Diabetes Mellitus Outpatients Research Articles

Exploring disparities: A comparative analysis of insulin-naïve, regular users, and inertia patients among type 2 diabetes mellitus outpatients in India

ABSTRACT Introduction: Insulin utilization pattern varies greatly in type 2 diabetes mellitus (T2DM) patients. Clinical inertia in treatment intensification hinders glycemic control in T2DM management. This study investigated insulin prescription trends and various predictors among insulin naive, user, and insulin inertia (II) patients in T2DM. Methodology: A retrospective analysis of T2DM patient records from the diabetes clinic at a tertiary care center was conducted. Data on socio-demographics, anthropometry, disease characteristics, comorbidities, adherence, and medication prescribing patterns were collected. Analysis was done using tests of significance, odds ratio (OR), and multivariate logistic regression. Results: A total of 950 records were analyzed, with 17.3% of patients identified as insulin users (IU), 70.9% being insulin-naïve (IN), and 11.8% having II. IUs had significantly higher glycemic levels including HbA1c, fasting, postprandial, and random blood sugars compared to the other groups. Higher HbA1c levels were associated with significantly increased odds of insulin usage (OR: 3.46, confidence interval (CI): 1.94–6.16), while individuals taking sulfonylureas had lower odds of insulin usage (OR: 0.27, CI: 0.08–0.91). A significant association was also seen with the total number of oral antidiabetic drugs prescribed (four drugs; OR: 15.6, and five drugs; OR: 9.1). Other factors did not show a significant association. The regression model showed HbA1c level as low as 7.9% could indicate a future insulin requirement in 22% of patients. Conclusion: The study outlines differences in characteristics and parameters among T2DM patients who require or do not require insulin and highlights the challenges in insulin initiation in Indian T2DM patients. Findings on II underscore the need for timely treatment intensification.

Role of muscle ultrasound in frailty assessment in older adults with type 2 diabetes mellitus

BackgroundFrailty is a geriatric syndrome that is characterized by increased vulnerability to intrinsic and extrinsic stressors due to decreased biologic reserves. Muscle ultrasound (US) is a valid and reliable method for assessing muscle quantity in older adults. The study aims to examine the relationship between frailty definitions and US-derived muscle parameters.MethodsWe conducted a cross-sectional study with type 2 diabetes mellitus outpatients in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment. For frailty assessment, the Fried Frailty Phenotype (FFP), the Clinical Frailty Scale (CFS), and the Edmonton Frailty Scale (EFS) were performed. Muscle US measurements included Gastrocnemius Medialis (GM) muscle thickness, GM fascicle length, GM pennation angle, Rectus Femoris (RF) muscle thickness, Rectus Femoris cross-sectional area (RFCSA), Rectus Abdominis (RA) muscle thickness, External Oblique (EO) muscle thickness, Internal Oblique (IO) muscle thickness, and Transverse Abdominis (TA) muscle thickness.ResultsIn all, 373 participants were included in the study. The median age of participants was 72.7 ± 5.9 years, and 64.6% of them were female. According to the FFP, 18.2% of the participants were living with frailty, 56% of them were pre-frail; 57.4% of them were living with frailty according to the CFS; 25.2% of them were living with frailty, and 20.6% of them were pre-frail according to the EFS. The FFP, CFS, and EFS scores were related to muscle thickness of GM, RF, and RA, fascicle length of GM, and pennation angle of GM and RFCSA. Particularly, GM pennation angle, RF muscle thickness, and RFCSA were associated with an increased risk of frailty. Besides muscle thickness of GM, RF, and RA, fascicle length of GM, pennation angle of GM, and RFCSA were significant for predicting the presence of frailty.ConclusionsUS-derived regional muscle measurements are associated with frailty definitions (in both physical, cumulative deficit, and multidimensional models) in a diabetic geriatric population.

