Effectiveness of Smartphone-Based Interventions on Medication Adherence in Type 2 Diabetes Mellitus: A Systematic Review

Aims:While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis.Methods:We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM) and oral (OAD) medications. Two analyses were performed, one which ignored adherence (analysis 1) and one which incorporated it (analysis 2). Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios.Results:In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY) gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY). This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM.Conclusions:Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be considered in health care decision-making. Future work on the impact of adherence on health economic outcomes, and validation of different approaches to modeling adherence, is warranted.

IntroductionThe management of diabetes has become a critical public health issue in China. The development of community-based type 2 diabetes management in China has not yet reached an ideal state,...

BackgroundCurrent interventions to support medication adherence in people with type 2 diabetes are generally resource-intensive and ineffective. Brief messages, such as those delivered via short message service (SMS) systems, are increasingly used in digital health interventions to support adherence because they can be delivered on a wide scale and at low cost. The content of SMS text messages is a crucial intervention feature for promoting behavior change, but it is often unclear what the rationale is for chosen wording or any underlying mechanisms targeted for behavioral change. There is little guidance for developing and optimizing brief message content for use in mobile device–delivered interventions.ObjectiveThis review aimed to (1) identify theoretical constructs (ie, the targets that interventions aim to change) and behavioral strategies (ie, features of intervention content) found to be associated with medication adherence in patients with type 2 diabetes and (2) map these onto a standard taxonomy for behavior change techniques (BCTs, that is, active ingredients of interventions used to promote behavioral change, to produce an evidence-based set of approaches that have shown promise of improving adherence in previous studies and which could be further tested in digital health interventions.MethodsA rapid systematic review of existing relevant systematic reviews was conducted. MEDLINE and PsycINFO databases were searched from inception to April 10, 2017. Inclusion criteria were (1) systematic reviews of quantitative data if the studies reviewed identified predictors of or correlates with medication adherence or evaluated medication adherence–enhancing interventions and included adult participants taking medication to manage a chronic physical health condition, and (2) systematic reviews of qualitative studies of experiences of medication adherence for adult participants with type 2 diabetes. Data were extracted on review characteristics and BCTs, theoretical constructs, or behavioral strategies associated with improved adherence. Constructs and strategies were mapped onto the BCT version 1 taxonomy.ResultsA total of 1701 references were identified; 25 systematic reviews (19 quantitative reviews, 3 qualitative reviews, and 3 mixed-method reviews) were included. Moreover, 20 theoretical constructs (eg, self-efficacy) and 19 behavioral strategies (eg, habit analysis) were identified in the included reviews. In total, 46 BCTs were identified as being related to medication adherence in type 2 diabetes (eg, habit formation, prompts or cues, and information about health consequences).ConclusionsWe identified 46 promising BCTs related to medication adherence in type 2 diabetes on which the content of brief messages delivered through mobile devices to improve adherence could be based. By using explicit systematic review methods and linking our findings to a standardized taxonomy of BCTs, we have described a novel approach for the development of digital message content. Future brief message interventions that aim to support medication adherence could incorporate the identified BCTs.

Background: Poor medication adherence in type 2 diabetes mellitus (T2DM) leads to poor glycemic control. Materials and Methods: This randomized, open-labeled, controlled study recruited consenting adult patients with uncomplicated T2DM who were on daily oral antidiabetics with documented poor medication adherence (missing ≥20% of their prescribed doses in the past 15 days). Patients in the “incentive group” installed a digital therapeutics mobile app (KYT-Adhere) and received multiple daily medication reminders. Patients were asked to show the pill/(s) to the app before consuming the medication, after which the patients received “KYT-Points”; these would be converted into financial incentives after 3 months, provided that they maintained ≥80% medication adherence. These patients received incentives for 3 months and medication reminders for 6 months. “Control group” patients received standard care. Results: A total of 118/120 recruited patients completed the study; 59 each with similar baseline parameters were randomized to incentive and control groups. At baseline, medication adherence and HbA1c were comparable (adherence: 65.7±4.7% and 65.3±4.0%; HbA1c: 9.0±0.3% and 9.0±0.3% for incentive and control groups, respectively). Over the study duration, the incentive group showed a significant improvement in medication adherence (P < 0.001) and significant HbA1c reduction (P < 0.001). At study closure, the average medication adherence and HbA1c were significantly different between the two groups (adherence: 86.8±3.2% vs. 67.7±4.6%, P < 0.001; HbA1c: 7.3±0.2% vs. 8.2±0.3%, P < 0.001). Conclusion: Gamification through combining repeated medication reminders and rewards through a smartphone application brought about a behavioral change, which improved medication adherence and glycemic control among T2DM patients within 3 months and was sustained for 3 more months without rewards.

