Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review

Aim. This paper is a report of a literature review to identify research involving interventions to improve medication adherence in people with multiple co-existing chronic conditions. Title. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Background. The importance of managing co-existing, chronic conditions in people of all ages is critical to prevent adverse health outcomes. Data sources. Databases, including Cumulative Index of Nursing and Allied Health Literature, Medline, PubMed and Web of Science were searched for the period January 1997–2007 using the combined keywords adherence, compliance, drug therapy, medication, clinical trial, randomized controlled trial, intervention, chronic condition, chronic disease, multiple morbidity and comorbidity. References of retrieved papers were also considered. Methods. The inclusion criteria were: English language, oral medication adherence, self-administered medications, multiple prescribed medications for three or more chronic conditions and randomized controlled trials lasting at least 3 months. Results. Studies examining medication adherence in people with multiple chronic conditions targeted people over 70 years of age, and were primarily focused on the management of polypharmacy and reducing healthcare costs. Adherence was measured using different tools and estimates of adherence, and interventions were predominantly delivered by pharmacists. The evidence for effective interventions to enhance medication adherence in multiple chronic conditions was weak, and psychosocial interventions were absent. Conclusion. Interventions that improve medication adherence for people with multiple chronic conditions are essential, given the increased prevalence of these conditions in people of all ages. Outcomes of improved adherence, such as disease control and quality of life, require investigation. Psychosocial interventions engaging people in medication self-management offer potential for improved patient outcomes in complex diseases.     

The effect of education given to patients with type 2 diabetes mellitus on self-care

This research was performed as a single group pretest--posttest experimental design to determine the effect of education given to patients with type 2 diabetes mellitus on self-care. The research was performed between October 2007 and June 2008 in the Internal Medicine Outpatient Clinics located in A and B Blocks of Erzincan State Hospital. The research population included 100 patients with type 2 diabetes mellitus who attended the above mentioned units between the specified dates and met the inclusion criteria. Patients were subjected to a pretest using a patient identification form, Diabetes Self-Care Scale (DSCS) form in Turkish language and metabolic control parameters. A statistically significant difference was found between the mean values of pre-education and posteducation DSCS scores with an increase in mean posteducation scores. These results demonstrate that the education given to patients improves their self-care and metabolic control variables.     

糖尿病信息管理系统联合同伴教育对糖尿病门诊患者治疗效果的影响

目的 探讨糖尿病信息管理系统(DIMS)与同伴教育相结合的糖尿病管理模式对患者的自我管理水平及综合指标的影响。方法 选取2型糖尿病患者200例,随机分为3组。A组利用DIMS系统为其建立电子病历,同时给予同伴教育干预。B组在DIMS管理同时对其进行传统健康教育。C组接受普通门诊治疗。观察治疗前及治疗12月后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA₁c)、血压(BP)、胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及体质量指数(BMI)及各指标达标率变化,同时对糖尿病相关知识掌握情况、自我管理行为进行治疗前后评估。结果 治疗12月后A、B组的FPG、2 hPG、HbA₁c、HDL-C、LDL-C、TG、TC、BMI、BP均较治疗前达标率提高(P＜0.05);C组仅血压较治疗前达标率提高(P<0.05)。治疗12月后A组较C组的FPG、2 hPG、HbA₁c、HDL-C、LDL-C、TG、TC、BMI达标率提高(P＜0.05),而较B组的2 hPG、HbA₁c、HDL-C、LDL-C、TG、TC、BMI达标率提高(P＜0.05)。治疗12月后A组较B、C组对糖尿病相关知识掌握情况、自我管理行为得分显著提高(P＜0.05)。结论 DIMS结合同伴教育管理模式能提高糖尿病患者自我管理水平,改善各项代谢指标。     

Effectiveness of a nurse-led personalized patient engagement program to promote type 2 diabetes self-management: A randomized controlled trial

PHEinAction® is a theory-based nurse-led patient engagement intervention developed among an Italian older adult population with various chronic diseases to facilitate cognitive, emotional, and behavioral processes in promoting individuals' active roles. This study aims to adapt and evaluate the effectiveness of PHEinAction® on diabetes self-management (DSM) among Turkish type 2 diabetes mellitus patients. First, the generic content of the intervention was customized for diabetes management and adapted for the Turkish population, including back-forward translation and expert panel evaluation; then, a randomized controlled trial was conducted with 51 adult diabetes patients randomly assigned to intervention or the control group receiving the usual care. The intervention consisted of two in-person sessions of 4-week intervals, a telephone consultation, and home-based written exercises, which involved personalized care activities addressing individuals' engagement levels and covering the cognitive, emotional, and behavioral aspects. The scores for treatment adherence, self-efficacy, and patient engagement had significantly improved with a large size effect in the intervention group at the fourth-week follow-up compared with the control group. Findings suggest that the nurse-led personalized patient engagement program could effectively promote DSM.     