Analysis of adherence and factors affecting insulin therapy outcomes in outpatients with Diabetes Mellitus

Background: Insulin is an effective diabetes treatment for outpatients with Diabetes Mellitus (DM) to maximize medication therapy. However, the level of insulin adherence is still low. This study aims to analyze adherence, glycemic control, and factors that influence the achievement of insulin therapy in Type 2 Diabetes Mellitus (T2DM) outpatients. Methods: This study was a cross-sectional study conducted on T2DM outpatients. Adherence to Refills and Medications Scale (ARMS) and Diabetes Knowledge Questionnaire (DKQ) were used to assess patients’ adherence and knowledge of insulin use. Multiple logistic regression tests were carried out to measure the effect of factors on adherence and insulin therapy outcomes. Results: Of the 141 patients adherence to insulin treatment was found to be 33.3%. Patients who achieved glycemic control assessed by Glycosylated Haemoglobin (HbA1c), Fasting Blood Glucose (FBG), and Two hours of Postprandial Blood Glucose (2hPPBG) were 36.2%, 39%, and 43.3%. The duration of insulin use had a significant effect on adherence (p-value 0.013) and 2hPPBG target (p-value 0,049), while other factors had no significance. Conclusion: Adherence to insulin therapy and glycemic control targets were found to be low. The duration of insulin use was associated with medication adherence and insulin therapy outcomes.

Relationship Between Medication Adherence and Blood Sugar Levels Among Diabetes Mellitus Outpatients

Diabetes Mellitus (DM) is a disease with progressively increasing prevalence every year and often leads to complications when not properly managed. Control or success of treatment is influenced by adherence of patients to the treatment process. This study aimed to analyze relationship between medication adherence and fasting glucose levels among DM outpatients. A correlation study was conducted using a cross-sectional approach on a sample of 300 respondents selected by probability sampling technique from the entire population. The instrument used was the MMAS-8 Test (Morisky Scale Medication Adherence Scales-8) and examination of fasting sugar levels. Meanwhile, data analysis was conducted with the Spearman Rho test. The results showed that the highest treatment adherence was in the moderate category by 130 (43.3%) and a decrease in fasting sugar levels was observed among 230 (76.7%) respondents. A significant relationship was found between medication adherence and fasting glucose levels with a p-value = <0.001 and r: -0.597. Based on the results, there was a negative relationship between medication adherence and fasting blood sugar. The higher medication adherence, the better the fasting sugar levels in DM outpatients.

Obesity and hypoglycaemia in type 2 diabetes mellitus outpatients on insulin therapy in Nigeria–data from the multicentre evaluation of type 2 diabetes mellitus outpatients patients on insulin therapy (METOIN) study

Background and Objective: Despite the obvious benefits of early insulin use in achieving good glycaemic control, insulin linked overweight/obesity and hypoglycaemia are sources of concern and worry. Burden of these side effects among type 2 diabetes mellitus (T2DM) outpatients on insulin therapy in Nigeria is unknown.
 Subjects and Methods: This was a prospective, cross sectional and observational study in which consenting T2DM outpatients that meet the inclusion criteria for the study in five tertiary health facilities were simultaneously recruited and relevant data obtained via investigator-administered questionnaire. Data obtained which included gender, arthropometric measures, hypoglycaemia and where it was treated were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software.
 Results: A total of 245 T2DM outpatients were recruited into the study, made up of 107 (43.7%) male and 138 (56.3%) female. Of this, 121 (49.8%) patients were overweight while 70 (28.7%) were obese. Among the patients, 104 (42.4%) T2DM outpatients on insulin therapy reported hypoglycaemia which was mild in 83 (79.8%) of the patients
 Conclusion: A significant number of the type 2 DM outpatients on insulin therapy were overweight/obese with mild hypoglycaemia in a majority of them.

A Cross-Sectional Study to Determine the Prevalence and Predictors of Depression and Anxiety in Type 2 Diabetes Patients in South India

Diabetic patients with depression or anxiety are more likely to develop diabetic complications and have a lower quality of life. The aim of the study is to determine the prevalence of depression and anxiety among type 2 diabetic patients and to identify the associated factors. A cross-sectional, observational study of type 2 diabetes mellitus outpatients, with diabetes-related conditions who attended the hospital from January to April 2023, was conducted by interviewing them using the Patient Health Questionnaire-9 for depression and Generalised Anxiety Disorders-7 for anxiety. Descriptive statistics, bivariate analysis, and multivariant regression were performed for statistical analysis. Out of 450 type 2 diabetic patients, 90% were between ages 30 and 45, 50.2% were male, 60% were living in rural areas, and 76.5% literate; most of them belong to the upper middle class (64%) and they live in joint family (32.7%). Depression and anxiety were observed among 65.3% and 62.4% of type 2 diabetic patients, respectively. When observing the severity, 47.8% of patients had mild depression, and 38.7% had minimal anxiety. Age group, socioeconomic status, treatment type, and years of diabetes were found to be factors associated with depression and family type is associated with anxiety. Hospitalized diabetics have higher depression and anxiety rates for multiple reasons. Therefore, diabetes management programmes should include regular depression and anxiety screenings to quickly identify and treat high-risk patients in healthcare facilities.

