scholarly journals Medication Adherence to Oral Hypoglycemic Agents Among Type II Diabetic Patients and Their Clinical Outcomes with Special Reference to Fasting Blood Glucose and Glycosylated Hemoglobin Levels

2015 ◽  
Vol 11 (3) ◽  
pp. 226-232 ◽  
Author(s):  
SS Shrestha ◽  
R Shakya ◽  
BM Karmacharya ◽  
P Thapa
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Special Reference ◽  
Clinical Outcomes ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Age Group ◽  
Oral Hypoglycemic Agents

Background Oral hypoglycemic agents (OHAs) are the major treatment for people with type 2 diabetes mellitus (DM2). However, non-adherence to OHAs remains as one of the main reasons for poor glycemic control. Objectives To assess the adherence pattern to OHAs and clinical outcomes with special reference to fasting blood glucose (FBG) level and glycosylated hemoglobin (HbA1c) levels. Methods Informed consent was obtained from patients fulfilling the criteria and from the patient party in case of incapacitated patients. Information was obtained by interviewing them and filled in the appropriate questionnaire. All the medical information of the patients was obtained from the medical case records and laboratory reports. Results OHAs had been discontinued by 25% of patients. Overall 38% had ever discontinued and/ or often missed OHAs. Intentional discontinuation of OHAs attributed for 72% of the patients, followed by forgetfulness (42.9%), carelessness (30.6%), and hypoglycemia, (24%). There were 50.50% patients who had uncontrolled FBG (>130 mg/dl) level and 39% had uncontrolled HbA1c (≥ 7%) level. Taking reference age group 51-60 years, control of FBG level was found to be statistically associated with the decreasing age group (p = 0.006, OR = 4.8) as well as increasing age group (p = 0.008, OR = 4.034). There was significant association between controlled HbA1c level and patients’ knowledge about the precautions to be taken while using OHAs (p = 0.044, OR = 4). However, there was no significant association between glycemic control and OHAs adherence. Conclusion Majority of the patients who had missed OHAs attributed it to forgetfulness. Hypoglycemia may also be one of the contributing factors for poor adherence to OHAs. However no association was found between adherence and various other factors like age groups, treatment complexity, health literacy and social or family support. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12508 Kathmandu Univ Med J 2013; 43(3):226-232

scholarly journals Safety test of a supplement, 5-aminolevulinic acid phosphate with sodium ferrous citrate, in diabetic patients treated with oral hypoglycemic agents

2014 ◽  
Vol 4 (9) ◽  
pp. 415 ◽  
Author(s):  
Naohide Yamashita ◽  
Atai Watanabe ◽  
Hikaru Kondo ◽  
Satofumi Kawata ◽  
Tohru Tanaka ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Adverse Events ◽  
Hemoglobin A1c ◽  
Aminolevulinic Acid ◽  
Fasting Blood Glucose ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Oral Hypoglycemic Agents ◽  
Acid Phosphate ◽  
Ferrous Citrate

Objective: This study aimed to examine the safety of 5-aminolevulinic acid phosphate (5-ALA) with sodium ferrous citrate (SFC) in diabetic patients treated with one or more oral hypoglycemic agents (OHAs).Background: Recent intervention studies performed in the USA and Japan have shown that a nutritional supplement of 5-ALA with SFC efficiently reduced blood glucose levels in pre-diabetic population without any adverse events. Thus, it was anticipated that 5-ALA with SFC may potentially be taken as a beneficial supplement by diabetic patients who were being treated with OHA therapy. Nevertheless, it is important to examine its safety and efficacy in diabetic population.Methods: This study was a prospective single-blinded, randomized, placebo-controlled and parallel-group comparison study. Medically treated diabetic patients between the ages of 30 and 75 were recruited from the Tokyo metropolitan area of Japan and 45 subjects were selected after screening. These subjects were randomly assigned to three groups: daily intake of 15mg 5-ALA, 50mg 5-ALA, and a placebo (n=15, respectively). The supplement or placebo was administered for 12 weeks followed by a four week washout period. The primary endpoint was safety and  occurrence of hypoglycemic attack, while the secondary endpoint was changes of fasting blood glucose (FBG) and hemoglobin A1c (HbA1c). Results: Adverse events related to 5-ALA with SFC were not observed in all the groups. Abnormalities in blood and urine tests were not observed either. Significant decrease in FBG was not detected in all the groups. However, there was a small but significant decrease in HbA1c at 4 and 8 week in the 15 mg 5-ALA group. Significant decrease in HbA1c was not observed in the 50 mg 5-ALA group, although a tendency to decrease after 4 weeks was apparent.Conclusion: 5-ALA with SFC is a safe and potentially beneficial supplement if taken by diabetic patients treated with OHAs.Trial registration: UMIN 000008038Key words: type 2 diabetes, 5-aminolevulinic acid (5-ALA), sodium ferrous citrate (SFC), oral hypoglycemic agent (OHA), hemoglobin A1c (HbA1c), fasting blood glucose (FBG)

