Diabetes Mellitus Outpatients Research Articles

Prescribing patterns in type 2 diabetes mellitus outpatients at a tertiary care centre in Jaipur, India

Background: Over the last few years, an unexpected increase in the prevalence of diabetes in India have been witnessed. The present study was planned to analyse prescribing patterns of anti-hyperglycaemic drugs and assess the influence of Chief Minister's Free Drug Scheme in Rajasthan, India. It aimed to evaluate, monitor and if possible, suggest modifications in prescribing practices to make medical care rational and also to assist minimising adverse drug reactions (ADRs). Methods: This was a cross-sectional, observational study carried out for a 12-month period. A total 400 known patients of type 2 diabetes mellitus (T2DM) from endocrinology outdoor of SMS Medical College Hospital (a tertiary care hospital in Jaipur, Rajasthan, India) were recruited and their prescriptions were analysed using the World Health Organization (WHO) prescribing indicators. Results: Most commonly observed age group was of 40-50 years (mean age 53.76 ± 8.84), with a male preponderance (57.5 %). Among them, 67.5 % of patients were found to be obese (mean BMI 29.79 ± 3.26). All anti-hyperglycaemic were prescribed in their generic names only. Metformin was the most frequently prescribed anti-hyperglycaemic agent. Among the fixed dose combinations, the most common was that of glimepiride and metformin (40.75 %), while most prescribed add on anti-hyperglycaemic was teneligliptin (51.5 %), followed by pioglitazone (30.5 %). A total of 53.25 % of these patients received insulin along with oral anti-hyperglycaemic agents. Conclusion: The anti-hyperglycaemic agent prescribing among endocrinology outpatients at tertiary care hospital in Jaipur was found to be satisfactory.

Association Between Sleep Quality and Health-related Quality of Life in Indian Type 2 Diabetes Mellitus Outpatients: Evidence from a Cross-sectional Study

Objective: The objective of this study is to measure the relationship between sleep quality and health-related quality of life (HRQOL), in Indian population with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study, included total of 300 patients with T2DM. All participants were responding the sleep quality instruments (PSQI) and EQ-5D (HRQoL) questionnaires. A PSQI global score ≥5 was defined as poor sleep quality. The score of EQ-5D index ranges from - 0.111 to 1, where 1 represents preferred health. EQ-5D is visual analogue scale (VAS), determining the overall health status. Logistic regression analysis was used to examine the association between PSQI and EQ-5D. All the study data were analysed using the SPSS software version 20.0. Values of p <0.05 were considered statistically significant. Results: The mean age of participants were 57.56. Majority of the participants (55.3%) were identified as “poor sleepers” and female (31.3%) contributing higher proportion. Poor sleepers had significantly lower the HRQOL (p < 0.001). After adjustment, poor sleep quality was significantly associated with a lower HRQOL; EQ-5D index (OR= 1.080, 95%, CI: 1.015 - 1.148, p < 0.05), and EQ-5D VAS (OR= 1.092, 95%, CI: 1.021 - 1.176, p < 0.01). Overall the EQ-5D index and EQ-5D VAS were found to be an independent predictors of sleep quality. Conclusions: This study suggests that poor sleep quality is prevalent in Indian T2DM population, and it imparts a negative impact on HRQOL. Therefore, further studies are needed to determine the causal relationship between T2DM and measure of objective sleep and their impact on health.

Effect of Pharmacist Intervention on Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Outpatients in Primary Healthcare in Indonesia.