饮食行为干预对2型糖尿病患者的效果评价

目的探讨饮食行为干预对2型糖尿病患者的影响。方法将80例2型糖尿病患者随机均分成对照组和干预组,对照组采用一般性随机饮食护理,干预组在一般饮食护理的基础上进行饮食行为干预,制定个性化饮食方案,通过比较2组患者糖尿病饮食知识的知晓率、行为变化情况来评估饮食行为干预的效果。结果 2 d后干预组患者糖尿病饮食知识知晓率和行为改变率较对照组有显著差异(P<0.05)。结论对2型糖尿病患者进行饮食行为干预,可使其掌握糖尿病饮食知识并建立科学的饮食行为,这对控制糖尿病病情、延缓并发症发生、提高患者生活质量具有积极意义。     

新诊断2型糖尿病伴高尿酸血症的相关因素分析

目的 探讨新诊断2型糖尿病(T2DM)患者伴高尿酸血症(HUA)的相关因素.方法 选取新诊断T2DM患者158例,根据血尿酸(SUA)水平(男性SUA≥420 μmol/L,女性SUA≥360μmol/L),将其分为正常尿酸(NUA)组126例,HUA组32例.比较两组临床指标的差异.结果 新诊断2型糖尿病患者HUA患病率为20.3％,其中男性26.3％,女性11.1％;HUA组患者舒张压(DBP)、体质量指数(BMI)、腰围(WC)、甘油三酯(TG)、血肌酐(SCr)、血尿素氮(BUN)、24小时尿微量白蛋白(UAER)均高于NUA组(P＜0.05),而高密度脂蛋白胆固醇(HDL-C)低于NUA组(P＜0.05),两组患者糖尿病病程、空腹血糖(FPG)、餐后2小时血糖(2 hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、收缩压(SBP)差异无统计学意义(P＞0.05).直线相关分析显示,TG、HDL-C、BMI、WC、DBP、SCr及UAER是高尿酸血症的影响因素(P＜0.01).结论 新诊断T2DM患者高尿酸血症与高血压、血脂异常、肥胖和肾脏病变相关.     

现代信息技术在2型糖尿病健康教育中的应用探讨

利用现代信息技术资源丰富、即时高效、成本低廉等特点,对2型糖尿病患者进行健康教育。结果表明此方法可优化健康教育方式、提高受教育者的学习自主性、增强学习效果、节约人力成本等,使健康教育变得更加方便、快捷、经济、有效。     

罗格列酮对2型糖尿病及糖尿病前期患者大血管事件影响的系统评价

目的讨论罗格列酮对2型糖尿病及糖尿病前期患者大血管事件的影响。方法按照国际Cochrane协作网的系统评价方法 ,检索关于罗格列酮对2型糖尿病或糖尿病前期患者大血管系统影响的临床随机对照试验,对照治疗包括安慰剂或阳性对照药物,其随访时间至少1年以上。由两位研究者独立地对符合纳入标准的试验进行质量评价和资料提取。采用下列指标对罗格列酮对2型糖尿病及糖尿病前期患者大血管系统的影响进行Meta分析:全因死亡、全部心血管事件、心肌梗死事件、心力衰竭事件、心血管死亡事件、脑卒中事件、周围血管事件。结果 5个试验符合纳入标准,包括11871例2型糖尿病及糖尿病前期患者。长期罗格列酮治疗与其它对照治疗比较,可能增加其心力衰竭事件(P<0.01)的发生率,但是对其全因死亡事件(P=0.42)、全部心血管事件(P=0.11)、心肌梗死事件(P=0.09)、心血管死亡事件(P=0.80)、脑卒中事件(P=0.18)及周围血管事件(P=0.32)发生率的影响差异无统计学意义。结论罗格列酮治疗糖尿病及糖尿病前期患者可能增加心力衰竭事件的发生,对于全因死亡事件、全部心血管事件、心血管死亡事件、脑卒中事件、周围血管事件等影响不大;而对于心肌梗死事件则有一定的增加其风险的趋势,但差异并不显著。     

健康体检中中年人2型糖尿病筛查相关指标的分析

目的探讨中年健康人群中空腹血糖水平与其他相关指标的关系。方法选择2004年1月～12月在我院体检中心进行体检的40～60岁的中年人1480例,测定空腹血糖、血清甘油三脂、总胆固醇、血尿酸、胰岛素、血压和BMI等指标,同时进行综合分析。结果中年健康人群中空腹血糖水平随年龄增长而升高,高血糖组人群的总胆固醇、血尿酸、血压和BMI高于正常血糖组。结论健康体检中血糖升高与体检者年龄、BMI、总胆固醇和舒张压有关联。     

Liraglutide for type 2 diabetes mellitus

Introduction: Prevalence of type 2 diabetes mellitus (T2DM) is increasing. Management of this condition and minimizing the cardiovascular risks associated with it poses a significant burden on healthcare resources across the world. Currently available therapeutic agents are effective in glycemic management; however, the majority of these are associated with undesirable effects such as hypoglycemia and weight gain. Incretin-based therapies have been introduced over the last few years and are associated with less risk of hypoglycemia and weight gain.

