence. RESEARCH DESIGN AND METHODS This was a cross-sectional study of patients with established type 2 diabetes attending the Port Moresby General Hospital Diabetes Clinic. Face-to-face interviews were conducted using a questionnaire designed for the study and data were collected concerning the 3 months prior to interview. The questionnaire covered demographic details, lifestyle, biochemical and physical measurements, and medication management. Glycemic control was investigated among patients adhering to their medications (not missing doses) to different degrees (100%, 95%, 90%, and 80%). RESULTS Of a total of 356 participants who were prescribed hypoglycemic medications, 59.6% omitted some of their doses. Age appeared to have a significant impact on adherence at some levels of adherence, with those aged >60 years being more likely to be adherent (logistic regression). Those who were 95%-99% and those who were <80% adherent had a statistically significant risk of a high glycated hemoglobin of >10% (85.5 mmol/mol). Multiple factors were identified as contributors to nonadherence, with patient-based issues (86.0%) and the health care system (21.7%) being the most common. CONCLUSION This study showed a significant level of nonadherence among patients with type 2 diabetes in Papua New Guinea. Nonadherence to medication appeared to be associated with poor glycemic control and was due to a variety of reasons. Future interventions aimed at improving adherence will need to take these into account.
Collapse
Affiliation(s)
| | - Richard W Parsons
- CHIRI and School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Jeffery D Hughes
- CHIRI and School of Pharmacy, Curtin University, Perth, WA, Australia
- Correspondence: Jeffery D Hughes, School of Pharmacy, Curtin University, GPO Box U1987, Perth, WA 6845, Australia, Tel +61 8 9266 7367, Fax +61 8 9266 2769, Email
| |
Collapse
|