Characteristics of monitored diabetic patients by glycated haemoglobin (HbA1c)

2016 ◽  
Vol 5 (05) ◽  
pp. 4563
Author(s):  
Tariq A. Zafar
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Glycated Haemoglobin ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Age Group ◽  
Hba1c Test ◽  
Significant Difference ◽  
Tract Infections ◽  
The Impact

Glycated haemoglobin (HbA1c) test indicates the blood glucose levels for the previous two to three months. Using HbA1c test may overcome many of the practical issues and prevent infections such as urinary tract infections (UTIs). The study aimed to evaluate the impact of glycemic control using HbA1c test to understand patient characteristics and UTIs prevalence. Glycemic control was evaluated by measuring HbA1c for a total of 208 diabetes patients who were regularly attending diabetes center in Al-Noor specialist hospital in Makkah.  The results showed that good and moderate glycemic controlled patients were 14.9% and 16.9% respectively while the poor glycemic patients were 68.3%. Among the good improved glycemic control, 83.9% were females, 48.4% were from age group (15-44y). Among the moderately improved glycemic control, 68.4% were females, 54.3% were from age group (45-64 y) with no significant difference. The total number of the patients with positive UTIs was 55 (26.4%) while the total number of patients with negative was UTIs 153 (73.6%). Among the positive UTIs, 76.3% were with poor glycemic control while only 12.3% and 11% were moderate and good improved glycemic control respectively. Among the negative UTIs, 65.3% were with poor glycemic control while only 19% and 15.7% were with moderate and good improved glycemic control respectively.  Prevalence of UTIs among diabetic patients was not significant (p > 0.05). It was concluded that HbA1c was useful monitoring tool for diabetes mellitus and may lead to improved outcomes. Using a HbA1c test may overcome many of the practical issues that affect the blood glucose tests.

scholarly journals COMPARATIVE STUDY OF ORAL HYPOGLYCEMIC AGENTS IN TYPE-2 DIABETES OBESE PATIENTS

2018 ◽  
Vol 11 (6) ◽  
pp. 505
Author(s):  
Venkateswarlu Konuru ◽  
Ram Mohan Reedy T
Keyword(s):  
Blood Sugar ◽  
Adverse Drug Reactions ◽  
Glycosylated Hemoglobin ◽  
Dipeptidyl Peptidase ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Drug Reactions ◽  
Oral Hypoglycemic Agents ◽  
Peptidase Inhibitors

  Objectives: The aim of this study was to evaluate safety and efficacy of oral hypoglycemic agents in obese Type-2 diabetic patients. The objectives are to compare fasting and postprandial blood sugar (PPBS) levels, to compare body mass index (BMI) in all the groups, and to identify glycosylated hemoglobin levels and adverse drug reactions (if present) in all the groups.Method: This is a prospective observational study conducted in care diabetic center over a period of 1 year. All the patients those are receiving only oral hypoglycemic agents continuously over a period of 3 months and BMI ≥30 were enrolled. The patients receiving insulin were excluded. Patients were followed over a period of 3 months and were reviewed on visit basis (every 30 days). All the necessary information was collected into the data collection form that includes demographic details (age, gender, etc.), past medication history, current treatment charts, and their relevant laboratory reports (fasting blood sugar levels [mg/dl], PPBS levels [mg/dl], glycosylated hemoglobin A1c [HbA1c] (%), and BMI [kg/m2]).  Results: A total of 395 patients were recruited into the study and the drugs received by the population were found to be metformin+sulfonylureas (33%), metformin+pioglitazone (26%), and metformin+dipeptidyl peptidase inhibitors (DPI) (23%). A significant reduction in HbA1c was seen in all groups of patients. Adverse drug reactions observed were hypoglycemia, pedal edema, and itching distributed to drugs metformin+DPI, respectively. A significant reduction in BMI was seen in patients receiving DPI and BMI was found to be increased in other groups of patients.Conclusion: Overall, three classes of drugs were found to have similar efficacy. Sulfonylureas were commonly associated with hypoglycemia when compared to other drugs and weight reduction observed in dipeptidyl peptidase inhibitors.