Background Patients with diabetes mellitus have an increased risk of developing dyslipidemia, predisposing them to macro- and microvascular consequences such as coronary heart disease. Aim The aim of this study was to assess the prevalence of dyslipidemia, drug therapy problems (DTPs), and medication adherence in type 2 diabetes mellitus (T2DM) patients in a tertiary hospital in North Central Nigeria. Method This study was a cross-sectional convenient sampling of eligible patients conducted in the General Outpatient Department of General Hospital, Ilorin, from March to May 2022. A validated questionnaire was administered to obtain all relevant information on sociodemographic information, and blood samples were collected in a medium plain heparinized tube and sent to the laboratory where fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) values were calculated as appropriate. Morisky's Medication Adherence Scale 8 (MMAS-8) was used to capture patient's adherence level, and DTP was assessed using the Pharmaceutical Care Network Europe (PCNE) Criteria version 7. Ethical approval was obtained from the Ministry of Health, Ilorin. Statistical Package for Social Sciences was used to analyze the data collected for descriptive and inferential statistics. Results The mean age of the respondents was 60 ± 0.7 years. Of the 60 respondents, 25 (41.67%) were males and 35 (58.33%) were females. All the respondents had dyslipidemia, 30% respondents were identified with a DTP of nonadherence, 16.7% needed additional drug/monitoring, dosage was too low in 11.7%, and 11.6% could not afford their medication due to high cost. In all, 45 (75%) respondents had poor sugar control and 33 (55%) had poor blood pressure control. Using MMAS-8, the majority (41, [68.30%]) of the respondents were found to have poor adherence to their diabetic medications. Conclusion High prevalence of dyslipidemia, poor medication adherence, and DTPs were found in the T2DM patients in this study.

Background: Diabetes mellitus is often called the silent killer and often causes complications for sufferers that require long-term treatment. Family support is the involvement provided by the family to the patient which includes a positive attitude, affirmation and assistance. Compliance is the degree to which patients carry out treatment methods and behavior recommended by health workers. This study aims to determine the relationship between family support and medication adherence to type 2 diabetes mellitus patients at the internal medicine polyclinic of Indonesian Hospital. Methods: Categorical comparative analysis in 2 groups was not paired with a cross-sectional approach. The population in this study is 325 respondents. Sampling was determined using the purposive sampling technique as many as 77 respondents who met the criteria. The instruments in this study used the Nursalam social family support questionnaire and the MMAS-8 (Morisky Medication 8-item Adherence Scale) questionnaire. Data analysis used univariate and bivariate analysis with the Fisher Exact test. Results: The results of the fisher exact test obtained a p-value of 0.00 or <0.05, namely there was a relationship between family support and medication adherence in type 2 diabetes mellitus patients. Conclusion: There is a significant relationship between family support and medication adherence in patients with type 2 diabetes mellitus at the internal medicine polyclinic of Cililin Hospital.

Diabetes Mellitus is a chronic metabolic disorder characterized by high bloodsugar levels. Consequently, this condition can cause various problems andcomplications, so patients’ medication adherence is essential to preventcomplications. Apart from that, family support is also a factor that affectsincreasing medication adherence in type 2 DM patients. This research wasclassified as quantitative research using a descriptive correlation method witha Cross-sectional design. The research population was all type 2 DM patientswith complications in the working area of Puskesmas (Public Health Center)Kabila, with as many as 516 people. In the meantime, the samples were 84people determined through Accidental Sampling. The research findingsindicated that 59 respondents (70.2%) had good family support, while 25respondents (29.8%) had poor one. Meanwhile, 48 respondents (57.1%)adhered to taking medication, whereas 36 respondents (42.9%) didnot.Additionally, the results of statistical tests using chi-square denoted a pvalue = 0.000 <?=0.05.In conclusion, there is a relationship between familysupport and medication adherence in type 2 diabetes Mellitus patients withcomplications in the working area of Puskesmas Kabila. Therefore, it isrecommended that this research be used as reference material, and futureresearchers can develop research related to factors affecting medicationadherence.

