scholarly journals Glycemic control, medication adherence, and injection practices among diabetic patients treated in the 3 tertiary referral hospitals in Bhutan: a call for more action

2018 ◽  
Vol 12 (1) ◽  
pp. 27-33
Author(s):  
Thinley Dorji ◽  
Pempa Lhamo ◽  
Tshering Tshering ◽  
Lungten Zangmo ◽  
Kencho Choden ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Glycemic Control ◽  
Blood Sugar ◽  
Injection Technique ◽  
Diabetic Patients ◽  
Tertiary Referral ◽  
Good Glycemic Control ◽  
Adherence To Medication ◽  
Referral Hospitals ◽  
Injection Practices

AbstractBackgroundThe burden of diabetes has increased rapidly with an increasing cost of treatment.ObjectivesTo describe the glycemic control, injection practices, and treatment adherence among diabetic patients treated with insulin.MethodsThis cross-sectional study was conducted using a convenience sampling method at the 3 tertiary referral hospitals in Bhutan. Sociodemographic, injection practices, and clinical details were collected. Good glycemic control was defined as glycated hemoglobin A (HbA1c) <7% if available or fasting blood sugar 70–130 mg/dL and 2 h postprandial blood sugar <180 mg/dL if HbA1c values were unavailable. Medication adherence was assessed using the Morisky, Green and Levine (MGL) scale. The injection technique was assessed using a 10-item checklist.ResultsWe studied 207 patients. Good glycemic control was achieved by only 58 (28.0%) of patients. Using the MGL scale score, the objective adherence with insulin therapy was mostly low to medium and a gross discordance was with self-declared adherence (P < 0.001). The injection technique was fair to poor in half of the participants. Those with good injection techniques also had good adherence to medication (P = 0.025, adjusted odds ratio = 4.4, 95% confidence interval 1.2–16.4). The majority (154, 74.4%) had self-injected insulin, while the remaining were dependent on their home caregivers. Forty percent of the participants used storage practices that were not recommended. The disposal of the used insulin needles was generally unsafe.ConclusionsGlycemic control and adherence to insulin administration recommendations were poor. The injection technique needs to be improved and standardized, and methods of safe disposal of sharps need to be developed.

scholarly journals An Overview of Glycaemic Control Status among Diabetes Patients and Its Predictive Associated Factors: A Review

2019 ◽  
Vol 9 (2) ◽  
pp. 81-86
Author(s):  
Pradip Panta ◽  
Rubin Pote ◽  
Parbati Thapa ◽  
Anil Giri
Keyword(s):  
Medication Adherence ◽  
Glycemic Control ◽  
Glycaemic Control ◽  
Diabetes Management ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Good Glycemic Control ◽  
Important Indicator ◽  
Poor Glycaemic Control ◽  
Good Glycaemic Control

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).

Fructosamine: structure, analysis, and clinical usefulness.

1987 ◽  
Vol 33 (12) ◽  
pp. 2153-2163 ◽  
Author(s):  
D A Armbruster
Keyword(s):  
Glycemic Control ◽  
Blood Sugar ◽  
Glycated Hemoglobin ◽  
Sugar Concentration ◽  
Diabetic Patients ◽  
High Concentration ◽  
Good Glycemic Control ◽  
The Past ◽  
Blood Sugar Concentration ◽  
Analytical Approaches

Abstract Glucose molecules are joined to protein molecules to form stable ketoamines, or fructosamines, through glycation, a nonenzymatic mechanism involving a labile Schiff base intermediate and the Amadori rearrangement. The amount of fructosamine in serum is increased in diabetes mellitus owing to the abnormally high concentration of sugar in blood. The concentration of fructosamine in serum thus reflects the degree of glycemic control attained by the diabetic patient and is useful in monitoring the effectiveness of therapy in diabetes over a period of several weeks, in a manner analogous to the determination of glycated hemoglobin. Of the analytical approaches used to measure fructosamine, affinity chromatography with m-aminophenylboronic acid and the nitroblue tetrazolium reduction method appear to be the most practical means for clinical chemists to assay fructosamine quickly, economically, and accurately. Fructosamine values can readily distinguish normal individuals and diabetic patients in good glycemic control from diabetics in poor control. Unlike glycated hemoglobin, which reflects the average blood sugar concentration over the past six to eight weeks, fructosamine reflects the average blood sugar concentration over the past two to three weeks. Thus a clinical advantage is that fructosamine responds more quickly to changes in therapy, thereby allowing for improved glycemic control. Used in conjunction with determinations of blood sugar and (or) of glycated hemoglobin, or by itself, the fructosamine assay can provide clinically useful information for the detection and control of diabetes.