Impact of pharmacist counseling on the clinical outcomes in the management of type 2 diabetes mellitus outpatients admitted to a hospital

Background: Type 2 Diabetes mellitus remains a global health problem due to its poor clinical outcomes, high morbidity, and mortality caused by many complicated problems, one of which is the ineffective role of pharmacists in providing counselling to DM patients Methods: This pre and post cohort study analyzed the impact of pharmacist counselling on the blood glucose level and glycosylated hemoglobin (HbA1C) of T2DM outpatients (n=88) admitted to Asahan General Hospital period June to December 2022. Counselling provided comprised the importance of medication adherence and non-pharmacological approaches. Characteristics, BGLs and HbA1C of the patients were extracted from their medical records before and after counselling using a predetermined questionnaire. Characteristics of the patients were descriptively analyzed. Results: The significance of the counselling on these outcomes was analyzed by applying Wilcoxon test (p <0.05 was considered significant). The mean age of the patients was 57.89±9.75 (years). Most (57.95%) of them were female. Proportion of the patients with controlled BGLs (%): before counselling, 27.7; after counselling, 89.8. Proportion of the patients with controlled HbA1C (%): before counselling, 27.3; after counselling, 89.8. Pharmacist counselling significantly improved the clinical outcomes of T2DM patients, p=0.000. Conclusions: Pharmacist counselling plays an important role to improve BGLs and HbA1C in T2DM patients which can finally improve their quality of life.

Analysis of Medical Costs of Type 2 Diabetes Mellitus Outpatient Muhammadiyah Hospital North Sumatra

Type 2 diabetes mellitus and its complications are expensive. Complications are major cost drivers. Of the ten most outpatient diagnoses at Muhammadiyah Hospital, North Sumatra, there was a negative difference between INA-CBGs rates and hospital rates for type 2 diabetes mellitus cases. This study aims to estimate the medical cost, assess the average cost difference, and examine the cost component associated with outpatient type 2 diabetes mellitus. This quantitative analytic research used secondary data on outpatient medical records of type 2 diabetes mellitus patients from May 2019-April 2020. There were 61 samples of medical records. Results showed that the average annual medical cost of outpatient type 2 diabetes mellitus without complication was IDR. 298,177, 8 and IDR. 853,696,7, IDR. 932,341,7, IDR. 938,433.3 if accompanied by macrovascular complications, microvascular complications, and both, respectively. There was a significant difference (p = 0.004) in the mean medical costs per year between the complication groups. Drug costs significantly differed (p = 0.010) between the complication groups. Drug costs are the most expensive and are strongly associated with the medical costs of complicated type 2 diabetes mellitus.

The Effect of Nutrition Education Using Leaflet Media on Knowledge of Meal Planning in Type II Diabetes Mellitus Outpatients at the Pasundan Health Center in Samarinda

Diabetes mellitus is a degenerative disease that cannot be fully cured, but can be managed and controlled by the sufferer. The knowledge of a person with diabetes mellitus is greatly influenced by the information obtained, informative and interesting educational media is a very strong supporting factor in increasing knowledge quickly. The purpose of this study was to determine the effect of nutrition education using leaflet media on knowledge in type II diabetes mellitus outpatients at the Pasundan Health Center in Samarinda. The pre-experimental research design used the One Group Pretest-Postest design with 40 respondents using a purposive sampling technique. Data analysis used the Wilcoxon test with a value of p=0.000. The results showed that there was a difference in the average value of knowledge before and after being given nutrition education using leaflet media. So that there is an influence of nutrition education using leaflet media on the knowledge of type II diabetes mellitus outpatients.

