Diabetes Medication Adherence Research Articles

43-LB: Diabetes Distress, Depression, Perceived Stress, and Medication Adherence in Type 2 Diabetes (T2D)

Objective: Diabetes distress and depression are associated with treatment nonadherence among adults with T2D. Evidence for the independence of these effects has been mixed. Whether perceived stress, or the degree to which situations in life in general are appraised as stressful, can account for these effects has not been examined. We tested whether perceived stress was associated with objective T2D medication adherence and whether effects of diabetes distress and depression showed independence from perceived stress. Methods: Participants (N = 104, Age = 56.57 ± 9.32; A1C = 7.75 ± 1.55; 39% insulin use; 24% Latino, 24% White, 62.5% Black, 5.7% Other) completed validated self-reports of perceived stress, diabetes distress and depression and had oral medication adherence electronically monitored (EM) over 3 months. Multiple regression evaluated the association between perceived stress and EM medication adherence when modeled with covariates as well as with diabetes distress and depression. Results: Perceived stress was correlated with lower EM adherence (r = -.24, p = .013) ; however, when accounting for age, insulin use, and days of EM monitoring, the association was attenuated (β = -.14, p = .109) . Diabetes distress (β = -.29, p = .001) and depression (β = -.34, p < .001) were associated with lower adherence after covariate adjustment, when each were adjusted for perceived stress (diabetes distress: β = -.32, p = .005; depression: β = -.48, p < .001) , and when both were modeled together with perceived stress (diabetes distress: β = -.22, p = .044; depression: β = -.41, p = .002) . In this final model, perceived stress showed an unexpected positive association with adherence (β = .27, p = .035) . Conclusion: The associations of diabetes distress and depression with treatment nonadherence were not accounted for by perceived stress in this diverse sample of adults with T2D. Their independent associations with treatment nonadherence support both constructs as important targets for intervention. Disclosure F. Mustafiz: None. C. J. Hoogendoorn: None. J. S. Gonzalez: Consultant; Virta Health Corp.

Medication adherence and its associated factors among type 2 diabetic patients in Ethiopian General Hospital, 2019: Institutional based cross-sectional study.

Globally, diabetes mellitus is becoming a major public health problem in developing countries. Diabetic medication has a major role in glycemic control. However, poor adherence to diabetes medication leads to increased morbidity and morbidity. This study aimed to determine diabetes medication adherence and its associated factors among type two diabetes (T2DM) patients from December 01, 2019 to December 31, 2019, at Debre Tabor General Hospital, Northwest Ethiopia. An institutional-based cross-sectional survey was conducted with a sample of 422 T2DM at Debre Tabor General Hospital diabetic clinic, Ethiopia. The study was conducted from December 01-31/2019. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale. The data were analyzed using STATA version 15.1 software. Logistic regressions were carried out to identify independent predictors for T2DM adherence. P-value less than 0.05 was used to declare statistical significance. A total of 408 T2DM patients were recruited for this study with a response rate of 96.7%. Overall, 58.33% (95% Confidence Interval (CI): 53.47-63.03) T2DM patients had good medication adherence.T2DM patients who were taking both oral and injectable anti-diabetic medications (Adjusted odds ratio (AOR) = 1.98, 95% CI: 1.16-3.39), got the prescribed anti-diabetic medication from the hospital (AOR = 0.51, 95% CI: 0.32-0.80), having own glucometer at home (AOR = 0.30, 95% CI: 0.16-0.54), and having good diabetes-related knowledge (AOR = 0.50, 95% CI: 0.27-0.90) were a significant determinant factors for anti-diabetic medication adherence. Overall, more than half of T2DM patients had good medication adherence. Medication type, access to anti-diabetic medication, having own glucometer at home, diabetes-related knowledge were independent predictors of medication adherence. T2DM patients should have own glucometer at home and health promotion should provide about diabetic Mellitus for T2DM patients.

The diabetes health plan and medication adherence among individuals with low incomes.