scholarly journals Pengaruh Pelayanan Kefarmasian di Rumah pada Pasien Diabetes Melitus Tipe 2 di Puskesmas Wilayah Kota Yogyakarta

2020 ◽  
Vol 10 (2) ◽  
pp. 126
Author(s):  
Nur Rasdianah ◽  
Suwaldi Martodiharjo ◽  
Tri Murti Andayani ◽  
Lukman Hakim
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Medication Adherence ◽  
Glycemic Control ◽  
Blood Sugar ◽  
Fasting Blood Sugar ◽  
Level Of Knowledge ◽  
Sugar Levels

The increasing prevalence of diabetes mellitus (DM) in Indonesia requires participation of all parties including pharmacists. This study aims to determine the impact of the implementation of home pharmacy service guidelines for patients with type 2 diabetes mellitus on the level of knowledge, medication adherence, therapeurical satisfaction and glycemic control. This study used a quasi-experimental design with one group pre-test and post-test design involving 37 patients with type 2 diabetes mellitus who met the requirements of inclusion and exclusion criterias. The Diabetes Knowledge Questionnaire (DKQ-24) and the Diabetes Medication Satisfaction Tool (DMSAT) were used for collecting the data. Patient adherence was measured using a pillcount method and fasting blood sugar levels (FSB) data were obtained from the laboratory results. The study was conducted in two community health centers and patient’s home in the Yogyakarta Municipality area. The data were analysed using Wilcoxon and Spearman test. The results showed the change of the level of knowledge, medication adherence, therapeutic satisfaction and glycemic control before and after intervention of pharmacy services at home. The average decreasing of fasting blood sugar levels 17.09 mg/dL ± 1.43

Patterns of drug therapy, glycemic control, and predictors of escalation – non-escalation of treatment among diabetes outpatients at a tertiary care center

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shubham Atal ◽  
Rajnish Joshi ◽  
Saurav Misra ◽  
Zeenat Fatima ◽  
Swati Sharma ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Medication Adherence ◽  
Glycemic Control ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Clinical Predictors ◽  
Antidiabetic Therapy ◽  
Adherence To Medication

Abstract Objectives The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM). Methods This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients’ prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed. Results A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA’s and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times. Conclusions Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored.

Should the quality of glycemic control guide dental implant therapy in patients with diabetes? Focus on implant survival

2021 ◽  
Vol 17 ◽  
Author(s):  
Dalia Nourah ◽  
Salwa Aldahlawi ◽  
Sebastiano Andreana
Keyword(s):  
Risk Factors ◽  
Glycemic Control ◽  
Dental Implant ◽  
Failure Rate ◽  
Implant Failure ◽  
Diabetic Patients ◽  
Marginal Bone Loss ◽  
Good Glycemic Control ◽  
Implant Therapy

Introduction: Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. Aim: This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less-than-optimal glycemic control. Discussion: Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well-controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. Conclusion: In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

Pre-Dialysis Glycemic Control is An Independent Predictor of Mortality Intype Ii Diabetic Patients on Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 179-183 ◽  
Author(s):  
Mai-Szu Wu ◽  
Chun-Chen Yu ◽  
Ching-Herng Wu ◽  
Jeng Yi Haung ◽  
Mei-Lin Leu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Glycemic Control ◽  
Serum Albumin ◽  
Poor Glycemic Control ◽  
Control Group ◽  
Diabetic Patients ◽  
Type Ii ◽  
Good Glycemic Control ◽  
Cholesterol Levels ◽  
Significant Difference