Objective:In Indonesia, the role of pharmacists in primary healthcare is still very limited or even absent. This study evaluates the effectiveness of programs delivered for type 2 diabetes mellitus (T2DM) patients by pharmacists in primary healthcare through counseling, short message service (SMS) reminders, and medication booklets.Methods:A quasi-experimental study with a pretest–posttest design was conducted from April to August 2018 at Merdeka and Dempo primary health-care centers, Palembang, South Sumatra Province, Indonesia. Counseling and medication booklets were distributed three times during the study period, while SMS reminders were sent once a week. Counseling was given for the management of diabetes mellitus (DM), including during the Ramadan fasting period, together with management for acute and chronic complications. The medication adherence level was measured using a medication adherence questionnaire (MAQ) and pill count adherence (PCA). The study sample comprised 80 T2DM patients, who were allocated into either the control group (CG) (n = 40) or intervention group (IG) (n = 40). Clinical outcomes were determined by measuring glycated hemoglobin (HbA1c), blood pressure, and lipid profiles.Findings:After the intervention, the IG showed significant improvements in most parameters, except for high-density lipoprotein cholesterol and systolic and diastolic blood pressure. HbA1c levels were reduced, while MAQ scores and PCA scores were improved. Lipid parameters were significantly reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglyceride (TG). Compared with the CG, most parameters were significantly improved in the IG. Pharmacist counseling significantly improved almost all clinical parameters (HbA1c, TC, LDL-c, and TG). Pharmacist counseling was 7.1 times greater in lowering HbA1c compared with no counseling, after adjusted by other variables. The variable that most influenced the lowering of HbA1c was infrequent (“not often”) consumption of unhealthy foods (OR 14.9; 95% CI 3.5-63.7).Conclusion:The pharmacist primary health-care intervention program implemented in this study significantly improved HbA1c, TC, LDL-c, TG, and medication adherence in outpatients with T2DM.

Profile Evaluation of Medication, Cost Comparison, and Clinical Outcome of Human and Analog Insulin Treatment to Type-2 Diabetes Mellitus Outpatient at Medistra Hospital Year 2012-2013

The data collection was conducted retrospectively, taking samples of 121 outpatients, of which 83 outpatients were evaluated for their clinical outcome. The medication profile data were collected from the medicine administration at the Hospital Pharmacy Installation. The clinical outcome data, such as fasting plasma glucose (FPG), two-hour postprandial plasma glucose (2HPP), and Hemoglobin A1c (HbA1c), were garnered from the patients’ medical records. The cost data were collected from the outpatients’ payment receipts provided by the Hospital’s Financial Department. Kolmogorov Smirnov normality test was applied in this research. The research result suggests that after Mann Whitney Test, the human and analogue insulin were not significantly different seen from the clinical outcome result showing FPG (p=0.676), 2HPP (p=0.175), HbA1c (p=0.0445) and from the cost result (p=0.795). Furthermore, the research also shows that the average cost of 30-day medication of single human insulin was Rp3,190,997.43, while the one of analogue insulin was Rp3,188,832.35. In conclusion, the research finds out that if seen from the cost (p=0.795), the human and the analogue insulin were not significantly different.

Provision of Mobile-Diabetic Applications on Knowledge and Compliance with Type II Diabetes Mellitus Outpatient Diet

Diabetes mellitus is a disease that threatens global health and most are classified as type 2 diabetes mellitus caused by interactions between factors to the environment. Environmental factors that are expected to increase the risk factors for type 2 diabetes mellitus are not adhering to a diet, changing one's lifestyle, including unbalanced eating habitsThis type of research is a quasi-experimental study with a design using the one group pretest posttest approach. The total sample of 35 people was taken by purposive sampling technique. Pre test was carried out before being given m-diabetic application media and given a post test after being given m-diabetic application media. This study used the Kolmogorov-Smirnov normality test and a different Wilcoxon test.The results showed a significant change in the form of increased knowledge (p = 0,000) and an increase in adherence to a type 2 diabetes mellitus diet (p = 0,000). The conclusion of this study is that there are differences in knowledge after being given m-diabetic application media and there are differences in adherence to the diet type 2 diabetes mellitus. Melitus type II, and further researchers can use an android-based application as an educational medium for sufferers of other diseases.

Association Between Abnormal Glycemic Phenotypes and Microvascular Complications of Type 2 Diabetes Mellitus Outpatients in China.