To test the impact of the Diabetes Health Plan (DHP), a diabetes-specific insurance plan that lowers out-of-pocket costs for diabetes-related medications and clinical visits, on adherence to oral hypoglycemic medications among low-income adults with Type 2 Diabetes (T2DM). Cohort of adults (18-64) with T2DM, an annual household income <USD 30,000, and who were continuously enrolled in an employer-sponsored UnitedHealthcare plan for at least two years between 2009 and 2014. We employed a linear regression Difference-In-Differences (DID) approach with a matched comparison group. To assess for differential DHP effects across adherent versus non-adherent patients, we ran a Difference-in-Difference-in-Differences (DDD) analysis by including an interaction term that included indicators for DHP exposure status and time, and low versus high baseline medication adherence. The analytic data set is limited to employer groups that purchased the DHP and standard benefit plans from UnitedHealthcare, had internal pharmacy contracts; complete pharmacy claims data, and sufficient medical claims and lab data to identify employees and their dependents with T2DM. Our DID analysis did not show improved medication adherence associated with employer DHP adoption. However, the DDD model suggested a difference between DHP-exposed and comparison beneficiaries when comparing the relative effect on individuals who were adherent versus non-adherent at baseline, as suggested by the significant three-way interaction term (10.2,p=0.028). This effect was driven by the 8.2 percentage point increase in medication adherence for the DHP subsample that was non-adherent at baseline. The DHP may benefit low-income patients with low baseline medication adherence. Value-based insurance design may be an important strategy for mitigating income disparities in T2DM outcomes.

Understanding Medication Adherence in Bhutanese Refugees With Diabetes in a Midwestern City.

Bhutanese refugees have a higher prevalence of type 2 diabetes but are less likely to achieve medication adherence and glycemic control. The purpose of this project was to understand factors affecting diabetes medication adherence in this population. This was a qualitative project using focus groups of adult Bhutanese refugees with type 2 diabetes ≥18 years old and hemoglobin A1C ≥8% and their caregivers from a family medicine clinic at the University of Kansas. Data were analyzed using content analysis. A total of 23 individuals participated. Three themes emerged from data analysis: desire to engage in care but face multiple barriers, family and community support invaluable for health, and considerations for culturally contextual person-centered care. Participants provided specific recommendations to address the barriers, with emphasis on improving health literacy. Integrating the identified factors can foster person-centered, culturally congruent care to improve diabetes medication adherence in Bhutanese refugees.

Association Between High-Deductible Health Plans and Engagement in Routine Medical Care for Type 2 Diabetes in a Privately Insured Population: A Propensity Score-Matched Study.

High-deductible health plans (HDHPs) are increasingly more common but can be challenging for patients to navigate and may negatively affect care engagement for chronic conditions such as type 2 diabetes. We sought to understand how higher out-of-pocket costs affect participation in provider visits, medication adherence, and routine monitoring by patients with type 2 diabetes with an HDHP. In a retrospective cohort of 19,379 Kaiser Permanente Northern California patients with type 2 diabetes (age 18-64 years), 6,801 patients with an HDHP were compared with those with a no-deductible plan using propensity score matching. We evaluated the number of telephone and office visits with primary care, oral diabetic medication adherence, and rates of HbA1c testing, blood pressure monitoring, and retinopathy screening. Patients with an HDHP had fewer primary care office visits compared with patients with no deductible (4.25 vs. 4.85 visits per person; P < 0.001), less retinopathy screening (49.9% vs. 53.3%; P < 0.001), and fewer A1c and blood pressure measurements (46.7% vs. 51.4%; P < 0.001 and 93.2% vs. 94.4%; P = 0.004, respectively) compared with the control group. Medication adherence was not significantly different between patients with an HDHP and those with no deductible (57.4% vs. 58.6%; P = 0.234). HDHPs seem to be a barrier for patients with type 2 diabetes and reduce care participation in both visits with out-of-pocket costs and preventive care without out-of-pocket costs, possibly because of the increased complexity of cost sharing under an HDHP, potentially leading to decreased monitoring of important clinical measurements.

Engaging Patient Advisory Boards of African American Community Members with Type 2 Diabetes in Implementing and Refining a Peer-Led Medication Adherence Intervention.