Areas covered: This review includes current challenges in the management of T2DM, and an overview of glucagon-like peptide-1 (GLP-1)-based therapies, in particular the results of Phase III clinical studies of recently approved liraglutide. Apart from glycemic control, multifactorial interventions are needed to minimize the cardiovascular risks associated with T2DM. Liraglutide is effective in improving glycemic control measured by HbA1c and it is also shown to improve weight. Recently, the National Institute of Health and Clinical Excellence in the UK has approved liraglutide 1.2 mg dose in dual and triple therapy for T2DM.

Expert opinion: Liraglutide, a once-daily GLP-1 analog, has a definite role in selected patients with T2DM and the long-term cardiovascular safety is currently being ascertained in ongoing trials.     

Factors influencing diabetes self-management in Chinese people with type 2 diabetes

Patients with diabetes must incorporate a complicated regimen of self-management into their daily lives (e.g., taking medication, diet, exercise). Diabetes self-management (DSM) is the cornerstone for controlling diabetes and preventing diabetic complications. The purpose of this study was to test a model describing the effects of individual and environmental factors on DSM in a sample of patients with diabetes in Beijing, China. Survey data were gathered from a convenience sample of 201 Chinese adults with type 2 diabetes during outpatient visits. Data were analyzed using structural equation modeling. Model fit indices indicated a good fit to the data. In the final model, belief in treatment effectiveness and diabetes self-efficacy were proximate factors affecting DSM. Knowledge, social support, and provider-patient communication affected self-management indirectly via beliefs and self-efficacy. The findings provide a theoretical basis to direct the development of interventions for improving DSM in Chinese individuals with diabetes.     

Barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes

song m., lee m. & shim b. (2009) Barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes. International Journal of Older People Nursing 5 , 211–218
doi: 10.1111/j.1748-3743.2009.00189.x Aim. The aim of this study was to identify the barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes. Design and methods. Qualitative data collected from 24 participants in three focus groups who had previously taken part in a diabetes self-management education programme in a community setting were analyzed using an interpretive method. Results. The barriers to adherence to self-management included ageing-related physical and psychological changes, restrictions related to specific cultural factors, lack of self-discipline and poor understanding of self-management. Facilitators of self-management were knowing the benefits of and having a system to reinforce self-management, being the master of oneself by reshaping historical life habits and family support. The perceived barriers and facilitators differed with gender as a result of the characteristics of Korean culture. Conclusions. This study identified the major barriers to and facilitators of self-management adherence specific to Korean older adults with diabetes, which can be used to develop better diabetes self-management education programmes for this population. Relevance to clinical practice. Korean nurses working with Korean older adults with diabetes can utilize the findings of this study to structure better tailored and culturally appropriate self-management programmes specific to older adults.     

个体化出院指导对2型糖尿病患者用药依从性的影响

【】目的 探讨在个体化出院指导后,对于2型糖尿病患者用药依从性的影响。方法 选取我院于2017年1月～2017年12月出院的300例2型糖尿病患者作为研究对象,随机分为试验组和对照组各150例,试验组根据出院前制定个体化的出院用药指导,由责任护士进行药物发放和宣教指导,对照组患者则于出院前由责任护士按护理常规进行药物发放和宣教。患者出院三个月后比较糖化血红蛋白指标和用药依从性。结果 用药依从性方面研究组Morisky评分中位数P50=3.00,对照组Morisky评分中位数P50=2.00,并且试验组评分8分的患者占54%,对照组占18%,说明了我科对于不同的患者进行的个体化出院药物指导,对于提高患者用药依从性的效果显著。试验组患者HbA1C的中位数P50=1.00,对照组HbA1C的中位数P50=2.00,并且试验组HbA1C≤7%的患者比例占64%,对照组占38%,说明患者用药依从性提高后,对于控制稳定血糖也同样有较好的效果。结论 个体化出院药物指导可以有效提高2型糖尿病患者的用药依从性,从而使诊疗计划中药物效果更好的发挥,有效地控制患者血糖。     

Incidence and prevalence of pulmonary tuberculosis among patients with type 2 diabetes mellitus: a systematic review and meta-analysis