Obstructive sleep apnea in type 2 diabetes mellitus patients

Abstract Objective The study aims to identify the prevalence and risk factors for OSA in a group of Egyptian patients with type 2 diabetes. Methods 125 type 2 diabetes mellitus patients visited Mansoura University Hospital (Diabetes Mellitus Outpatient Clinic (OPC) at Specialized Medical Hospital and the Sleep Disordered Breathing Unit of the Chest Department), all of them exposed to history taking, the patients underwent anthropometric measurements (weight, height, body mass index, neck circumference), a test of their tonsillar size, Malampati score, Friedman OSA score, Epworth sleepiness scale (ESS), Berlin questionnaire, STOP BANG questionnaire, full-night polysomnography, fasting, and postprandial blood sugar. Results The study included 125 T2DM Egyptian patients with a mean age of 54.63 ± 9.47 years. Males accounted for 35.2 percent of patients, while females accounted for 64.8%. According to the study of co-morbidity, hypertension constituted 77 (61.1%), ischemic heart disease 28 (22.4%), other cardiac diseases 11 (8.8%), bronchial asthma 6 (4.8%), liver diseases 6 (4.8%), hypothyroidism 3 (2.4%), and renal diseases 3 (2.4%). A total of seven patients (5.6%) had no OSA symptoms, 87 had borderline symptoms, and 31 had positive symptoms. There were 51 (40.8%) normal patients, 12 (9.6%) borderline patients, and 62 (49.6%) sleepy patients on the Epworth scale. According to the Stop-Bang questionnaire, 121 (96.8%) patients answered positively. It was determined that 122 patients (97.6%) were at high risk based on the Berlin questionnaire. There were 17 patients (13.6%) with OSA on polysomnography, of which six were moderate (35.3%) and 11 were severe (64.7%). Among moderate and severe OSA patients, glycosylated hemoglobin levels differed significantly. Multivariate logistic regression analysis for independent predictors of OSA, chronic renal disease patients is the most common associated risk factor (OR = 14.3, CI = 1.2–67) then hypertension (OR = 5.6,CI=1.2–25.5) and heart failure (OR = 4.4). Conclusions OSA affects 13.6% patients with type 2 diabetes patients who are hypertensive are at higher risk of OSA, chronic renal failure is considered another risk factor Furthers studies are needed on a big scale of Egyptian diabetic patients to detect the prevalence of OSA

Pengaruh Edukasi Gizi Terhadap Pengetahuan, Pola Makan Dan Kadar Glukosa Darah Pasien Diabetes Melitus Tipe 2 RSU Kota Mataram Dengan Provinsi NTB

The phenomenon of diabetes mellitus from year to year an increasing number. One major factor is the lack of knowledge in conducting therapy in patients with diabetes mellitus diit so may lead to increased blood sugar levels. The aim of this study was to determine the effect of nutrition education to increase the knowledge, dietary compliance and uncontrolled blood sugar levels Type 2 Diabetes Mellitus Outpatient in Kota Mataram Dg Provinsi NTB Public Hospital Jeneponto. The design of this research was experimental studies with pre experimental designs One Group Pretest And Postest Design. Sampling was conducted using purposive sampling technique with a sample of 30 people. Data was collected by the secondary data and primary data. The dietary pattern data was collected by 24 hours recall questionnaire, blood glucose level of patients were measured by blood glucose meter. While the knowledge of patients were collected by interview using questionnaire.given before and after the education. Height and weight of patients were measured by scale and microtoice. The secondary data are the description of hospital and laboratory result data obtained from the hospital. Data analysis was performed by Mc Nemar test.The results showed, after education, knowledge of patients categorized sufficiently increased (p = 0.031), from 33.3% to 53.3%, as well as the diet of patients (p = 0.003), from 23.3% to 60 , 0% categorized fairly, as well as the patient's blood sugar levels were controlled (p = 0.000), from 3.3% to 46.7%. It is recommended to patients to better manage diet to control blood sugar levels with the help of physical activity and obedient in taking the drug.

Fast-acting insulin aspart in pediatric type 1 diabetes mellitus patients in a tertiary care center: Indian experience