African Americans are more likely than non-Hispanic whites to be diagnosed with and die from diabetes. A contributing factor to these health disparities is African Americans’ poor diabetes medication adherence that is due in part to sociocultural barriers (e.g., medicine and illness misperceptions), which negatively affect diabetes management. In our prior work, we engaged with community stakeholders to develop and test a brief version of a culturally adapted intervention to address these barriers to medication adherence. The objective of this study was to elicit feedback to inform the refinement of the full 8-week intervention. We utilized a community-engaged study design to conduct a series of meetings with two cohorts of patient advisory boards of African Americans with type 2 diabetes who were adherent to their diabetes medicines (i.e., peer ambassadors). In total, 15 peer ambassadors were paired with 21 African American participants (i.e., peer buddies) to provide specific intervention support as peers and serve in an advisory role as a board member. Data were collected during nine board meetings with the patient stakeholders. A qualitative thematic analysis of the data was conducted to synthesize the findings. Feedback from the patient advisory board contributed to refining the intervention in the immediate-term, short-term, and long-term. The inclusion of African American community members living with type 2 diabetes on the advisory board contributed to further tailoring the intervention to the specific needs of African Americans with type 2 diabetes in the community.

Feasibility of a Randomized Controlled Mixed Methods Trial to Address Health Literacy, Beliefs, Medication Adherence, and Self-Efficacy (ADHERE) in a Clinical Pharmacist-Led Clinic.

PurposeTo assess the feasibility and acceptability of a health literacy-psychosocial support intervention – ADHERE and explore changes in glycemic values and medication adherence.Patients and MethodsThirty-one participants with hemoglobin A1c (HbA1c) ≥ 8% were randomly allocated to control (usual care) or intervention groups (receiving usual care plus a 6-session pharmacist-led intervention focusing on the modifiable psychosocial factors that may influence medication adherence). Feasibility metrics evaluated recruitment, retention, and intervention adherence. Questionnaires were administered to collect psychosocial factors and self-reported medication adherence at baseline, the end of the intervention, 3 months, and 6 months post intervention. HbA1c values were extracted from electronic medical records. Repeated measures analysis of variance was used to compare differences in mean outcomes between the control and intervention groups. To assess intervention acceptability, eleven individuals participated in semi-structured interviews about their intervention experiences. Qualitative content analysis was used for analyzing the interviews.ResultsThirty participants completed the study. Overall, the findings support the feasibility of the intervention. There were significant differences in HbA1c values. Participants in the intervention group had lower A1C (8.3 ± 1.4) than in the control group (9.2 ± 1.3) at the time of 6-month follow-up (p = 0.003). In addition, the participants in the intervention group showed improved HbA1c at 6-month follow-up (8.3 ± 1.4), compared to baseline (9.4 ± 1.5, p = 0.011) and after 6-session intervention (8.9 ± 1.6, p = 0.046). However, there were no significant differences in medication adherence between groups over time. Qualitative themes suggest participants liked the intervention and perceived the additional support from the pharmacist as beneficial.ConclusionA pharmacist-led intervention to provide additional health literacy-psychosocial support may contribute to long-term improvements in HbA1c. Equipping pharmacists with patient-specific diabetes medication adherence information and building in additional follow-up support for patients may improve patient health outcomes.

EVALUATING MEDICATION ADHERENCE BY MORISKY SCALE AND ADVISORY EFFECTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Introduction: Good glycemic control is the most important factor in treatment of diabetes. Medication adherence in diabetes is crucial to achieve optimal glycemic control. Objectives: To evaluate the medication adherence by the Morisky Medication Adherence Scale (MMAS-8) and the effectiveness of counseling in patients with type 2 diabetes. Methods: The longitudinal descriptive study was conducted with 396 patients diagnosed of type 2 diabetes mellitus during 2019 - 2020 at Hue University of Medicine and Pharmacy. Interviewing patients with questionnaires, advising medication adherence (according o Treatment principles for diabetic patients - “Guidelines for diagnosis and treatment of type 2 diabetes” of the Ministry of Health); and The Morisky Medication Adherence Scale (MMAS-8) was used to assess the patients’adherence of treatment at the beginning of the study and reevaluated after 3 months. Results: The mean age of the patients was 66.28 ± 14.08 years; 68.7% females. At baseline: 36.6% of patients were nonadherent. After 3 months, 26.3% of patients were non-adherent. Factors affecting the patients’ compliance level was statistically significant: Physical activity (p = 0.009); diet (p = 0.039); reminders of medication adherence from health officer (p = 0.042); satisfied with medical services (p = 0.022). At baseline: 19.2% of patients achieved good glycemic control (6.3 ± 0.8 mmol/l), 22.0% of patients with HbA1c reached target of treatment (6.4 ± 0.4%). After 3 months: 29.0% of patients achieved good glycemic control (6.1 ± 0.9 mmol/l), 33.3% of patients with HbA1c reached target of treatment (6.3 ± 0.4%). The proportion of patients achieved blood glucose and HbA1c targets at baseline and after 3 months was related statistically significant with medication adherence level (p&lt;0.05). Conclusions: Relevant glycemic control was statistically significant with medication adherence. Improving patients’ medication adherence may improve glycemic control. In order to improve medication adherence better, good consultation counseling and health education are required. Key words: Type 2 diabetes, Medication adherence, Morisky Medication Adherence Scale

Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review.