PurposeThe objective of this study was to investigate the association of abnormal glycemic phenotypes with microvascular complications in type 2 diabetes patients.Participants and MethodsA total of 24,266 participants who were from the multicenter cross-sectional survey of China National HbA1c Surveillance System across China were included in the present study. Diabetes patients with abnormal glucose were divided into three groups according to phenotype: isolated fasting hyperglycemia (IFH), isolated postprandial hyperglycemia (IPH), or combined hyperglycemia (CH). The main outcomes were isolated diabetic retinopathy, isolated diabetic nephropathy, and combined diabetic retinopathy with nephropathy. Multivariate logistic regression was used to assess the association of abnormal glycemic phenotypes with microvascular complications.ResultsThe CH phenotype had the highest prevalence of isolated diabetic retinopathy, isolated diabetic nephropathy and combined diabetic retinopathy with nephropathy, followed by IPH. Multivariate analysis showed that the CH phenotype was associated with the highest risk of isolated diabetic retinopathy (OR: 1.20, 95% CI: 1.02–1.41), isolated diabetic nephropathy (OR: 1.59, 95% CI: 1.27–2.01) and combined diabetic retinopathy with nephropathy (OR: 1.93, 95% CI: 1.44–2.59). More importantly, participants with IPH phenotype also showed significantly higher risks of isolated diabetic retinopathy (OR: 1.16, 95% CI: 1.05–1.28), isolated diabetic nephropathy (OR: 1.37, 95% CI: 1.09–1.37) and combined diabetic retinopathy with nephropathy (OR:1.64, 95% CI: 1.21–2.21) compared to the IFH phenotype. After stratifying by age, sex, diabetes duration and BMI, the higher risks of isolated diabetic retinopathy, isolated diabetic nephropathy and combined diabetic retinopathy with nephropathy were confirmed in IPH phenotype group, compared to the IFH phenotype group.ConclusionDiabetic patients with IPH phenotype had higher risks of isolated diabetic retinopathy, isolated diabetic nephropathy and combined diabetic retinopathy with nephropathy compared with the participants phenotype of IFH, but lower than the phenotype of CH.

Management Practice and Contributing Risk Factors for Chronic Complications Among Type 2 Diabetes Mellitus Adult Patients in Follow-Up at a Tertiary Care Teaching Hospital.

BackgroundDiabetes Mellitus is a complex, chronic disease that requires a coordinated management practice beyond blood glucose control. The disease causes chronic complications that affect the quality of the life of patients, place major pressure on the health-care system and cause a rise in diabetes-related mortality.ObjectiveTo determine the prevalence of chronic diabetes mellitus complications, related risk factors, and management practice among adult type 2 diabetes mellitus outpatients at Tikur Anbessa Specialized Hospital (TASH).MethodsA cross-sectional study design was carried out from July to September 2018. The pre-tested data abstraction format was used to gather demographic and clinical information. We also used a balance of weight measurement, upright placed meter for height measurement, waist circumference measurement meter and BP equipment. Statistical analysis was accomplished using Statistical Package for the Social Sciences (SPSS) 25® software. The significance level for statistics was set at p<0.05.ResultsIn this study, 320 patients were involved. Of these, about 57% were female and had a mean age of 58 ±11.2 years. About 85% of the study participants had comorbidity and 42.5% had complications. Hypertension and neuropathy were the most common comorbidity and complication, respectively. The usage of vascular preventive medication among study participants was 74.7% and 55.3% for statins and ASAs, respectively. Participants in the study who had disease duration of 5–10 years (AOR=3.50, 95% CI: 1.19–10.28) and fifteen and above (AOR= 3.59, 95% CI: 1.36–9.49) were at higher risk of diabetes complication as compared to less than five years.ConclusionThe prevalence of chronic complications was high among adult T2DM outpatients. The duration of disease and the number of medications used were the factors associated with chronic complications. The use of vascular preventive medications was low among study participants.