Background: The objective of this retrospective study was to evaluate the effectiveness and safety of fast-acting insulin aspart with additional drug excipients (L-arginine and niacinamide) in the Indian pediatric population. Methods: Data of pediatric type 1 diabetes mellitus (T1DM) outpatients in the age group of 1 to 18 years on treatment with injection degludec as long-acting Insulin OD and faster aspart as rapid-acting mealtime insulin 5-minutes before the meal for 20-weeks, was collected from the medical records of subjects. The primary endpoint was the mean change in glycated hemoglobin (HbA1c) and the secondary endpoints were mean changes in fasting plasma glucose (FPG) and 1 and 2-hour postprandial glucose (PPG), from baseline to 20-weeks post-treatment. The safety of treatment was also evaluated. Results: Data of 30 pediatric patients (Male: Female-14:16) with a mean age of 7.98 years was considered for this retrospective data analysis. Compared to baseline, there was a significant decline (p<0.001) in mean HbA1c levels by -0.72, in FPG by -32.87 mg/dl, in 1-hour PPG levels by -8.57 mg/dl, and 2-hour PPG levels by -11.3 mg/dl, after 20-weeks of treatment. Three and two patients reported symptomatic undocumented hypoglycemia and symptomatic documented hypoglycemia respectively, and one patient each reported local site reaction, and lipodystrophy. No episodes of nocturnal hypoglycemia were reported. Conclusions: In Indian pediatric T1DM patients 20-weeks mealtime faster aspart along with insulin degludec provided effective glycemic control, and treatment resulted in lower HbA1c, FPG, and 1 and 2-hour PPG levels. Conclusions: In Indian pediatric T1DM patients 20-weeks mealtime faster aspart along with insulin degludec provided effective glycemic control, and treatment resulted in lower HbA1c, FPG, and 1 and 2-hour PPG levels.

Insulin initiation in Type 2 diabetes mellitus outpatients – data from the multicentre evaluation of type 2 diabetes mellitus outpatients on insulin therapy in Nigeria (METOIN study)

People living with type 2 diabetes mellitus (T2DM) have relative insulin deficiency and, therefore, have options to insulin therapy. To be on insulin alone or in combination with other therapies in type 2 DM outpatients is a choice made personalized for each patient. Published literature on the insulin initiation patterns among T2DM outpatients in Nigeria is scanty. The objective of this study, therefore, is to bridge this gap in knowledge. This was a prospective cross sectional study conducted in five tertiary health facilities in Nigeria in which consenting type 2 DM outpatients on insulin therapy alone or in combination with other therapies and who meet the inclusion criteria for the study were recruited. Relevant data relating to insulin use initiation by the patients were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. A total of 268 outpatients living with type 2 DM on insulin therapy, made up of 116 (43.3%) male and 152 (56.7%) females participated in the study. Only 55 (20.5%) of the patients started insulin at onset of diagnosis of T2DM while 46 (17.2%) of the patients started insulin therapy after 5 years of living with T2DM. The duration of living with DM before insulin initiation and the patient's highest level of education were not statistically significant. Insulin initiation was delayed several months to years after diagnosis of T2DM by predominantly endocrinologists in tertiary health facilities but it was initiated in 19 (7.1%) of the T2DM outpatients by primary care physicians (GPs) in peripheral hospitals. It is recommended that diabetes education be intensified for T2DM patients to appreciate the key role of insulin therapy in diabetes care.
 Keywords: insulin initiation, type 2 diabetes mellitus outpatients, Nigeria.

Impact of pharmacist-led education on knowledge, adherence, and glycaemic control of type 2 diabetic outpatients

Objectives: This study aimed to evaluate the effect of a pharmacist-led education programme on knowledge, adherence, and glycaemic control of type 2 diabetic outpatients. Methods: A prospective cohort study was conducted among adult type 2 diabetes mellitus (DM) outpatients. The pharmacist-led education programme was delivered to patients and their family members. Patient knowledge and adherence were assessed using questionnaires. Plasma glucose levels were also monitored during the study. Results: 26 patients completed the study (median (IQR) age 61.5 (58.3 – 65.0) years, female 57.7%, median (IQR) duration of DM 5.0 (3.0 – 15.0) years). At the end of study, the education programme improved patient’s knowledge by 19.2% (p = 0.409) and medication adherence by 46.1% (p = 0.002). Glycaemic control in fasting plasma and postprandial glucose levels were achieved in 19.2% and 23.1% of patients, respectively. Conclusion: An education programme led by pharmacists may improve diabetic outpatient’s knowledge, adherence to therapy, and glycaemic control.

Modified brief counseling-5A, motivational SMS on medication-taking behavior and compliance among diabetic patients

Knowledge of diabetes mellitus (DM) management can improve adherence in medication-taking behavior. Counseling by pharmacists is believed to contribute to its better acquisition. Nevertheless, many counseling and reminder media are still currently developed. This study aimed to identify the effects of brief counseling-5A modification and a motivational reminder through short message services (SMS), designed with a religious approach, on medication-taking behavior and adherence among DM outpatients at Jetis 1 Community Health Center, Bantul, Yogyakarta, Indonesia. This quasi-experimental study employed a pretest-posttest control group design. Data were collected prospectively from May to August, 2018. There were 72 patients who met the inclusion criteria divided evenly into two groups, the treatment group and the control group. The data collected by interviews using questionnaires on medication-taking behavior and the medication adherence rating scale (MARS) and were statistically assessed using the Wilcoxon test. The results showed that brief counseling-5A, combined with religious motivational SMS, raised the stage of behavior change in DM patients. There were increases (Δ) in medication-taking behavior by 2.76±1.59 and patient compliance by 3.44±3.45. In conclusion, brief counseling-5A by pharmacists and motivational text reminders can improve the medication-taking behavior and compliance of DM patients with the therapy.