PurposeType 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation.MethodsSearches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD).ResultsNine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug’s weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type.ConclusionFindings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual’s treatment, weight journey, and behaviors over time should be undertaken.

Diabetes outcomes before and during telehealth advancements surrounding COVID-19

BackgroundPharmacists can optimize outcomes related to type-2 diabetes (T2D) by taking advantage of telehealth opportunities despite the coronavirus 2019 (COVID-19) Public Health Emergency (PHE). ObjectiveIdentify and compare changes in T2D outcomes before (August 2019 through February 2020) and during (March 2020 through October 2020) the COVID-19 PHE. Secondary objectives were to identify and compare pay-for-performance metrics and additional fee-for-service submitted in these patients. MethodsThis study examined changes in T2D outcomes at one primary care office within a community health system. Pharmacists started regularly using Remote Patient Monitoring (RPM) services during the COVID-19 PHE to reduce in-person visits. Patients with an initial glycosylated hemoglobin (A1C) greater than or equal to 8% were included. Data collected included comorbidities, change in A1C, and diabetes and statin medication therapy adherence. Percentage of Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) measures were met, and billing code frequencies were also assessed. ResultsIn the pre–COVID-19 PHE group (N = 30), the average 3- and 6-month A1C reductions were 1.3% and 1.2%, respectively, and the reductions were 2.0% and 2.2% in the during-COVID-19 PHE group (N = 61). The percentage of patients appropriately initiated or maintained on statins was 96.2% in the pre–COVID-19 PHE group versus 82.6% in the during-COVID-19 PHE group. Related to HEDIS, statin adherence was 95.2% in the pre–COVID-19 PHE group and 84.2% in the during-COVID-19 PHE group, and A1C control was 41.7% versus 54%, respectively. A1C control related to MIPS was 60% before COVID-19 PHE versus 73.8% during the COVID-19 PHE. Diabetes medication adherence related to HEDIS and medication reconciliation related to MIPS was 100% for both groups. ConclusionData demonstrate the opportunity for pharmacists to maintain and improve clinical outcomes related to T2D despite the ongoing COVID-19 PHE through implementation of telephonic monitoring.

Linking the Flint Food Store Survey: Is Objective or Perceived Access to Healthy Foods Associated with Glycemic Control in Patients with Type 2 Diabetes?

Type 2 diabetes mellitus (DM-2) remains a significant public health concern, particularly in low-income neighborhoods where healthy foods may be scarcer. Despite the well-known relationship between diet and diabetes, little evidence exists on the connections among the objectively measured community and consumer food environment, perception of food access, and diabetes management or outcomes. This cross-sectional, ecological study represents the first example of combining a GIS-based, objectively measured food store audit considering quality, variety, and price of foods in stores with a clinical survey of patients with DM-2 (n = 126). In this way, we offer evidence on the relationship between healthy food access—measured more robustly than proximity to or density of certain store types—and diabetes management knowledge, medication adherence, and glycemic control. Better glycemic control was not correlated with better overall food store score, meaning that people in neighborhoods with better access to healthy foods are not necessarily more likely to manage their diabetes. While perceived healthy food access was not correlated with glycemic control, it was strongly correlated with objective healthy food access at shorter distances from home. These results have great importance both for clinical understanding of the persistence of poor diabetes management outcomes and for the understanding of the influence of the food environment on health behaviors.

Hypertension, cholesterol and diabetes medication adherence, health care utilization and expenditure in a Medicare Supplemental sample.