GAMBARAN PENGETAHUAN GIZI DAN POLA MAKAN PASIEN RAWAT JALAN DIABETES MELLITUS TIPE-2 DI RUMAH SAKIT

Background: Knowledge of nutrition is the ability to understand the concepts and principles as well as information related to nutrition. Provincial health profile data south sulawesi in 2015, Diabetes Mellitus outpatients aged 40 years and above is 85%. Data on the record medic general hospital the area of a city makassar be seen that of diabetes mellitus in 2015 were 234 men and women 165.Objective: This research aims to describe the knowledge about nutrition and food consumption pattern among outpatients diabetes mellitus tipe-2 ( dm tipe-2 ) in a public hospital the area of a city Makassar.Method: Sampling done by purposive sampling criteria of Diabetes Mellitus patients visiting the hospital in June 2016 and suffered no complications.Result: The results of this study are patients with good nutritional knowledge are 48.6% and patients who have less nutritional knowledge are 51.4%. Patients who have food consumption pattern based on the frequency of good food is 42.9 % and 57.1% have less. Food consumption pattern based on the composition dishes of food in general is good which is 100%. Conclusion: Conclusions from this research is their knowledge about nutrition generally still less that is 51,4 % .Food consumption pattern based on the frequency of food is generally less that is 57.1 % , Food consumption pattern based on the composition dishes of food in general is good which is 100% and a %. Food consumption pattern based on a kind of food is generally good but lacking in fruits.Suggest: For side Hospital so that to schedule it illumination to patient Diabetes Mellitus about its important various of fruit to patient Diabetes Type Mellitus-2.Key Word : Nutrient Knowledge, eating Pattern, Patient Take care Way,Type DM-2

INVESTIGATION OF DRUG-RELATED PROBLEMS IN TYPE 2 DIABETES MELLITUS PATIENTS WITH MACROVASCULAR COMPLICATIONS: A CROSS-SECTIONAL STUDY

Objective this study to identify and classify DRPs in type 2 diabetes mellitus patients with macrovascular complications. Method A cross-sectional observational study was conducted in type 2 diabetes mellitus outpatients with macrovascular complications at Makassar Regional Hospital, for two months (July and August 2018). The study complied with all clinical research requirements in accordance with the Declaration of Helsinki. Ethics committee approval was obtained from UIN Alauddin Makassar. Thirty eight prescriptions were collected for this study. Samples were recruited based on inclusion and exclusion criteria. The identification and classification of DRPs were according to the PCNE tool v 8.02. Result: The most common drug-related problems were adverse drug reactions (n = 73; 77.7%) of the therapeutic safety domain, followed by optimal therapeutic effects (n = 15; 15.9%) of the effectiveness domain and finally unneeded drugs therapy (n = 4; 4.3%) from other domains. The highest cause of DRPs was the required of drug information was not available (n = 73; 77.7%), followed by drugs not in accordance with the guidelines (n = 10; 10.6%). The results of identification and causes of DRPs obtained 101 causes of DRPs in T2DM patients with macrovascular complications. Interventions that have been made by pharmacists to doctors in the form of providing information, interventions given to patients in the form of giving drug counseling and providing interventions on drugs in the form of drug replacement and drug dosage and stopping drugs. The implementation of the intervention given by the pharmacist was well received but the implementation was not known to be the highest, at 58.8%. The status of the PTO intervention by the pharmacist was unknown because patients were outpatients at 58.8%. Conclusion : Pharmacists have identified and categorized DRPs that occur in T2DM patients with macrovascular complications in the form of potential problems that are adverse drug reactions (may) occur as well as problems that have occurred namely the effect of suboptimal drug therapy, unnecessary drug therapy and symptoms or indications that are not treated.

ASSESSMENT OF THE HEALTH-RELATED QUALITY OF LIFE IN OUTPATIENTS WITH DIABETES MELLITUS AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: The prevalence of diabetes mellitus (DM) has been increasing significantly in the world as well as in Viet Nam. DM is a serious and complex chronic disease that affects the physical health of the patients and lower health-related quality of life (HRQoL). Objectives: (1) To analyze the HRQoL in DM outpatients at Hue University of Medicine and Pharmacy Hospital. (2) To evaluate the associated factorsin outpatients with DM. Materials and method: A cross-sectional descriptive study was conducted on 253 outpatients at Hue University of Medicine and Pharmacy Hospital. EuroQoL-5 dimension-5 level (EQ-5D-5L) scale was used for the assessment of HRQoL. Results: The median of the EQ-5D index was 0.85(interquartile range (IQR) = 0.28). The mean of EQ-VAS score was 64.07 (SD=16.99). Aging was associated with lower HRQoL. Unemployed participants had the lowest HRQoL index compared to workers. Higher educational levels led to higher HRQoL. Patients withDM duration of over 10 years had lower HRQoL index than the other groups. Conclusion: The median of the EQ-5D index was 0.85 (IQR = 0.28). The mean of EQ-VAS score was 64.07 (SD=16.99). The HRQoL in diabetic patients was associated with age, occupation, level of education and DM duration. Key words: EQ-5D-5L, quality of life, diabetes mellitus.