The role of clinical pharmacist in hospital settings of Ethiopia is still new and infant. To evaluate the impact of pharmaceutical care on clinical outcome and medication adherence in type 2 diabetes mellitus (T2DM) patients. A single cantered, pre-post interventional study design was carried out by enrolling 100 uncontrolled T2DM patients from March 1-August 30, 2020. The intervention package included assessment of pharmacological and non-pharmacological needs, counselling patients in person at the clinic, and providing educational materials. Of the 100 patients initially enrolled, 87(87%) completed the follow-up and included in the final data analysis. The intervention showed a decrease in average FBG, systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-C) by 47.3 mg/dL, 22.6mmHg and 31.4mg/dL, while high density lipoprotein cholesterol (HDL-C) and estimated glomerular filtration rate (eGFR) exhibited significant increase by 13.4 mg/dL and 11.5 ml/min/1.73m2 respectively (p<0.0001). In addition, diastolic blood pressure, lipid values, kidney function parameters, and liver function parameters showed significant decrease in post intervention compared to pre-intervention (p<0.05). Medication adherence of the patients increased significantly at 6-month follow-up (p<0.001). These results also suggest the benefits of integrating clinical pharmacist services in multidisciplinary healthcare teams and diabetes management in Ethiopia.

The level of adherence usually decreases in patients with chronic conditions compared to acute conditions; this is related to the long-term nature of chronic disease due to the most rapid decrease in adherence after the first 6 months of therapy. The decline in compliance not only resulted in poor health outcomes but also had a significant impact on health costs. The purpose of this study was to determine family support for medication adherence in type 2 DM patients. This study used descriptive correlational using a cross-sectional study approach of 100 respondents. Patient demographic data and family support were obtained using a questionnaire while the level of compliance used Morisky Medication Adherence Scales. The results show that there is a relationship between family support and medication adherence in patients with type 2 diabetes, which is viewed from 4 dimensions: appreciation support, emotional support, information support, and instrumental support. Support from family can improve medication adherence in type 2 DM patients.

International Journal of Pharmacology and Clinical Sciences,2015,4,4,94-97.DOI:10.5530/ijpcs.4.4.5Published:Dec 2015Type:Research ArticleAuthors:Manju Cheenkallel Sreenivasan, Rinisha Razak, Athira Balakrishnan, and Chandni Radhakrishnan Author(s) affiliations:Manju Cheenkallel Sreenivasan1*, Rinisha Razak,1 Athira Balakrishnan1, Chandni Radhakrishnan,2 1College of Pharmaceutical Science, Govt Medical College, Kozhikode, Kerala, INDIA. 2Department of Medicine, Govt Medical College, Kozhikode, Kerala, INDIA. Abstract:Background: Diabetes mellitus is a complex chronic disease and people with diabetes estimated to reach 552 million by 2030 worldwide. World Health Organization stated that only 50% of patients diagnosed with a chronic illness were fully compliant with their treatment regime. Objectives: To test the hypothesis that adherence decreases with increase in number of medications prescribed in patients with type II diabetes mellitus. Materials and methods: It was a comparative cross sectional study conducted in the department of medicine, medical college, Kozhikode. Patients visiting in the outpatient department of general medicine who satisfy the inclusion criteria were enrolled into the study. Patient medication adherence was measured by medication adherence questionnaire. Results analyzed using student’s t test. Results: A total of 218 type II diabetic patients enrolled in this 6 months study in which minor poly pharmacy accounts for 18 patients, and the remaining were major poly pharmacy regime. The average number of drugs prescribed was 4.71 ± 2.12. The mean value of medication adherence score is more in major poly pharmacy group (3.48) when compared with minor poly pharmacy group (1.96). Higher the value of medication adherence score lower is the value of medication adherence of the patient. Conclusion: Polypharmacy continues to be a significant issue and little research has been conducted regarding the relationship between medication adherence and poly pharmacy. Medication adherence is affected by certain factors other than the number of drugs prescribed. Keywords:Compliance, Diabetes Mellitus, Medication Adherence, Patients, PolypharmacyView:PDF (244.82 KB) PDFClick here to download the PDF file. Images Manju et al.: Poly Pharmacy on Medication Adherence in type II Diabetes Mellitus patients

ObjectiveMedication adherence in type 2 diabetes mellitus (T2DM) improves glycemic control and is associated with reduced adverse clinical events, and accurately assessing adherence assessment is important. We aimed to determine...

Highlights Type 2 diabetes mellitus (T2DM) that is not appropriately handled can result in macro- or micro-complications. Medication adherence is one of the most important efforts to do to prevent complications in chronic diseases such as T2DM. Abstract Background: Diabetes medication non-adherence can aggravate the patient's condition and raise the chance of acquiring diabetes complications such as coronary heart disease. Medication adherence can help prevent micro- and macrovascular problems. Objective: This study aimed to investigate the medication adherence of type 2 diabetic patients with coronary heart disease. Material and Method: This research used a systematic literature review for the research design, with a PRISMA chart as a guideline. Researchers searched 3 databases using predefined keywords: PubMed, Google Scholar, and ScienceDirect. Result: The search yielded 3.373 pieces of literature, and six pieces that fit the requirements were chosen. The total number of people who responded was 9.950. More men over 60 years old who have had diabetes for more than 5 years, who are taking oral medication, insulin, or combination treatment, and who are ex-smokers were shown to have characteristics of people with type 2 diabetes mellitus and coronary heart disease. Results from a systematic literature review revealed five kinds of literature with low medication adherence levels and one literature with a high medication adherence rate. Conclusion: Medication adherence differs among type 2 diabetic patients with coronary heart disease. More research, however, has revealed that the level of medication adherence in type 2 diabetic patients with coronary heart disease remains low.