Limited evidence exists regarding the relationships between adherence, as defined in Pharmacy Quality Alliance (PQA) medication adherence measures, health care utilization, and economic outcomes. PQA adherence measures for hypertension, cholesterol, and diabetes are of particular interest given their use in Medicare Star Ratings to evaluate health plan performance.The objective of this study was to assess the relationship between adherence and utilization and cost among Medicare Supplemental beneficiaries included in the aforementioned PQA measures over a 1-year period.Retrospective cohort study.Three cohorts (hypertension, cholesterol, and diabetes) of eligible individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009–2015) were used to assess associations between adherence and health care expenditure and utilization for Medicare Supplemental beneficiaries.Generalized linear models with log link and negative binomial (utilization) or gamma (expenditure) distributions assessed relationships between adherence (≥80% proportion of days covered) and health care utilization and expenditure (in 2015 US dollars) while adjusting for confounding variables. Beta coefficients were used to compute cost ratios and rate ratios.Adherence for all 3 disease cohorts was associated with lower outpatient and inpatient visits. During the 1-year study period, adherence was associated with lower outpatient, inpatient, and total expenditures across the cohorts, ranging from 9% lower outpatient costs (diabetes cohort) to 41.9% lower inpatient costs (hypertension cohort). Savings of up to $324.53 per member per month in total expenditure were observed for the hypertension cohort.Our findings indicate adherence is associated with lower health care utilization and expenditures within 1 year.

Factors impacting on diabetes knowledge, medication adherence and glycemic control among adult diabetics visiting a county teaching and referral hospital in Kenya: a cross-sectional study.

Introductionoptimal management of diabetes involves interplay between patients’ understanding of their disease and medication adherence, which would eventually influence glycemic control. However, there is scant published literature on the interconnection of patient related factors that impact on optimal management of diabetes in resource-limited settings such as Kenya.Methodsa hospital based cross-sectional survey involving 270 freely consenting adult diabetics investigated the interconnection between diabetes knowledge, medication adherence and glycemic control. Data on the patient´s knowledge and medication adherence was collected using validated tools whilst glycemic control was evaluated using the patients' glycated haemoglobin values. Data analysis was carried out using STATA version 13 statistical software, employing the chi square test for association and simple linear regression for prediction, with p ≤0.05 considered significant.Resultsparticipants´ level of knowledge on diabetes was significantly associated with the academic achievement (p=0.001), while their medication adherence was significantly associated with family support (p=0.001) and duration of disease since diagnosis (p=0.019). On linear regression, family support occasioned by the nature of participants’ household setup, had a strong positive correlation [r=0.99 (CI 0.60-1.00)] with optimal glycemic control.Conclusionfamily support is an important determinant of medication adherence and optimal glycemic control among diabetic patients. Clinicians should team up with family members of diabetic patients for optimal glycemic control.

Improved Patient-Reported Medication Adherence, Patient Satisfaction, and Glycemic Control in a Collaborative Care Pharmacist-Led Diabetes "Tune-Up" Clinic.

Diabetes complications remain a leading cause of death, which may be due to poor glycemic control resulting from medication nonadherence. The relationship between adherence status and HbA1c (glycemic control) has not been well-studied for clinical pharmacist interventions. This study evaluated medication adherence, patient satisfaction, and HbA1c, in a collaborative pharmacist-endocrinologist diabetes clinic over 6 months. Of 127 referred, 83 patients met the inclusion criteria. Mean medication adherence scores, considered “good” at baseline, 1.4 ± 1.2, improved by 0.05 points (p = 0.018), and there was a 26% increase in patients with good adherence. A significant improvement of 0.40 percentage points (95% CI: −0.47, −0.34) was observed in mean HbA1c across the three time points (p < 0.001). Mean total satisfaction scores were high and increased, with mean 91.3 ± 12.2 at baseline, 94.7 ± 9.6 at 3 months, and 95.7 ± 10.8 at 6 months (p = 0.009). A multimodal personalized treatment approach from a pharmacist provider significantly and positively impacted glycemic control regardless of self-reported medication adherence, and patient satisfaction remained high despite changing to a clinical pharmacist provider and increased care intensity.