Analisis Faktor Kepatuhan Berobat Berdasarkan Skor MMAS-8 pada Pasien Diabetes Mellitus Tipe 2

&lt;p&gt;Diabetes mellitus is a chronic metabolic disease known as a deadly killer. Indonesia ranks 5th in the world in the number of people with Diabetes Mellitus in 2014. Poor medication adherence can increase microvascular and microvascular complications that cause damage to organs such as fat, heart, brain, and eyes. Patient adherence can be measured using a questionnaire 8- Morisky item Medication adherence Scale (MMAS-8). This instrument can be used to measure medication adherence in patients with chronic diseases such as hypertension, diabetes mellitus, tuberculosis, etc. This study aimed to analyze the factors associated with Medication Adherence Based On MMAS-8 Score to Type 2 Diabetes Mellitus Outpatient at Mardi Waluyo Hospital Metro in 2018. This research is an analytic observational study with a design cross-sectional study. The population of this study was type 2 DM outpatients who were treated at Mardi Waluyo Hospital Metro in 2018. The data collected were the results of research using the MMAS-8 questionnaire. Data were analyzed by using chi-square and multivariate logistic regression method. Result of this study showed that the patient who has income &amp;lt;Rp 2,100,000 risk nonadherence 2,981 times higher than a patient who has an income of ≥Rp.2,100,000. Patients with primary education risk nonadherence 2.724 times higher than patients with further education.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Real-World Data in Support of Short Sleep Duration with Poor Glycemic Control, in People with Type 2 Diabetes Mellitus.

Aims Sleep duration (SD) has been associated with metabolic outcomes. Is there an independent association between short/long SD and glycemic control (GC) in type 2 diabetes mellitus (T2DM) outpatients, compared to intermediate SD? Employing up-to-date definitions of SD, we comprehensively considered, simultaneously, all known confounding/mediating factors that recently emerged in the literature: age, gender, diet, physical activity, obesity, night pain, nocturnal diuresis, sleep quality, chronotype, sleep apnea, depressive symptoms, alcohol, caffeine, tobacco, number of endocrinologist appointments, T2DM family history, and sleep medication. Methods A cross-sectional study of 140 consecutive T2DM outpatients, ages 40-65, glycohemoglobin (HbA1c) goal ≤ 7. We searched for variables (including HbA1c) significantly associated with short (<6 hours) or long (>8 hours) SD, in comparison to intermediate SD (6-8 hours). Results Higher HbA1c levels increased the chance of belonging to the group that sleeps <6 hours (p ≤ 0.001). Better sleep quality, nocturnal diuresis, and morningness increased the chance of belonging to the group that sleeps >8 hours (p < 0.05). Conclusions There is an independent association between short SD and elevated HbA1c, in real-world T2DM outpatients. Future interventional studies could evaluate weather consistent, long-term sleep extension, from <6 hours to 7–9 hours per 24 hours, improves GC in T2DM outpatients.

Drug utilization study and adverse drug reactions of oral anti diabetics among type 2 diabetes mellitus patients in tertiary care hospital

Background: The aim was to evaluate the drug utilization pattern of oral antidiabetic drugs in type 2 diabetes mellitus outpatients and monitor adverse drug reactions (ADRs) associated with oral antidiabetic drugs.Methods: A retrospective observational study was carried out by collecting the data of type 2 diabetes mellitus patients visiting outpatient department of noncommunicable disease clinic of a tertiary care hospital for a period of one year. The data of demographic, drug utilization pattern and adverse drug reactions of patients on oral antidiabetic drugs was collected and entered in a proforma.Results: Total number of patients in this study were 39 out of which 21 (53.85%) patients were females and 18 (46.15%) patients were males. Majority of patients were in the age group 51-70 years (66.6%). Metformin was the most commonly prescribed drug 76.9% followed by Glibenclamide 17.9%. About 7.7% of patients who were taking oral antidiabetic drugs later switched over to insulin as their blood glucose levels were not controlled. Out of 18 (46.15%) patients, hypertension (38.5%) was the most common comorbid condition and a concomitant drug was prescribed was amlodipine 25.6%. Among all the adverse drug reactions observed, diarrhoea was the most common adverse drug reaction reported 76.9%.Conclusions: Metformin was the most commonly used oral antidiabetic drug. Diarrhoea was the common adverse drug reaction reported.