BackgroundThe epidemic of type 2 diabetes mellitus (T2DM) poses a great challenge to pulmonary tuberculosis (PTB) control. However, the incidence and prevalence of PTB among T2DM patients has not been fully determined. This meta-analysis aimed to provide the estimation on the global incidence and prevalence of PTB among T2DM patients (T2DM-PTB).MethodsOnline databases including Web of Science, PubMed, China National Knowledge Infrastructure and Cochrane Library were searched for all relevant studies that reported the incidence or prevalence of T2DM-PTB through 31 January 2022. Pooled incidence and prevalence of T2DM-PTB with 95% confidence interval (CI) was estimated by the random-effect model. All statistical analyses were performed using R software.ResultsA total of 24 studies (14 cohort studies, 10 cross-sectional studies) were included. The pooled incidence and prevalence of T2DM-PTB were 129.89 per 100,000 person-years (95% confidence interval (CI): 97.55–172.95) and 511.19 per 100,000 (95% CI: 375.94–695.09), respectively. Subgroup analyses identified that the incidence of T2DM-PTB was significantly higher in Asia (187.20 per 100,000 person-years, 95% CI: 147.76–237.17), in countries with a high TB burden (172.04 per 100,000 person-years, 95% CI: 122.98–240.68) and in studies whose data collection ended before 2011 (219.81 per 100,000 person-years, 95% CI: 176.15–274.28), but lower in studies using International Classification of Diseases-10 codes (73.75 per 100,000 person-years, 95% CI: 40.92–132.91). The prevalence of T2DM-PTB was significantly higher in countries with a high TB burden (692.15 per 100,000, 95% CI: 468.75–1022.04), but lower in Europe (105.01 per 100,000, 95% CI: 72.55–151.98).ConclusionsThis systematic review and meta-analysis suggests high global incidence and prevalence of PTB among T2DM patients, underlining the necessity of more preventive interventions among T2DM patients especially in countries with a high TB-burden.

Key messages

• A total of 24 studies (14 cohort studies, 10 cross-sectional studies) containing 2,569,451 T2DM patients were included in this meta-analysis.
• The pooled incidence and prevalence of T2DM-PTB are 129.89 per 100,000 person-years (95% CI: 97.55–172.95) and 511.19 per 100,000 (95% CI: 375.94–695.09) respectively.
• The incidence of T2DM-PTB was significantly higher in Asia, in countries with a high TB burden and in studies whose data collection ended before 2011, but lower in studies using International Classification of Diseases-10 codes.
• The prevalence of T2DM-PTB was significantly higher in countries with a high TB-burden, but lower in Europe.

     

糖化蛋白检测在2型糖尿病监控中的意义

目的 探讨糖化血红蛋白A1c(HbA1c)及糖化血清蛋白(GSP)的检测对2型糖尿病(DM)监控的临床意义.方法 选择167例临床确诊的2型DM患者和120例健康体检者,进行空腹血糖(FPG)、餐后2 h血糖(2hPG)、HbA1c、GSP指标的检测,结果进行统计学处理.结果 2型DM组FPG、2hPG、HbA1c及GSP等指标与健康对照组比较差异有统计学意义(P＜0.01),DM患者的HbA1c与FPG、2hPG呈显著正相关.经过治疗后,病情得到控制的DM组FPG、2hPG、HbA1c及GSP等4项指标与健康对照组比较差异无统计学意义(P＞0.05),但HbA1c水平与FPG、2hPG水平并不完全一致.结论 FPG、2hPG、HbA1c及GSP的联合检测有助于2型DM的早期诊断,对控制DM并发症的发生、发展及DM的预后监测均有重要临床意义.     

Efficacy of low-dose metformin in Japanese patients with type 2 diabetes mellitus

The goal of this study was to examine the antihyperglycemic effect of low-dose metformin in nonobese and obese Japanese patients with type 2 diabetes mellitus. After 3 months of reeducation and stabilization of diet therapy (25 kcal/kg of ideal body weight), metformin treatment was initiated. We administered metformin (500 to 750 mg daily) as monotherapy (n = 11) or in combination with a sulfonylurea (n = 14). After 6 months of treatment, the fasting plasma glucose level (mean ± SD) decreased from 190 ± 42 mg/dL to 155 ± 37 mg/dL and the glycated hemoglobin A_1c level (mean ± SD) from 8.8 ± 1.2% to 7.4 ± 1.0% in the monotherapy group. These same variables decreased from 218 ± 60 mg/dL to 162 ± 30 mg/dL and from 9.5 ± 1.2% to 8.4 ± 1.2% in the combination therapy group. All of these changes were statistically significant. Our results demonstrate that even low doses of metformin can improve hyperglycemia in Japanese patients with type 2 diabetes mellitus.