Objective To evaluate the impact of pre-dialysis glycemic control on clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPO). Materials and Methods One hundred and one type II diabetic patients receiving CAPO for at least 3 months were enrolled in a single institute. The patients were classified into two groups according to status of glycemic control. In the good glycemic control group, more than 50% of blood glucose determinations were within 3.3 11.0 mmol/L and glycosylated hemoglobin (HbA 1 C) levels were within 5% -10% at all times. In the poor glycemic control group, less than 50% of blood glucose determinations were within 3.3 -11.0 mmol/L, or HbA1C levels were above 10% at least 6 months before peritoneal dialysis was started. In addition to glycemic control status, pre-dialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and modes of glycemic control were also recorded. Results The patients with good glycemic control had significantly better survival than those with poor glycemic control (p < 0.01). There was no significant difference in pre-dialysis morbidity between two groups. No significant differences were observed in patient survival between patients with serum albumin above 30 g/L and those with serum albumin under 30 g/L; between those with cholesterol levels above or below 5.2 mmol/L; and between those with different peritoneal membrane solute transport characteristics as evaluated by a peritoneal equilibration test (PET). Furthermore, there was no significant difference in survival between patients who controlled blood sugar by diet and those who controlled it by insulin. Cardiovascular disease and infection are the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetic patients maintained on CAPO. Conclusions Glycemic control before starting dialysis is a predictor of survival for type II diabetic patients on CAPO. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.

scholarly journals Comparison of Effectiveness between DPP4 inhibitors combined with Versus Other Oral Hypoglycaemic Agent(s) in Diabetic patients

2019 ◽  
Vol 30 (2) ◽  
pp. 63-70
Author(s):  
Md Shameem Haidar
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Combination Group ◽  
Diabetic Patients ◽  
Glycemic Status ◽  
Good Glycemic Control ◽  
Dpp4 Inhibitor ◽  
Number Of Patients ◽  
Inhibitor Combination

Background: Diabetes is global health burden of disease that requires life-long pharmacological and non-pharmacological management to prevent complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. Treatment of type 2 diabetes is based on an interplay of patient characteristics, severity of hyperglycemia and available therapeutic options. Metformin, sulfonylureas (SU) and DPP IV inhibitor are the most studied of the oral medications used worldwide. They play a prominent initial role in the type 2 diabetes treatment algorithm recommended by the several guideline. The growing evidence on new technologies and therapeutic interventions is rapidly expanding our knowledge and ability to manage diabetes and its complications; at the same time, however, it is challenge for physicians to select appropriate medication in appropriate dose for optimal patients care. Objectives: To compare the safety and efficacy of the dipeptidylpeptidase-4 (DPP-4) inhibitors combination with other oral hypoglycaemic agent(s) in patients with type 2 diabetes and inadequate glycemic control. Materials & method: Study was conducted among 600 patients over a period of 24 months. All the patients were adult male and female type 2 diabetic patients who received regular oral anti-diabetic drug(s) and duration of T2DM for one year or more were enrolled for study. Total 150 cases were selected. Patients with Type 1 DM, pregnant women with DM and who was receiving injectable antidiabetic medications were excluded from this study. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Main outcome variable was Glycemic status (HbA1C, FBG, 2HABF). Effectiveness of drugs was evaluated by glycaemic status of the patients. Result: Maximum number of patients (38.5%) was between 31-40 years age group with mean age 37.8±9.5 years. Present study shows that, for good glycemic control, all three results (FBS, 2H ABF and HbA1c) were within targeted level in majority patients of DPP4 Inhibitor combination group. Although FBS was best result in metformin group. About 51.9% of SUs group achieved the glycemic control targets level. In case of metformin group it was in 59.8% of patients, and in combined therapy 67.1% patients shows good glycemic target. So DPP4 Inhibitor combination is better medication than other to maintain good glycemic status in type 2 DM patient, due to maximum number of patients reached all three components of result within target range. Conclusion: Diabetes is chronic illness. Good glycemic control with choosing appropriate anti-diabetic medication is pivotal for DM management. In this study it is observed that DPP4 Inhibitor combination group of drug is better than other anti-diabetic medication to maintain good glycemic status in type 2 DM patients. Bangladesh J Medicine July 2019; 30(2) : 63-70

scholarly journals Systemic association of newly diagnosed proliferative diabetic retinopathy among type 2 diabetes patients presented at a tertiary eye hospital of Nepal

2015 ◽  
Vol 7 (1) ◽  
pp. 26-32
Author(s):  
R Thapa ◽  
S Bajimaya ◽  
S Sharma ◽  
B B Rai ◽  
G Paudyal
Keyword(s):  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
Blood Sugar ◽  
Proliferative Diabetic Retinopathy ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Duration Of Diabetes ◽  
Case Series Study