Okara Improved Blood Glucose Level in Vietnamese with Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) has been increasing rapidly in Vietnam. We hypothesized that the main reason may be low fiber intake. Regarding sources, fiber comes mainly from vegetables. However, vegetables popular in Vietnam have low fiber (<2 g fiber/100 g vegetable), so it is difficult to supply sufficient fiber only from vegetables. Therefore, in this study we tried to increase fiber intake a day by using 60 g of Okara foods, containing about 6 g of fiber per day, and assess the effects on the blood glucose levels of DM patients. We contacted 300 type 2 DM outpatients at a hospital and selected 60 of them. We formed 30 pairs matched by gender, age, BMI and years with DM and divided them randomly into an intervention group and a control group. The intervention group consumed about 6 g of fiber from Okara per day for 2 wk. At the baseline and final periods, anthropometric measurements, blood withdrawal and a 3-d weighing method nutrition survey were conducted. Dietary fiber intake increased from 6.9 to 12.6 g (p<0.01) in the intervention group, but there was no change in the control group. Fasting blood glucose and fructosamine in the intervention group dropped from 6.3 to 5.4 mmol/L (p<0.05) and from 319 to 301 μmol/L (p<0.05), respectively but they remained unchanged in the control group. Vietnamese people consumed about 60 g of Okara per day from various menus and increased fiber intake to 6 g/d in 2 wk, which improved blood glucose in DM patients.

Effect of Pharmaceutical Care Services Provided by Clinical Pharmacists on Type-2 Diabetes Patients

Objectives: The study aimed to provide diabetic pharmaceutical care and evaluate the effect in terms of glycaemic control and blood pressure. Methods: Randomized, interventional, controlled and comparative clinical study was conducted recruiting a total of 152 type 2 Diabetes mellitus outpatients. The control group received only common clinical care from medical staff, whereas the intervention group received additional pharmaceutical care from clinical pharmacists. Biochemical data such as blood pressure, fasting and post prandial blood sugar were collected pre and post intervention. Knowledge, Attitude and Practice (KAP) questionnaire was administered to both groups before and after intervention. Changes in outcome were measured using t-test and independent t-test. For statistical significance, P Key words: Diabetes, Pharmaceutical Care, Type 2 Diabetes, KAP, Clinical pharmacists.

Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D

ObjectivesTo present EuroQol-5D (EQ-5D) index scores in Indonesian type 2 diabetes mellitus (T2DM) outpatients and to investigate the associations between EQ-5D and socio-demographic characteristics and clinical condition.MethodsSocio-demographic data were collected by interviewing participants, clinical data were obtained from treating physicians and self-reporting. Participants originated from primary and secondary care facilities in the Java and Sulawesi regions. Ordinal regression analysis was conducted with the quintiles of the EQ-5D index scores as the dependent variable to investigate the multivariate association with the participants’ socio-demographic characteristics and clinical condition.Results907 participants completed the five-level Indonesian version of the EQ-5D. The mean age of the participants was 59.3 (SD 9.7), and 57% were female. The overall EQ-5D index score was 0.77 (0.75–0.79). Male participants had a higher EQ-5D index score compared to females, and the highest percentage of self-reported health problems was in the pain/discomfort dimension (61%). Factors identified as being significantly associated with lower EQ-5D index scores were: (i) treatment in secondary care, (ii) lower educational level, (iii) dependency on caregivers, (iv) not undergoing T2DM therapy, and (v) being a housewife.ConclusionThis study provides estimates of EQ-5D index scores that can be used in health economic evaluations. As housewives were found to experience more T2DM-related pain/discomfort and anxiety/depression, targeted approaches to reduce these problems should be aimed specifically at this group of patients. Potential approaches could involve disease-specific-counselors (health literacy partners) who provide routine monitoring of T2DM therapy as well as improved health promotion among T2DM communities.