Assessment of Serum Free Light Chains as a Marker of Diabetic Nephropathy; A Cross-Sectional Study in the Kumasi Metropolis.

Although traditional tests such as serum urea, creatinine, and microalbuminuria have been widely employed in the diagnosis of diabetic nephropathy, their sensitivity and accuracy are limited because kidney damage precedes the excretion of these biomarkers. This study investigated the role of serum free light chains in the disease manifestation of diabetic nephropathy. Using a cross-sectional design we recruited 107 diabetes mellitus out-patients who visited the Diabetes and Renal Disease Clinics at the Komfo Anokye Teaching Hospital, Manhyia District Hospital, and Suntreso Government Hospital all in Ghana from November 2019 to February 2020. Five (5) mls of blood was collected from each participant and analyzed for fasting blood glucose (FBG) urea, creatinine, immunoglobulin free light chains. Urine samples were obtained and analyzed for albumin. Anthropometric characteristics were also measured. Data were analyzed using descriptive analysis, analysis of variance (ANOVA) test, Tukey HSD post hoc, and Kruskal Wallis test. Chi-squared test was used to examine if there are significant associations with the indicators of interest. In addition, Spearman's correlation was used to test for associations between appropriate variables. Receiver operating characteristic analysis (ROC) was also performed to assess the diagnostic performance of free light chains. The mean age of studied participants was 58.2 years (SD: ± 11.1), 63.2% were females and most of the participants were married (63.0%). The mean FBG of the studied participants was 8.0mmol/L (SD: ± 5.86), and the average duration of diabetes mellitus (DM) was 11.88 years (SD: ± 7.96). The median serum Kappa, Lambda, and Kappa: Lambda ratios for the studied participants were 18.51 (15.63-24.18), 12.19(10.84-14.48), and 1.50(1.23-1.86) respectively. A positive correlation was observed between albuminuria and; Kappa (rs=0.132; p=0.209), and Lambda (rs=0.076; p=0.469). However, a negative correlation was observed between albuminuria and K: L ratio (rs=-0.006; p=0.956). The current study observed an increasing trend in the levels of free light chains and degree of diabetic nephropathy, although not statistically significant. The exploration of serum free light chains as a better marker of diabetic nephropathy showed very promising results but further studies are required to elucidate its predictive value as a diagnostic tool for diabetic nephropathy.

Cost of Illness Type 2 Diabetes Mellitus Outpatient BPJS on Malang City Health Center

Background: Type 2 diabetes mellitus is a progressive illness that impacts the costs borne by patients. The Cost of Illness method can be used further to analyze the medical expenses for type 2 diabetes mellitus. Objective: Determine the annual total cost of type 2 diabetes mellitus outpatients in Indonesia Health Insurance (BPJS) participants and treated with metformin-glibenclamide. Methods: This study applied the non-probability sampling technique and the purposive sampling method to the cross-sectional approach. The research was conducted in the Mulyorejo Health Care of Malang City, using 58 patients as samples. The research instrument involves a systematic interview that has been tested for its validity. The data were analyzed using Microsoft Excel. Results: The direct medical cost per patient is IDR 173,560.00 – IDR 1,266,240.00. Non-medical direct cost is IDR 0.00 – IDR 240,000,00. The indirect cost is IDR 0.00 – IDR 1,920.000,00. Conclusion: The estimated annual total medical expenses of diabetes mellitus type 2 Indonesia Health Insurance (BPJS) outpatients employing metformin-glibenclamide therapy at Mulyorejo Health Center in Malang is IDR 173,560.00 – IDR 3,426,240.00.

