Comparing the cost, glycaemic control and medication adherence of utilizing patients’ own medicines (POMs) versus usual dispensing among diabetic patients in an outpatient setting

Diabetes Mellitus (DM) is a rapidly leading public health problem and responsible for three quarters of morbidity and 88% of mortality affecting millions of people worldwide. Achieving good glycaemic control is an important indicator in diabetes management. Glycated hemoglobin (HBA1C i.e.≤7%) and fasting blood glucose (FBG i.e.<130mg/dl) were used to determine glycaemic control for type 2 diabetic patients. Factors associated with good glycemic control were older age, high medication adherence and better health literacy. Duration of DM>7 years was inversely related to good glycemic control and was higher in patients residence in rural areas along with hyperlipidemia, sedentary lifestyle, physical activity and oral hypoglycemic drug (OHD) as part of their T2DM therapeutic regimen. Patients on insulin and oral hypoglycemic agents, patients on insulin and low-medication adherents were more likely to have uncontrolled and poor glycaemic control while exercise contributed to glycaemic control status as a protective factor. Besides, patient’s information on glycemic control and lifestyle modification, consultation is probably infrequent due to various reasons such as patients’ economic issues, educational levels, health awareness and remote distance to health care centers, have direct impact to possess the good glycaemic control. Hence, data gotten by specialists can't exhaustively mirror patients' wellbeing status and may prompt have imperfect wellbeing choices. So, this is also the markable reason behind poor glycaemic control and has been now widely reported even though efforts have been implemented. Thus, to achieve wide-scale promotion of diabetes management, it is essential to explore knowledge of medication adherence and better health knowledge along with promoting good practices (regular exercise behavior, dietary habits and awareness of diseases).

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Medication Adherence and its Association with Glycaemic Control, Blood Pressure Control, Glycosuria and Proteinuria Among People Living With Diabetes (PLWD) in the Ho Municipality, Ghana

The Open Public Health Journal ◽

10.2174/1874944501811010552 ◽

2018 ◽

Vol 11 (1) ◽

pp. 552-561

Author(s):

James Osei-Yeboah ◽

Sylvester Yao Lokpo ◽

William K. B. A. Owiredu ◽

Beatrice Bella Johnson ◽

Verner Ndudiri Orish ◽

...

Keyword(s):

Blood Pressure ◽

Medication Adherence ◽

Glycaemic Control ◽

Fasting Blood Glucose ◽

Clinical Information ◽

Pressure Control ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Cross Sectional ◽

Adherence To Medication

Background:Adherence is the active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result. The study is aimed at assessing adherence to medication and its relation to therapeutic outcomes among people living with diabetes in the Ho Municipality.Methodology:A cross-sectional study was conducted involving 150 diabetic patients attending the diabetic clinic at the Ho Municipal Hospital. Urine glucose and urine protein were measured using a two-parameter dipstick. The current fasting blood glucose and blood pressure, as well as the measurements of two previous visits, were documented. A semi-structured questionnaire including the Diabetes Complication Checklist and the Morisky, Green and Levine Adherence Scale were used to capture biodata, clinical information and medication adherence.Results:Optimal medication adherence was 60.67%. Glycaemic control and controlled blood pressure were 33.33% and 58.67%, respectively. The prevalence of glycosuria and proteinuria was 10.67% and 3.3%, respectively. Percentage glycaemic control and controlled blood pressure were found to be higher among the medication adherent group, while glycosuria and proteinuria were the highest among participants presenting with low medication adherence.Conclusion:In this group of patients living with diabetes in the Ho Municipality, high level of uncontrolled glycaemia and blood pressure exist.However, these two treatment outcomes may be modulated by optimal medication adherence.

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Association between glycaemic control and fracture risk in diabetic patients: a nested case control study

10.1055/s-0039-1680040 ◽

2019 ◽

Author(s):

J Vavanikunnel ◽

S Charlier ◽

C Becker ◽

C Schneider ◽

SS Jick ◽

...

Keyword(s):

Glycaemic Control ◽

Fracture Risk ◽

Case Control Study ◽

Case Control ◽

Diabetic Patients ◽

Nested Case Control ◽

Control Study

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Faculty of 1000 evaluation for Perioperative glycaemic control for diabetic patients undergoing surgery.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.717958444.793466603 ◽

2012 ◽

Author(s):

Nikolaus Gravenstein

Keyword(s):

Glycaemic Control ◽

Diabetic Patients

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Proportion of type 2 diabetic patients achieving treatment goals and the survey of patient’s attitude towards insulin initiation in patients with inadequate glycaemic control with oral anti-diabetic drugs

Current Diabetes Reviews ◽

10.2174/1573399816666200611134121 ◽

2020 ◽

Vol 16 ◽

Author(s):

Shivashankara Bhat ◽

Mukta Chowta ◽

Nithyananda Chowta ◽

Rajeshwari Shastry ◽

Priyanka Kamath

Keyword(s):