Effect of hospital pharmacist counseling on clinical outcomes of type 2 diabetes mellitus outpatients

Objective:In Indonesia, the role of a hospital pharmacist in pharmaceutical care is still limited or even absent. This study aimed to determine whether counseling by a pharmacist could improve medication adherence, controlling the glycemic status, lipid profile, and blood pressure of type 2 diabetes mellitus (T2DM) outpatients.Methods:We conducted an interventional study at RSUD Kota Depok, a secondary public hospital, Indonesia, from April to October 2018. Counseling was given three times during the 4-month study. The study design was quasi-experimental with pretest-posttest group design on 77 respondents divided into intervention group (IGs) (n = 39 people) who received counseling and booklets from the hospital pharmacist and control group (CG) (n = 38 people) who were only given the booklets. We measured adherence with the Medication Adherence Questionnaire and conducted blood tests for fasting blood glucose (FBG), postprandial blood glucose (PPBG), glycosylated hemoglobin A1, lipid profiles (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and TG), and blood pressure measurements.Findings:In the IG, adherence parameters such as HbA1c and lipid profile improved, whereas in the CG, there were no statistically significant changes in clinical parameters and even nonadherence score increased (P = 0.008). IG showed statistically significant improvement in medication adherence, in parameters such as FBG, PPBG, and HbA1c, compared to CG. Based on the Chi-square test, IG also showed a statistically significant improvement in the number of controlled FBG (P = 0.05) and HbA1c (P < 0.001) compared to CG. In addition, a multivariate analysis showed that counseling by hospital pharmacist was 2.764 times (95% confidence interval [CI]: 1.096–6.794) and 9.964 times (95% CI: 3.434–28.917) better than no counseling in improvement of FBG and HbA1c, respectively. However, the significance disappeared after adjusted by type of medicine, duration of diabetes mellitus drug use, and medication adherence.Conclusion:Hospital pharmacist counseling is an important and significant factor in improving FBG and HbA1c levels of T2DM outpatients.

Factors Associated with Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes Mellitus in Surakarta, Central Java

Background: Peripheral neuropathy is the most common chronic complication and often occurs in diabetes mellitus. Peripheral neuropathy can cause morbidity, decreased quality of life,and mortality. This study aimed to analyze the determinants of peripheral neuropathy in patients with type 2 diabetes mellitus in Surakarta, Central Java. Subjects and Method: This study was an observational analytic with cross sectional design. This study was conducted at Surakarta Regional Hospital, Central Java on July 2019. A total of 200 type 2 diabetes mellitus outpatients was selected by simple random sampling. The dependent variable was peripheral neuropathy. The independent variables were age, education level, income, self-efficacy, diet, medication adherence, physical activity, health literacy, duration of illness, and fasting blood sugar. Peripheral neuropathy was measured using the Michigan Neu-black Screening Instrument (MNSI). Other variable data were obtained using questionnaires. Analysis of data used multiple logistic regression. Results: The risk of peripheral neuropathy increased with age of ≥55 years (b = 3.61; 95% CI = 1.51 to 5.70; p= 0.001), duration of illness ≥ 5 years (b = 2.78; 95% CI = 0.51 to 5.04; p = 0.016 ), and fasting sugar ≥110 mg / dL (b= 1.64; 95% CI= -0.01 to 3.03; p= 0.052). The risk of peripheral neuropathy decreased with education level ≥senior high school (b= -2.41; 95% CI = -4.31 to -0.51; p= 0.013), income ≥ Rp 1,800,000 (b= -1.58; 95% CI= -3.12 to -0.04; p = 0.044), high self-efficacy (b= -1.67; 95% CI= -3.26 to -0.07; p= 0.040), controlled diet (b= -1.89; 95% CI= -3.64 to -0.14; p= 0.034), high medication adherence (b= -2.34; 95% CI= -4.13 to -0.56; p= 0.010), high physical activity (b= -2.33; 95% CI= -4.17 to -0.49; p = 0.013), and high health literacy (b= -1.52; 95% CI = -3.18 to 0.14; p = 0.073). Conclusion: The risk of peripheral neuropathy increases with age of ≥55 years, duration of illness ≥ 5 years, and fasting blood sugar ≥ 110 mg/dL. The risk of peripheral neuropathy decreases with a high education level, income of ≥1,800,000, high self-efficacy, controlled diet, high medication adherence, high physical activity, and high health literacy. Keywords: peripheral neuropathy, diabetes Correspondence : Akhmad Azmiardi. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java, Indonesia. Email: aazmiardi@gmail.com.Mobile: 085245412021 Indonesian Journal of Medicine (2019), 4(4): 300-312 https://doi.org/10.26911/theijmed.2019.04.04.02

How dietary intake of type 2 diabetes mellitus outpatients affects their fasting blood glucose levels?

