Predictors of medication adherence in patients with type 2 diabetes mellitus

Abstract

Objective:

Medical professionals are often challenged by lack of patient compliance with pharmaceutical treatments. Research has shown that patients with diabetes have one of the lowest medication adherence rates at 65% to 85%. Some causes have been identified in the literature, but the influence of type of medication is unknown. This study assessed the impact of a broad range of factors on medication adherence and persistence among adult patients with type 2 diabetes mellitus.     

糖尿病病人常见用药问题及分析

目前,我国糖尿病病人数量已经超过了9千万,成为世界上糖尿病病人最多的国家,但病人对糖尿病的知晓率却仅为44.0%,并且年轻病人对糖尿病的知晓率还远远低于中、     

老年2型糖尿病患者用药特点分析

目的 了解北京朝阳医院西院老年2型糖尿病患者用药现状.方法 调取2019年第二季度我院门诊全部处方,对老年2型糖尿病患者的降糖方案、合并症及多重用药情况进行分类统计,分析老年糖尿病患者的用药特点.结果 在降糖方案方面,840例患者中,单药、二联、三联及以上治疗的患者占比分别为43.45％,31.55％和25.00％;在...     

Pharmaceutical care of the patient with diabetes mellitus: pharmacists' priorities for services and educational needs in Scotland

Objective To determine the extent of service provision by pharmacists in Scotland to patients with diabetes. Also, to investigate pharmacists' perceived education needs and their priorities for future service development to this patient group. Setting A random sample of pharmacists in Scotland who had previously participated in NHS Education for Scotland (NES) education. Method Questionnaire survey of pharmacists to estimate extent of provision of 28 defined aspects of diabetes care, educational needs and their professional aspirations. Key findings Approximately two‐thirds of community pharmacists who responded offered the following patient‐centred services for patients with diabetes and included education/advice on: lifestyle, smoking cessation, medicines administration times, footcare and self‐monitoring of glycaemia. Perceived need for further education was found to be linked with levels of service provision. Priorities for development of future services in this patient group were established, and preferred methods of educational support were also examined. Conclusion Pharmacists in Scotland are providing services for patients with diabetes although these are not consistent. The profession in Scotland also has clear ideas of future priorities in practice for this patient group. However there is a need to provide further training and education in order to support service development.     

Evaluation of a pilot study to influence medication adherence of patients with diabetes mellitus type-2 by the pharmacy

Background Interventions aimed to increase adherence to drug treatment usually are not tailored to the needs of individual patients. A modular pharmacy intervention, named ‘Support for Diabetes’, was developed to improve adherence to type 2 diabetes treatment. Objective To evaluate the implementation of a new care intervention by using focus groups including pharmacy teams, and assess patient satisfaction. Setting Community pharmacies in The Netherlands Method The intervention comprises a structured patient interview, an intervention guide and modular interventions tailored to the underlying cause of non-adherence. Feasibility was studied in non-adherent type 2 diabetes mellitus patients, and evaluated by means of focus group interviews with pharmacists and pharmacy technicians. Topics included practicability of the patient selection procedure, patient interviews, materials developed for the intervention and general practitioner (GP) co-operation. Patients’ experiences (n = 36) were assessed by means of a questionnaire. Main outcome measure Feasibility of the intervention and patients’ satisfaction. Results Pharmacists and pharmacy technicians considered the intervention feasible and appreciated its pro-active approach. Involvement of pharmacy technicians proved a stimulating factor. Poor co-operation with GPs and lack of time as well as financial compensation were interfering factors. Patients appreciated the intervention and reported to follow the advice of pharmacists. Conclusion The ‘Support for Diabetes’ intervention is feasible to implement in pharmacy practice. Poor co-operation between pharmacists and GPs and lack of re-imbursement are obstructions for implementation on a wider scale. These issues should receive attention of pharmacists, policymakers and researchers.     

社区药师对糖尿病患者进行家庭用药指导的效果分析

目的 探讨社区药师通过家庭用药指导参与糖尿病慢病干预的效果.方法 100例血糖控制不理想的2型糖尿病患者作为研究对象,按照动态随机分组法分为对照组和观察组,每组50例.对照组采用常规干预,观察组采用社区药师家庭用药指导.比较两组患者的饮食、用药、运动、血糖检测依从性,干预前后的空腹血糖、餐后2 h血糖、糖化血红蛋白水平...     

The use of insulin in elderly patients with type 2 diabetes mellitus

Introduction: Older patients with diabetes sometimes present comorbidities that increase the risk of other common geriatric syndromes. In such patients, treatment with insulin is usually started when full doses of oral hypoglycemic agents are no longer adequate to achieve acceptable glycemic control.

Areas covered: This article reviews the available literature on the use of insulin in elderly patients with type 2 diabetes. The aims are to gain information on: the benefits and risks of initiating insulin treatment, the efficacy and safety of different types of insulin and the most appropriate initial dosing and titration regimens. Thirteen published trials have evaluated the effects of different insulin regimens in the management of elderly subjects with type 2 diabetes but, given that older people are generally excluded in clinical studies with insulin, only three published reports on subgroup analyses are limited to elderly patients.

Expert opinion: The available literature shows that the addition of insulin to current oral treatments is generally safe and effective in improving metabolic control, with a low risk for hypoglycemia. Further research is needed to better understand the most appropriate insulin regimens necessary to achieve glycemic goals while appropriately addressing the risk of hypoglycemia.     