Background: Type 2 diabetes mellitus (DM) is a chronic disease which requires long-term therapy. Medication adherence plays an important role for therapeutic success in patients with T2DM. Antidiabetic usage pattern might involve with some problems related to medication adherence. Objectives: The aim of this study was to analyze the association between antidiabetic usage pattern with medication adherence. Material and Methods: This observational study was conducted cross-sectionally involving 90 participants of T2DM outpatient at Private Hospital in Buleleng Bali during July-September 2020. Patients were included if aged ≥18 years, received the same antidiabetic for three months before the study, signed informed consent, and provided with complete medical record data. Patients were excluded if appeared to be unwell, pregnant or breastfeeding. Demographic data and antidiabetic usage patterns were collected retrospectively based on the patient's medical records. Probabilistic Medication Adherence Scale (ProMAS) questionnaire was used to assess medication adherence. Data were analyzed with Kruskal-Wallis test. Results: The results showed that 55.6% patients were male, aged 46-65 years (61.1%), education predominantly by elementary school (37.8%), had suffered from DM for 5-10 years (46.7%), with comorbidities (50%), and without complications (77.8%). The antidiabetic usage pattern was dominated by a combination of two antidiabetics (53.3%). Most patients (42.2%) showed moderate-high medication adherence. There was no statistically significant association between antidiabetic usage pattern and medication adherence (p=0.275). Conclusions: A higher rate of medication adherence was found in patients taking combination of two antidiabetics compared to combination of three or four antidiabetics.

Background: Type 2 diabetes mellitus (DM) is a chronic disease which requires long-term therapy. Medication adherence plays an important role for therapeutic success in patients with T2DM. Antidiabetic usage pattern might involve with some problems related to medication adherence. Objectives: The aim of this study was to analyze the association between antidiabetic usage pattern with medication adherence. Material and Methods: This observational study was conducted cross-sectionally involving 90 participants of T2DM outpatient at Private Hospital in Buleleng Bali during July-September 2020. Patients were included if aged ≥18 years, received the same antidiabetic for three months before the study, signed informed consent, and provided with complete medical record data. Patients were excluded if appeared to be unwell, pregnant or breastfeeding. Demographic data and antidiabetic usage patterns were collected retrospectively based on the patient's medical records. Probabilistic Medication Adherence Scale (ProMAS) questionnaire was used to assess medication adherence. Data were analyzed with Kruskal-Wallis test. Results: The results showed that 55.6% patients were male, aged 46-65 years (61.1%), education predominantly by elementary school (37.8%), had suffered from DM for 5-10 years (46.7%), with comorbidities (50%), and without complications (77.8%). The antidiabetic usage pattern was dominated by a combination of two antidiabetics (53.3%). Most patients (42.2%) showed moderate-high medication adherence. There was no statistically significant association between antidiabetic usage pattern and medication adherence (p=0.275). Conclusions: A higher rate of medication adherence was found in patients taking combination of two antidiabetics compared to combination of three or four antidiabetics.

Type II DM is a disease with special symptoms, namely hyperglycemia. Poor adherence to medication is problematic when managing DM. An aspect that can improve medication discipline in Type II DM sufferers is family support. The family is a component that influences Type II DM sufferers in supporting patients to fulfill their medication. The research aims to assess the effectiveness of family support for medication discipline in Type II DM sufferers at Mitra Medika RSU. This research method uses an analytical survey with a cross sectional approach. The population in this study were all Type II DM patients in the internal medicine ward at Mitra Medika RSU in 2022 with a total of 308 patients. Samples were taken using a side purposive technique of 75 respondents. This study used a questionnaire instrument on family support and medication adherence for Type II DM patients. This study used a questionnaire instrument on family support and medication adherence in Type II DM patients. Based on analysis using the chi-square test, the p-value = 0.000 (&lt;0.05). The conclusion was drawn that there is a significant relationship between family support and medication adherence in Type II DM patients at Mitra Medika General Hospital in 2022. It is hoped that families of Type II DM patients will maximize family support for treatment for family members who experience Type II DM.