A SYSTEMATIC REVIEW ON SELF-REPORTED QUESTIONNAIRES TO ASSESS MEDICATION ADHERENCE IN DIABETIC PATIENTS

Adherence to pharmacological therapies are keys to effective treatments in diabetic patients. Previous reviews found that most adherence measurement studies on chronic diseases used a self-reported scale. However, there is no consensus on the best scale to measure adherence in diabetic patients. The purpose of this systematic review was to identify the potential self-reported scale that could be considered for measuring medication adherence in diabetic patients and to provide recommendations for researchers or clinicians to determine appropriate adherence self-reported scales in diabetic patients. This review follows general guidelines in the implementation of systematic reviews. After further review, it was found that 33 studies met all inclusion criteria from 4 databases (Wiley, Science Direct, Scopus, and PubMed). The articles were done by the PRISMA, while the keywords were determined by the PICO method. Most research was conducted in Asia (69.7%) and America (18.2%) on patients with type 2 diabetes (81.3%), patients in hospitals (54.5%), suffering for 1–6 months (54.5%), and using a cross-sectional study design (78.8%). HbA1c clinic data (57.6%) were used in most studies as biological markers of adherence. The measurement scales of medication adherence in diabetic patients are MMAS-8 (57,.5%), MMAS-4 (12.1%), BMQ (9%), MCQ (6%), ARMS (3%), ARMS-D (3%), GMAS (3%), LMAS-14 (3%), and MARS-5 (3%). This review provides information on the different self-reported scales most widely used in diabetic medication adherence research. Various aspects need to be considered before choosing the scale of adherence.

Pharmacist led intervention towards management of type 2 diabetes mellitus and assessment of patient satisfaction of care - A prospective, randomized controlled study

BackgroundDiabetes mellitus, a metabolic disorder characterized by hyperglycaemia is due to impaired insulin secretion and deficiency. Though effective current drug therapies are available for diabetes, yet glycaemic maintenance remains a challenge without medication adherence. This necessitates a holistic approach to improve clinical outcomes for a better patient health care. MethodsA prospective, interventional, randomized controlled study was conducted among 97 type 2 diabetic patients for 6 months. The primary outcome measures included patient satisfaction of care assessment by diabetes treatment satisfaction questionnaire (DTSQ) and medication adherence by medication adherence rating scale (MARS). Secondary outcomes included assessment of knowledge, attitude, and perception and laboratory parameters. The collected data was analyzed using paired and unpaired T-test. ResultsOf 97 patients randomized to group A (n = 49) and group B (n = 48), there were 3 and 1 drop-out in group A and B, respectively. The mean age of patients was found to be 56.82 ± 4.06 years. At the 6thmonth follow up, significant improvement of glycaemic parameters was observed in group A vs B. Mean MARS and DTSQ scores also improved in group A vs. B (P-value <0.05). ConclusionPharmacist-provided counselling improves patient compliance, quality of life and satisfaction of care in diabetic patients.

Hypertension, Diabetes and Medication Adherence among the Older Supplemental Nutritional Assistance Program Population.

The burdens of chronic diseases such as hypertension and diabetes for older Americans are profound. Yet, data on the population-level prevalence of hypertension and diabetes among the older adult Supplemental Nutritional Assistance Program (SNAP) population and the associated level of medication adherence is lacking despite evidence of the "treat or eat" trade-off in the general population. We used linked administrative data from SNAP and Medicaid between 2006 and 2014 in the state of Missouri to document rates of hypertension or diabetes diagnoses and medication adherence. About 69% of the study sample were found to be diagnosed with a hypertension and 40% with diabetes. Approximately 1 in 4 of those living with hypertension and 1 and 3 of those living with diabetes were nonadherent to antihypertensive or antidiabetic medications each year, on average. Furthermore, medication non-adherence increases with age and is more common among non-White and urban residents.

A cross-sectional study clarifying profiles of patients with diabetes who discontinued pharmacotherapy: reasons and consequences