Introduction: Proliferative diabetic retinopathy (PDR) is the leading cause of blindness among the diabetics. Objective: to study the systemic association of proliferative diabetic retinopathy. Materials and methods: A prospective, case-series study was conducted among the newly diagnosed proliferative diabetic retinopathy cases presenting at the Tilganga Institute of Ophthalmology (TIO) from January 2012 to January 2013. Diabetic retinopathy was classi¿ed using the Early Treatment Diabetic Retinopathy Study criteria. Blood pressure, fasting and postprandial blood sugar, glycosylated hemoglobin, lipid pro¿le, urine for microalbumin, urea, and creatinine were evaluated at the time of diagnosis.Results: A total of 104 type 2 diabetic patients with newly diagnosed PDR presented during the study period. Concurrent macular edema was present in 93 cases (89.42 %). The mean age was 56.96 ± 9.394 (range 32 - 78) years. Males and females comprised of 75.7 % and 24.3 % respectively. The majority (37.5 %) were involved in business, followed by government service (17.30 %), and housewives (16.34 %). Mean duration of diabetes was 11.42 ± 5.356 years (range 1 month - 26 years). Concurrent hypertension was found in 55.76 %, uncontrolled fasting and or postprandial blood sugar in 72.54 %, poor glycemic control (HbA1C > 7 %) in 73.97 %, abnormal lipid profile in 52.56 %, microalbuminuria in 67.85 %, and positive urine albumin in 50 % of the cases.Conclusion: Despite the short duration of diabetes, the concurrent hypertension, poor glycemic control, proteinuria and dyslipidemia were the main systemic associations for PDR at our clinical set-up. Awareness, identification and management of these systemic problems could reduce the rapid progression to PDR.

scholarly journals Nateglinide Reduces Carotid Intima-Media Thickening in Type 2 Diabetic Patients Under Good Glycemic Control

2007 ◽  
Vol 27 (11) ◽  
pp. 2456-2462 ◽  
Author(s):  
Tomoya Mita ◽  
Hirotaka Watada ◽  
Tomoaki Shimizu ◽  
Yoshifumi Tamura ◽  
Fumihiko Sato ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Good Glycemic Control ◽  
Type 2 Diabetic

scholarly journals Assessment of a glycated hemoglobin point-of-care analyzer (A1CNow+) in comparison with an immunoturbidimetric method: a diagnostic accuracy study

2015 ◽  
Vol 133 (6) ◽  
pp. 460-464 ◽  
Author(s):  
Aurélie Affret ◽  
Luiz Henrique Maciel Griz ◽  
Eduarda Ângela Pessoa Cesse ◽  
Yuri da Silva Specht ◽  
Eduardo Maia Freese de Carvalho ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Sensitivity And Specificity ◽  
Glycated Hemoglobin ◽  
Point Of Care ◽  
Venous Blood ◽  
Reference Method ◽  
University Hospital ◽  
Diabetic Patients ◽  
Good Glycemic Control ◽  
Accuracy Study

CONTEXT AND OBJECTIVE: To monitor glycemic control in diabetic patients, regular measurement of glycated hemoglobin (HbA1c) is recommended, but this can be difficult in remote places without access to laboratories. Portable point-of-care testing devices can prove a useful alternative. Our study aimed to assess the performance of one of them: A1CNow+, from Bayer. DESIGN AND SETTING: Cross-sectional accuracy study conducted at a university hospital in Brazil. METHODS: We made three successive measurements of capillary HbA1c using the A1CNow+ in 55 diabetic volunteers, while the same measurement was made on venous blood using the hospital reference method (Vitros 5,1 FS). We used the Bland-Altman graphical method to assess the A1CNow+ in relation to the Vitros 5,1 FS method. We also evaluated clinical usefulness by calculating the sensitivity and specificity of A1CNow+ for detecting patients with HbA1c lower than 7%, which is the usual limit for good glycemic control. RESULTS: The coefficient of variation between repeat testing for the A1CNow+ was 3.6%. The mean difference between A1CNow+ and Vitros 5,1 FS was +0.67% (95% confidence interval, CI: +0.52 to +0.81). The agreement limits of our Bland-Altman graph were -0.45 (95% CI: -0.71 to -0.19) and +1.82 (95% CI: +1.52 to +2.05). The sensitivity and specificity in relation to the 7% limit were respectively 100% and 67.7%. CONCLUSIONS: Although the A1CNow+ had good sensitivity, its accuracy was insufficient for use as a replacement for laboratory measurements of HbA1c, for glycemic control monitoring in diabetic patients.

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