scholarly journals Biochemical Urine Testing of Medication Adherence and Its Association With Clinical Markers in an Outpatient Population of Type 2 Diabetes Patients: Analysis in the DIAbetes and LifEstyle Cohort Twente (DIALECT)

2021 ◽  
Author(s):  
Jelle M. Beernink ◽  
Milou M. Oosterwijk ◽  
Kamlesh Khunti ◽  
Pankaj Gupta ◽  
Prashanth Patel ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Real World ◽  
Ldl Cholesterol ◽  
Elevated Serum ◽  
Macrovascular Complications ◽  
Treatment Targets ◽  
Urine Testing ◽  
Diabetes Patients

Objective: To assess adherence to the three main drug classes in real-world patients with type 2 diabetes using biochemical urine testing and to determine the association of non-adherence with baseline demographics, treatment targets and complications. <p> </p> <p>Research Design and Methods: Analyses were performed in baseline data of 457 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Adherence to OADs (oral antidiabetics), antihypertensives and statins was determined by analyzing baseline urine samples using LC-MS/MS. Primary outcomes were micro/macrovascular complications and treatment targets of LDL-cholesterol, HbA1c and blood pressure. These were all assessed cross-sectionally at baseline.</p> <p> </p> <p>Results: Overall, 89.3% of the patients were identified as being adherent. Adherence rates to OADs, antihypertensives and statins were 95.7%, 92.0%, and 95.5%, respectively. The prevalence of microvascular (81.6% vs 66.2%, p = 0.029) and macrovascular complications (55.1% versus 37.0%, p = 0.014) was significantly higher in non-adherent patients. The percentage of patients who reached an LDL-cholesterol target of £2.5 mmol/L was lower (67.4% versus 81.1%, p = 0.029) in non-adherent patients. Binary logistic regression indicated that a higher BMI, current smoking, elevated serum LDL-cholesterol, high HbA1c, the presence of diabetic kidney disease and the presence of macrovascular disease were associated with non-adherence.</p> <p> </p> Conclusion: Despite medication adherence of real-world type 2 diabetes patients managed in specialist care was relatively high, the prevalence of microvascular and macrovascular complications was significantly higher in non-adherent patients and treatment targets were reached less frequently. This emphasizes the importance of objective detection and tailored interventions to improve non-adherence.

scholarly journals Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Boon-How Chew ◽  
Husni Hussain ◽  
Ziti Akthar Supian
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Ldl Cholesterol ◽  
Therapeutic Inertia ◽  
Treatment Targets ◽  
Health Clinics

Abstract Background Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia. Methods The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61–72%), anti-hypertensive (34–65%) and lipid-lowering therapies (56–77%), and lesser in insulin (34–52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions Although therapeutic intensifications were more likely in the presence of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but might be more of patient-related non-adherence or non-availability of the oral medications. These observations require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences. Trial registration Number NCT02730754, April 6, 2016.

scholarly journals Effect of Diabetes Treatment-Related Attributes on Costs to Type 2 Diabetes Patients in a Real-World Population

2017 ◽  
Vol 23 (4) ◽  
pp. 446-452 ◽  
Author(s):  
Jie Meng ◽  
Roman Casciano ◽  
Yi-Chien Lee ◽  
Lee Stern ◽  
Dmitry Gultyaev ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
World Population ◽  
Diabetes Treatment ◽  
Diabetes Patients

scholarly journals The incremental costs of recommended therapy versus real world therapy in type 2 diabetes patients

2006 ◽  
Vol 22 (11) ◽  
pp. 2301-2311 ◽  
Author(s):  
C. Crivera ◽  
D. C. Suh ◽  
E. S. Huang ◽  
E. Cagliero ◽  
R. W. Grant ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Recommended Therapy ◽  
Diabetes Patients

scholarly journals Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

2020 ◽  
Author(s):  
Kai-Cheng Chang ◽  
Shih-Chieh Shao ◽  
Shihchen Kuo ◽  
Chen-Yi Yang ◽  
Hui-Yu Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Real World ◽  
Comparative Effectiveness ◽  
Blood Pressure Reduction ◽  
Renal Functions ◽  
Diabetes Patients

Abstract Background Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. Methods We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016-2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every three months in the one-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. Results A total of 1,512 subjects receiving dulaglutide and 1,513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: -1.06%, p<0.001; liraglutide: -0.83%, p<0.001), with a significant between-group difference (-0.23%, 95% confidence interval: -0.38 to -0.08%, p<0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: -1.14 kg, -3.08 U/L and -2.08 ml/min/1.73 m2, p<0.01; liraglutide: -1.64 kg, -3.65 U/L and -2.33 ml/min/1.73 m2, p<0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (-2.47 mmHg, p<0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. Conclusions In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.

scholarly journals The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Type 2 Diabetes Patients (TROPHIES): Baseline Patient-Reported Outcomes

2020 ◽  
Vol 11 (10) ◽  
pp. 2383-2399
Author(s):  
Kristina S. Boye ◽  
Hélène Sapin ◽  
Luis-Emilio García-Pérez ◽  
Myriam Rosilio ◽  
Marco Orsini Federici ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Outcomes ◽  
Prospective Study ◽  
Real World ◽  
Patient Reported Outcomes ◽  
The Real ◽  
Observational Prospective Study ◽  
Patient Reported ◽  
Diabetes Patients

scholarly journals Reduced Hypoglycemia Risk in Type 2 Diabetes Patients Switched to/Initiating Insulin Glargine 300 vs 100 U/ml: A European Real-World Study

2020 ◽  
Vol 37 (9) ◽  
pp. 3863-3877
Author(s):  
Javier Escalada ◽  
Fabrice Bonnet ◽  
Jasmanda Wu ◽  
Mireille Bonnemaire ◽  
Shaloo Gupta ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Glargine ◽  
Real World ◽  
Diabetes Patients
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