scholarly journals Utilizing Technology-Enabled Intervention to Improve Blood Glucose Self-Management Outcome in Type 2 Diabetic Patients Initiated on Insulin Therapy: A Retrospective Real-World Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jian Lin ◽  
Xia Li ◽  
Shan Jiang ◽  
Xiao Ma ◽  
Yuxin Yang ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Fasting Blood Glucose ◽  
Blood Glucose Control ◽  
Diabetic Patients ◽  
Premixed Insulin ◽  
Type 2 Diabetic Patients ◽  
Self Monitoring

Background. The aim of this study was to assess the benefits of a mobile-enabled app through Lilly Connected Care Program (LCCP) in achieving blood glucose control and adhering to self-monitoring of blood glucose in patients with type 2 diabetes mellitus (T2DM). Methods. This retrospective study included T2DM patients who were initiated on insulin therapy (mostly premixed insulin) after failure to respond to oral antidiabetic drugs. Patients were provided with glucometers enabled with synchronous data transmission to healthcare providers and family members. The primary objective was to assess the benefits of LCCP based on changes in fasting blood glucose (FBG) and postprandial glucose (PPG) levels from baseline to 12 weeks. Paired t-test was used to assess the change in blood glucose (BG) from baseline to week 12. Results. In total, 14,085 T2DM patients were recruited. Compared with baseline, significant reductions in FBG and PPG were evident at week 12 (FBG: -0.39 mmol/L; PPG: −0.79 mmol/L; both P < 0.001 ). Furthermore, at week 12, the proportion of patients attaining a target glucose level of FBG <7.0 mmol/L and PPG <10.0 mmol/L was 25.37% and 59.68%, respectively, with a statistically significant increase compared with that at baseline (6.74% and 45.59%, respectively, both P < 0.001 ). The frequent monitoring of patients could gain a higher target achievement of FBG (28.1% vs 24.2%) and PPG (64.4% vs 55.1%) than the occasional monitoring patients. Additionally, the incidence of hypoglycemia gradually decreased and was significantly lower than the baseline level. Conclusions. In T2DM patients with poor glycemic control, the application of mobile enabled intervention (LCCP) along with insulin significantly reduced the hypoglycemia while improving glycemic control during period of naïve initiating insulin therapy. Additionally, the high frequency of BG self-monitoring was associated with better glycemic control.

scholarly journals Once Daily Self-Monitoring of Blood Glucose (SMBG) Improves Glycemic Control in Oral Hypoglycemic Agents (OHA)–Treated Diabetes

2015 ◽  
Vol 10 (2) ◽  
pp. 378-382 ◽  
Author(s):  
Shin-ichi Harashima ◽  
Akiko Nishimura ◽  
Kaori Ikeda ◽  
Yu Wang ◽  
Yanyan Liu ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Self Monitoring ◽  
Once Daily

Management of Patients with Type 2 Diabetes by Pharmacists in Primary Care Clinics

1998 ◽  
Vol 32 (6) ◽  
pp. 636-641 ◽  
Author(s):  
Elizabeth A Coast-Senior ◽  
Beverly A Kroner ◽  
Catherine L Kelley ◽  
Lauren E Trilli
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Face To Face ◽  
Primary Care Clinics ◽  
Blood Glucose Concentrations

OBJECTIVE: To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus. DESIGN: Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose. The pharmacists provided diabetes education, medication counseling, monitoring, and insulin initiation and/or adjustments. All initial patient interactions with the pharmacists were face-to-face. Thereafter, patient–pharmacist interactions were either face-to-face or telephone contacts. SETTING: Two primary care clinics in a university-affiliated Veterans Affairs Medical Center. PARTICIPANTS: Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control. OUTCOME MEASURES: Primary outcome variables were changes from baseline in glycosylated hemoglobin, fasting blood glucose, and random blood glucose measurements. Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia, and the number of emergency room visits or hospitalizations related to diabetes. Twenty-three veterans aged 65 ± 9.4 years completed the study. Fifteen (65%) patients were initiated on insulin by the pharmacists; 8 (35%) were already using insulin. Patients were followed for a mean ± SD of 27 ± 10 weeks. Glycosylated hemoglobin, fasting blood glucose concentrations, and random blood glucose concentrations significantly decreased from baseline by 2.2% (p = 0.00004), 65 mg/dL (p < 0.01), and 82 mg/dL (p = 0.00001), respectively. Symptomatic hypoglycemic episodes occurred in 35% of patients. None of these episodes required physician intervention. CONCLUSIONS: This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin.