ObjectiveThe study aims to explore the association between the adherence to dietary recommendations among type 2 diabetes mellitus (T2DM) patients with their fasting blood glucose levels.MethodThis is a cross-sectional anthropometric and dietary study conducted on 169 T2DM patients receiving outpatient treatment at the Central Nursing and Rehabilitation Hospital in Thanh Hoa provincial hospital in Vietnam in 2018.ResultsThe rate of patients who had good fasting glycemic control was still low (30.8%). Their diets were poor in energy and unbalanced; the contribution of carbohydrates to the total dietary intake was high (68.2%), and only 24.9% of patients consumed 4–6 meals/day. There was a statistically significant association between the dietary intake with carbohydrate dietary intake containing ≥60% carbohydrate and the number of meals per day (<4 meals) with their fasting blood glucose levels (OR = 4.964, p < 0.05 and OR = 16.508; p < 0.01, respectively).Conclusions and recommendationsHospital staff are advised to combine treatment with dietary counseling to help patients controlling their weights and glycemic levels more efficient, thereby contributing to improving their treatment outcomes.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P138. Outpatient lumbar discectomy has significantly lower postoperative surgical wound infection and postoperative infection rates in tobacco use disorder and diabetes mellitus patients

BACKGROUND CONTEXT Outpatient lumbar discectomy has seen an increase in recent years. Outpatient setting is considered safe and cost effective procedure for lumbar discectomy. However, the safety of outpatient lumbar discectomyin patients who have tobacco use disorder (TUD) or Diabetes Mellitus (DM) is still not well investigated. PURPOSE The aim of this study was to compare the rates of postoperative complications after lumbar discectomy in TUD and DM patients between outpatient and inpatientsettings. STUDY DESIGN/SETTING Retrospective study using Humana database from 2007 to 2016 (PearlDiver Technologies) (Colorado Springs, CO, USA). PATIENT SAMPLE Patients who underwent lumbar discectomy at any level in outpatient and inpatient setting, from 2007 to the first quarter of 2016. Each patient group was divided based on the comorbidity (TUD or DM). OUTCOME MEASURES The presence of re-exploration within 1 year after index surgery, venous-thombotic event (VTE) within 1 year after surgery, surgical site and postoperative infection within 3 months were evaluated. The VTE was defined as deep vein thrombosis and pulmonary embolism. The postoperative infections were defined as surgical site infection, urinary tract infection, catheter related infection and sepsis-related infection. The surgical site complications were defined as wound disruption, hematoma or seroma at surgical wound and nonhealing surgical wound. METHODS The nationwide Humana private insurance database was queried using International Classification of Diseases 9th edition and Current Procedural Terminology Codes. Patients who underwent lumbar discectomy were subdivided into two groups: inpatient and outpatient setting group. Each group was further stratified by presence or absence of TUD or DM. The occurrence of re-exploration, VTE, infection and surgical wound complications were investigated. The Chi-Square test was used to compare between two setting groups in each complication, the p-value, odd-ratio (OR), and 95% Confidence Interval (95% CI) were calculated.The statistically significant difference level was set at a p-value of less than 0.05. RESULTS A total of 24,407 patients underwent lumbar discectomy procedures. Of these, 69.49% (16,961) of patients received lumbar discectomy in outpatient setting. A total of 2,630 patients had TUD and of those 70.57% (1,856) had the lumbar discectomy in the outpatient setting. Of 24,407 patients 3,511 had DM (65.45% (2,298) outpatient lumbar discectomy). In general, the outpatient setting showed significantly lower incidence of postoperative infection (p CONCLUSIONS Inpatient procedures had a higher rate of surgical-wound related complications, postoperative infections and VTE compared to the outpatient setting. At the same time, the outpatient setting had a higher rate of reoperation at the same lumbar level than inpatient setting. The rate of complications occurrence in TUD and DM outpatients and inpatient lumbar discectomy group was not different from the overall patients.