The use of insulin in elderly patients with type 2 diabetes mellitus

INTRODUCTION: Older patients with diabetes sometimes present comorbidities that increase the risk of other common geriatric syndromes. In such patients, treatment with insulin is usually started when full doses of oral hypoglycemic agents are no longer adequate to achieve acceptable glycemic control. AREAS COVERED: This article reviews the available literature on the use of insulin in elderly patients with type 2 diabetes. The aims are to gain information on: the benefits and risks of initiating insulin treatment, the efficacy and safety of different types of insulin and the most appropriate initial dosing and titration regimens. Thirteen published trials have evaluated the effects of different insulin regimens in the management of elderly subjects with type 2 diabetes but, given that older people are generally excluded in clinical studies with insulin, only three published reports on subgroup analyses are limited to elderly patients. EXPERT OPINION: The available literature shows that the addition of insulin to current oral treatments is generally safe and effective in improving metabolic control, with a low risk for hypoglycemia. Further research is needed to better understand the most appropriate insulin regimens necessary to achieve glycemic goals while appropriately addressing the risk of hypoglycemia.     

糖尿病相关皮肤病变

由于血糖长期慢性升高而导致的各种急慢性并发症是糖尿病患者寿命缩短、生活质量下降的重要原因。糖尿病引起的皮肤病变虽不像心、脑、肾、眼病那样直接危害生命，但也给患者带来很多痛苦，如处理不好也会导致严重后果。     

肌酐在糖尿病患者肾小球滤过功能评价中的作用

目的：探讨肌酐在糖尿病患者肾小球滤过功能评价中的作用。方法选择糖尿病患者75例,选择健康体检者67例,测定入组者的血清肌酐值和血清胱抑素C值,并进行比较。结果肌酐对发生中重度肾功能损害的糖尿病患者的肾功能有较好的评价。结论对仅发生轻度肾功能损害的糖尿病患者的肾功能进行评价时,血清Cr敏感性较差。     

Antiplatelet therapy in patients with diabetes mellitus

Platelets are key players in arterial thrombosis, and oral antiplatelet therapy is a cornerstone in the treatment and prevention of cardiovascular events. However, although currently approved antiplatelet drugs have proved successful in reducing cardiovascular events, platelet-dependent thrombosis remains an important cause of morbidity and mortality in patients with coronary artery disease. It is well-known that patients with diabetes mellitus (DM) have an increased risk of cardiovascular events and, therefore, understanding the mechanism of action and safety profile of antiplatelet drugs in this high-risk population is of particular interest. There is considerable inter-individual variation in the efficacy of established antiplatelet drugs, and high on-treatment platelet reactivity is associated with an increased risk of cardiovascular events, thus prompting the search for novel drugs against platelet-dependent thrombosis. New antiplatelet treatment strategies include drugs with more efficient and reversible platelet inhibition. This review discusses selective inhibitors of the platelet cyclooxygenase enzyme, thienopyridine and non-thienopyridine inhibitors of the platelet adenosine diphosphate receptor, phosphodiesterase inhibitors, and protease-activated receptor antagonists. An overview of currently available antiplatelet drugs is provided, focusing on benefits and limitations in patients with DM. Furthermore, the rationale for new oral antiplatelet drugs under development is discussed with particular focus on the potential role of these drugs to improve cardiovascular outcomes in patients with DM.     

Serum fructosamine in patients with diabetes mellitus

Serum fructosamine was compared with other measures of blood glucose control in 11 non-diabetic volunteers, 14 type 1 and 14 type 2 diabetic patients. Estimates of mean plasma glucose concentrations for the 28 diabetic patients were made by nine physicians, based on their interpretation of historical data, home capillary blood glucose profiles, fasting and random plasma glucose and plasma lipid levels. Significant differences between estimated and measured mean glucose levels were apparent with a tendency for physicians to underestimate mean blood glucose in the hyperglycaemic range (glucose greater than 11 mmol/l). Fructosamine results on the same patients correlated linearly both with mean plasma glucose concentrations (r = 0.86, p less than 0.001) and with glycosylated haemoglobin (HbA1c) levels (r = 0.93, p less than 0.001) and correctly classified diabetes control in most patients. Despite marked fluctuations of plasma glucose concentration, serum fructosamine levels measured at different times of the day did not alter significantly. We conclude that a random serum sample analysed for fructosamine provides a simple and reliable means to measure the efficacy of therapy and often provides information superior to clinical assessment of diabetic control.     

深圳市糖尿病患者服药依从性及相关危险因素分析

目的了解本地区糖尿病患者服药依从性及其影响因素,为进一步开展糖尿病预防控制工作提供依据。方法对就诊于本院门诊的547例糖尿病患者进行调查,对其基本情况、糖尿病患病情况以及服药依从情况进行调查,并进行单因素和多因素分析。结果从糖尿病服药依从性单因素分析发现,依从性与居住情况、并发症情况、文化程度、监测血糖次数、病程长短、糖尿病知晓率、服药种类等因素相关。Logistic多因素回归分析发现病程(OR=1.776,P=0.011),DM知识知晓率(OR=1.634,P=0.009)和治疗复杂程度(OR=3.867,P=0.013)是影响糖尿病患者用药依从性的独立相关因素。结论糖尿病患者用药依从性与多种因素相关,而加强糖尿病患者健康教育、简化治疗方案、加强社会支持、长期规律用药等有利于患者治疗用药依从性的提高。