Glycaemic Control ◽

Diabetic Patients ◽

Treatment Goals ◽

Insulin Initiation ◽

Type 2 Diabetic Patients ◽

Number Of Patients ◽

Patient’S Perception ◽

Hba1c Target ◽

Type 2 Diabetic

Background: Type 2 diabetic patients often require insulin therapy for better glycaemic control. However, many of these patients do not receive insulin or do not receive it in a timely manner. Objective: The study was planned to assess the proportion of type 2 diabetic patients attaining treatment goals as per the ADA 2018 guidelines. In addition, patient’s perception on insulin therapy assessed and compared between insulin naïve and insulin initiated type 2 diabetic patients. Methods: The study was conducted in type 2 diabetic patients. Data on their demographics, medical history, duration of diabetes, history of diabetes related complications, the current antidiabetic medication received, most recent glycaemic parameters were noted. Patient’s perception on insulin initiation was recorded through structured interview. Results: A total of 129 patients were included in the study. Around 76.7% patients achieved HbA1c target (<7%). Duration of the disease is much higher in patients who did not meet the HBA1c target. A good number of patients felt that insulin injection would be physically painful (56.5%). Majority of the patients also felt that insulin will make their life less flexible (64.8%). Many patients are having the opinion that insulin is required for life long (73.2%). More number of patients on insulin agreed with the statement ‘Leads to good short-term outcomes as well as long-term benefits’ compared to insulin naïve patients. Conclusion: The results highlight that the proportion of patients achieving recommended glycaemic target is not satisfactory. Many patients who are inadequately controlled with oral antidiabetic drugs were reluctant to initiate insulin.

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Methylglyoxal in diabetes: link to treatment, glycaemic control and biomarkers of complications

Biochemical Society Transactions ◽

10.1042/bst20130275 ◽

2014 ◽

Vol 42 (2) ◽

pp. 450-456 ◽

Cited By ~ 26

Author(s):

Paul J. Beisswenger

Keyword(s):

Glycaemic Control ◽

Diabetic Complications ◽

Predictive Biomarkers ◽

Complication Rates ◽

Specific Chemical ◽

End Products ◽

Carboxymethyl Lysine ◽

Genetic And Environmental Factors ◽

Novel Concept ◽

The Cost

Diabetic complications are major health problems worldwide, with the cost of caring for diabetes rising to US$245 billion in 2012 in the U.S.A. alone. It is widely recognized that non-enzymatic glycation in diabetes is a major cause of damage and dysfunction of key vascular cells. MG (methylglyoxal) is directly toxic to tissues, and is a major precursor of AGEs (advanced glycation end-products). Various propensities to diabetic complications are seen among individuals with diabetes, with accelerated rates occurring in some individuals with modest hyperglycaemia, while others never progress in spite of poor glycaemic control over many years. Since production and detoxification of MG is ultimately controlled by enzymatic mechanisms, both genetic and environmental factors could regulate tissue glycation and potentially account for these variable complication rates. Activation of pathways that determine MG levels occurs in susceptible patients, indicting an important role in pathogenesis. MG leads to formation of specific AGEs, which are likely to predict propensity to diabetic complications. We have shown recently that three specific plasma AGE biomarkers [MG-H1 (MG-derived hydroimidazolones), CEL (Nε-carboxyethyl-lysine) and CML (Nε-carboxymethyl-lysine)] predict biopsy-documented fast DN (diabetic nephropathy) progression. Since two of the predictive biomarkers are MG end-products, these outcomes support a role for MG in the development of DN. Our studies on MG and its end-products have also shown anti-complication effects of the drug metformin, which binds and inactivates MG, thus reducing MG-related AGEs. We have also shown that reducing post-meal glucose decreases MG levels, as well as levels of MG-related AGEs. Our clinical outcome studies have been based on the novel concept that the unique glycation products that we can measure reflect the activity of specific chemical pathways that are selectively activated by hyperglycaemia in patients that are inherently more susceptible to diabetic complications, and can be used to solve other diabetes-related medical questions.

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The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-02-2019-0042 ◽

2020 ◽

Vol 33 (4/5) ◽

pp. 323-331

Author(s):

Mohsen pakdaman ◽

Raheleh akbari ◽

Hamid reza Dehghan ◽

Asra Asgharzadeh ◽

Mahdieh Namayandeh

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Regular Insulin ◽

Diabetes Control ◽

Diabetic Patients ◽

Insulin Analogs ◽

Content Type ◽

Patients With Diabetes ◽

The Government ◽

The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

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Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.776 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S328-S328

Author(s):

Pushpalatha Bangalore Lingegowda ◽

Say-Tat Ooi ◽

Jyoti Somani ◽

Chelsea Law ◽

Boon Kiak Yeo

Keyword(s):

Infectious Diseases ◽

Diabetic Foot ◽

Wound Care ◽

Cost Savings ◽

Outpatient Setting ◽

Multidisciplinary Teams ◽

Diabetic Patients ◽

Wound Debridement ◽

Diabetic Foot Infections ◽

Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

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