BackgroundAlthough diabetes is one of the fastest increasing diseases in prevalence worldwide and demands significant medical resources, more than half of all patients with diabetes do not achieve the expected target level of blood glucose. As a potential cause of poor glycemic control, insufficient adherence to medication has long been discussed and variably studied. However, dropout from treatment as another plausible cause has not been fully examined. The aim of this study was to clarify profiles of patients with diabetes who discontinued pharmacotherapy (Discont group) by extracting reasons of their decisions and by comparing with those who continued (Cont group) in terms of the related factors to glycemic control.MethodsA cross-sectional, internet-based survey was conducted among Japanese with diabetes registered in a database. A self-administered questionnaire consisting of the 8-item version of the Morisky Medication Adherence Scale (MMAS-8), glycosylated haemoglobin (HbA1c) level, and demographic and disease characteristics was completed by all participants. Reasons for medication discontinuation and resumption were also received retrospectively from participants in the Discont group. To examine the risk of uncontrolled HbA1c, logistic regression analysis was conducted in each group.ResultsIn the Discont group (148 cases), older age at resumption of pharmacotherapy and current smoking habit increased the probability of uncontrolled HbA1c, whereas in the Cont group (146 cases), a familial history of diabetes and better medication adherence in MMAS-8 scores decreased the probability of uncontrolled HbA1c. A relationship between medication adherence and HbA1c level was seen in the Cont but not in the Discont group. About 70 % of those in the Discont group made their decision to terminate diabetes treatment without consulting physicians and half of them perceived their situations inappropriately.ConclusionsThose who discontinued pharmacotherapy were less adherent to medication than those who did not discontinue. Risk factors for glycemic control also differed between those who discontinued and those who did not. More than one-third of participants with diabetes who discontinued pharmacotherapy had inappropriate perceptions of their disease, which medical professionals should be aware of for better interventions.

Patient-Reported Preference and Clinical Efficacy of Insulin Pen Devices With Safety Needles in Adolescents and Young Adults With Type 1 Diabetes: A Prospective Study

PurposeCurrent evidence indicates that diabetic patients' preference and medication adherence can be affected by the type of insulin pen needles. We aimed to assess the impact of insulin pen devices with safety needles (SPN) on the usability, behavioral, lifestyle, and emotional aspects of type 1 diabetes mellitus (T1DM) in adolescents and young adults.Patients and methodsWe conducted a prospective single-center study on adolescent T1DM patients treated with multiple insulin doses using basal-bolus therapy for at least one year. Patients were followed for 12 weeks to compare the changes in the baseline usability and insulin fear of self-injection scales between SPN and conventional needles.ResultsIn this 12-week study, we included 72 participants with a mean age of 15.5 ± 1.3 years. The mean disease duration was 5.1 ± 2.2 years. At 12 weeks, substantial improvement was evident in the SPN group, compared to the conventional group, in terms of the overall satisfaction score with a mean difference (MD) of 4.1 ± 1.9 (p < 0.01). Participants in the SPN group reported significant reduction in all aspect of fear from self-injection, such as being restless (MD = -1.4 ± 0.9), tense (MD = -1.8 ± 0.9), afraid (MD = -1.9 ± 0.9), worried (MD = -1.9 ± 0.9), nervous (MD = -1.7 ± 0.9), and brood using the SPN needles (MD = -1.6 ± 0.9), as compared to the conventional needles group. The glycemic control parameters, as determined by HbA1c and fasting blood glucose, exhibited significant improvements in the SPN group compared to the conventional group (p < 0.05).ConclusionSPN significantly improved usability, glycemic parameters, and reduced the fear of insulin self-injections amongst T1DM patients compared to conventional pen therapy.

Development of a Typology of Diabetes-Specific Family Functioning Among Adults With Type 2.

Family members' responses to adults' diabetes and efforts to manage it vary widely. Multiple aspects of diabetes-specific family functioning have been identified as important for self-management and psychosocial well-being in theoretical (i.e., theories of social support and collaborative coping) and observational literature. Develop a typological framework of diabetes-specific family functioning and examine cross-sectional associations between type and diabetes outcomes. We used electronic health record (EHR) data to identify a cohort of 5,545 adults receiving outpatient care for type 2 diabetes and invited them to complete a survey assessing 10 dimensions of diabetes-specific family functioning. We used k-means cluster analysis to identify types. After type assignment, we used EHR data for the full cohort to generate sampling weights to correct for imbalance between participants and non-participants. We used weighted data to examine unadjusted associations between participant characteristics and type, and in regression models to examine associations between type and diabetes outcomes. Regression models were adjusted for sociodemographics, diabetes duration, and insulin status. We identified and named four types: Collaborative and Helpful (33.8%), Satisfied with Low Involvement (22.2%), Want More Involvement (29.6%), and Critically Involved (14.5%; reflecting the highest levels of criticism and harmful involvement). Across these types, hemoglobin A1c, diabetes distress, depressive symptoms, diabetes medication adherence, and diabetes self-efficacy worsened. After covariate adjustment, type remained independently associated with each diabetes outcome (all p's < .05). The typology extends theories of family support in diabetes and applications of the typology may lead to breakthroughs in intervention design, tailoring, and evaluation.