Factors Associated with Non-Adherence to Drugs and Dietary Regimen Among Type Ii Diabetes Mellitus Out-Patients Attending University College Hospital, Ibadan

Diabetes is an increasing global health problem and this puts high demands on the health care system. Medication non-adherence results in increased morbidity, mortality and financial loss among patients and non-adherence is multifactorial. This study therefore was aimed at determining factors associated with non-adherence to drugs and dietary regimen among Type II Diabetes Mellitus patients attending University College Hospital (UCH), Ibadan, Nigeria. This study utilized a quantitative design using descriptive survey method to collect data from 330 Type II diabetes out-patients in UCH, Ibadan on factors associated with non-adherence to drug and dietary regimen. Data were analysed using descriptive statistics (frequency, mean and standard deviation) for research questions and inferential statistics, Chi-square and ANOVA for testing hypotheses at 5% level of significance. Findings revealed that non-adherence to medication mean was 3.4±1.1 and 27.7% of respondents had poor adherence to medication. Mean attitude to medication non-adherence was 12.0±2.2 and 62.0% respondents had negative attitude to medication adherence. Clinical factors like: not being able to access clinic regularly for consultation and not getting medication information had influence on anti-diabetic medication non-adherence (1.37±0.49; F=42.036; P=0.000) and 1.54±0.50; F=29.431; P=0.000) respectively. Individual factors like: not being comfortable with physician diagnoses (1.33±0.47; F=22.190; P=0.000); found it difficult in taking their drugs when they are many (1.46±0.50; F=42.992; P= 0.000); receiving detailed written instruction regarding exercise programs from healthcare provider (1.43±0.50; F=23.485; P=0.000) were all influencing factors to anti- diabetics medication adherence. Lack of patients-physician relationship and inconsistent information about the medicines prescription influences non-adherence to anti-diabetic medication greatly in this study. Improving on these areas by health

Oral health-related quality of life in type 2 diabetic patients of Yogyakarta General Hospital

Yogyakarta is a province in Indonesia with the highest prevalence (2.4%) of Diabetes Mellitus (DM). Around 90% of diabetic patients suffer from type 2 DM. Oral manifestations of DM may disturb oral functions which in turn influence oral health - related quality of life (OHRQo)L. This study aimed to evaluate the OHRQoL of type 2 DM outpatients in Yogyakarta General Hospital. The study subjects comprised 50 male outpatients and 32 female outpatients with type 2 DM (40-81 years old). Geriatric Oral Health Assessment Index (GOHAI) and Xerostomia Inventory were used to assess OHRQoL and xerostomia status, respectively. Intraoral examinations comprising periodontal tissue, oral hygiene (OH), coated tongue, and present teeth were performed. There were 49 (59.76%) subjects with low and 33 (40.24%) subjects with high score of GOHAI; 78 (95.12%) with and 4 (4.88%) without periodontal tissue defect; 79 (96.34%) with poor and 3 (3.66%) good OH; 17 (20.73%) with coated tongue >50% and 65 (79.27%) with coated tongue ≤50%; 34 (41.46%) with present teeth <20 and 48 (58.54%) with present teeth ≥20; and 39 (47.56%) with xerostomia and 43 (52.44%) with normal status. Only ‘present teeth’ had a significant contribution to the proportion of GOHAI status in type 2 DM patients in this study (p=0.032). Type 2 DM patients with ≥20 teeth had a more significant proportion of high GOHAI status compared to those with <20 teeth. The majority of type 2 DM outpatients of Yogyakarta General Hospital had poor OHRQoL as reflection of their oral condition that is partly contributed by patients with present teeth <20.

Relationship between family support and compliance in diabetes mellitus patients

Background: Indonesia holds fourth place in the world with the highest number of patients with diabetes mellitus (DM), and the province of East Kalimantan is in third place with the city of Bontang. The existence of distance restrictions during the COVID-19 pandemic led to restrictions on the number of outpatients in health facilities, so family support had a prominent role in drug therapy adherence in DM patients. Aim: This study aims to determine the relationship between family support and adherence to antidiabetic drug therapy in DM patients. Methods: This observational cross-sectional research conducted from May to June 2021 at the Pupuk Kaltim Hospital, Bontang city, used a purposive sampling technique. It enrolled 104 DM outpatients who completed a validated questionnaire instrument to measure family support and drug therapy adherence. Results: Data analysis showed a significant relationship between family support and drug therapy adherence (p=0.009) and the emotional support dimension (p=0.0001), while the three other dimensions (informational support, instrumental support, and reward support) were not significant. Conclusion: Family support, especially emotional support, is associated with adherence to antidiabetic drug therapy in DM patients.