The Insulin Regimen That Works

2018 ◽  
Vol 11 (2) ◽  
pp. 165-168
Author(s):  
Svitlana Crawley ◽  
Susan Chaney
Keyword(s):  
Blood Glucose ◽  
Insulin Therapy ◽  
Nurse Practitioners ◽  
Basal Insulin ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Insulin Regimen ◽  
Acting Insulin ◽  
Antihyperglycemic Therapy

Background: Type 2 diabetes mellitus requires monitoring patients’ glycemic control. Treatment must be escalated if glucose levels remain above the recommended goal in patients who are adherent to their current treatment. If glycosylated hemoglobin (HbA1c) levels remain unmet with maximum doses as recommended by the American Diabetes Association (ADA) after adding basal insulin, but fasting blood glucose is at goal, one to three injections daily of rapid-acting insulin are typically added to the treatment plan to be injected prior to meals while continuing all other antihyperglycemic medications. Objective: To describe an effective method of intensifying insulin therapy based on patients’ needs and abilities to self-manage their medications. Methods: We retrospectively reviewed the case of a patient who was referred to the Endocrinology Specialty Clinic for diabetes management. Results: Diabetes control was improved after intensifying insulin therapy by adding once-daily rapid-acting insulin injections. Conclusions: Intensifying insulin therapy by adding one dose of rapid-acting insulin prior to meals can improve HbA1c to < 7% in patients on maximum doses of basal insulin whose fasting blood glucose is at goal but whose HbA1c is above goal. Implications for Nursing: Nurse practitioners must use current care guidelines supported by evidence-based literature to improve patients’ outcomes. This case study supports ADA recommendations on early intensification of antihyperglycemic therapy in diabetic patients to decrease the risk of complications by achieving and maintaining HbA1c goals early.

scholarly journals The Relation between Diabetes-Related Distress and Glycemic Control

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Hamed ◽  
N A Ibrahim ◽  
H M Ali ◽  
C G Kheir
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Significant Relationship ◽  
Positive Relationship ◽  
Fasting Blood Glucose ◽  
Diabetes Distress ◽  
Diabetic Patients ◽  
Significant Relation ◽  
Emotional Burden ◽  
Significant Positive Relationship

Abstract Background Diabetes Distress is the understandable sense of burden or defeat that may occasionally punctuate the diabetic patient life. Also, Diabetes distress (DD) refers to the unique, often hidden emotional burdens and worries that are part of the spectrum of patient experience when man-aging a severe demanding chronic disease like diabetes. Objectives is to assess the relationship between Diabetes-related distress (using a Diabetes Distress Screening Scale) and the glycemic control (using A1C) and inflammation (using hs-CRP) in diabetic patients. Patients and Methods This study is a cross sectional study which had been carried out in outpatient clinic of endocrinology department of El Agouza Police Hospital during the period between June 2017 to June 2018.The study was done on 350 Type2 Diabetic patients.BMI,Wist/Hip Ratio, Fasting blood glucose,Post prandial blood glucose,HbA1c,hs-CRP,Creatinin,BUN,SGPT and SGPT were done to the patients, also Diabetes Distress Screening Scale Quastionnaire was completed by the patients. Results In this study we found that there is a highly significant positive relationship between HbA1c and both Fasting Blood Glucose and Post Prandial Blood Glucose. Also,there was a highly significant positive relationship between CRP and Fasting Blood Glucose while there was a non significant relationship between CRP and Post Prandial Blood Glucose.Fasting blood glucose and Post Prandial Blood Glucose showed a highly significant positive relationship with Total DDS score, Emotional burden and Physician realted distress, and showed non significant relationship with Regimen related distress and interpersonal distress.As regard the relation between HbA1c and Total DDS score, there was a highly significant positive relationship between them and also highly significant positive relationship between HbA1c and Emotional burden and physician related distress, but there was non significant relation between HbA1c and Regimen related distress and interpersonal distress. There was highly significant positive relationship between CRP and Total DDS score and also emotional burden, and there was significant positive relationship between CRP and Regimen related distress, and non significant relation between CRP and physician related distress and interpersonal distress. Conclusion In this study 350 type 2 diabetic patients were included. 55 diabetic patients show moderate distress with a highly significant relationship with the glycemic control (HbA1c) and significant relationship with CRP. In this age and sex were non significant factors while duration of diabetes, BMI and Wist-hip ratio show significant relation with HbA1c which reflect the glycemic control.

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