Associated Factors and Pharmacists’ Role in Medication Adherence and Glycemic Control : A Study in Outpatients With Diabetes at Hue University Hospital, Vietnam

Objective: To evaluate medication adherence, associated factors, and the role of pharmacists in adherence and outcome treatments in outpatients with diabetes at Hue University Hospital. Type 2 diabetes (T2DM) is a chronic illness that requires daily treatment. Poor adherence to antidiabetic medication can have negative consequences for patients. Data on medication adherence and programs to improve adherence for patients with diabetes in Vietnam are lacking. Methods: A pre-post study was conducted on 354 outpatients diagnosed with T2DM at Hue University Hospital. Participants were interviewed, counseled, and educated by a pharmacist once. The researchers assessed medication adherence levels and glycemic outcomes before and around three months after the intervention. Results: The prevalence of achieving adherence before the intervention was 65.0%. Factors associated with achieving medication adherence were medication regimen (P = 0.001) and controlled glycemic target (P < 0.001). The most common nonadherence behavior was forgetting to take antidiabetic medication. After the intervention, the prevalence of achieving adherence rose to 74.6%, and patients reported that they were more likely to remember to take antidiabetic medications (with statistical significance). The prevalence of achieving the glycemic target (both glycated hemoglobin and fasting plasma glucose) rose from 21.8% (before the intervention) to 31.1% (after the intervention). Conclusions: A significant proportion of patients did not achieve medication adherence. Medication adherence is associated with better glycemic outcomes. The role of pharmacists in patient education, medication counseling, and reminding is beneficial in terms of improving adherence levels and glycemic outcomes.

Diabetes Type 2 in the Berlin Aging Study II: Prevalence, Incidence and Severity Over up to Ten Years of Follow-up

Aim: To describe the prevalence, incidence, and severity of diabetes mellitus type 2 (T2D) and antidiabetic medication in older people and to assess the prognostic value of diagnostic laboratory parameters.Methods: Baseline data of 1,671 participants of the Berlin Aging Study II (68.8 ±3.7 years) and follow-up data assessed 7.4 ±1.5 years later were analysed. T2D was diagnosed based on self-report, antidiabetic medication use, laboratory parameters. T2D severity was determined by the diabetes complications severity index (DCSI). Prognostic capacity of laboratory parameters was evaluated by Receiver Operating Characteristics (ROC) and Areas Under the Curve (AUCs).Results: The proportion of participants with T2D increased from 12.9% (37.3% women) at baseline to 17.1% (41.1% women) with 74 incident cases and 22.2% not being aware of the disease at follow-up. More than half of the 41 newly identified incident T2D cases were diagnosed solely by the 2h-plasma glucose test (OGTT) and diagnosis based on OGTT as the only criterion among incident cases was found more frequently in women (p=0.028). The OGTT assessed at baseline predicted incident T2D less accurate in men (AUC: 0.671, 95% CI 0.570-0.771) when compared to women (AUC: 0.7893, 95% CI 0.7036-0.8751). No sex differences were detected with respect to antidiabetic medication used and T2D severity. Conclusions: A comprehensive picture of T2D with respect to prevalence, incidence, and severity in older people is provided. Clinically relevant sex differences in the capacity of the commonly used T2D diagnostic laboratory parameters to predict incident T2D on average 7.4 years later were detected.

Characterization and analysis of the antidiabetic activities of sulphated polysaccharide extract from Caulerpa lentillifera

Caulerpa lentillifera is a type of green seaweed that is cultivated in tropical and subtropical areas. The objectives of this study were to determine the characteristics of the sulfated polysaccharides from C. lentillifera and evaluate its antidiabetic activity. In the initial process of this study, samples were macerated with ethanol (1:10). Then, the maceration residue was extracted with an accumulator at 75 °C for three hours. The crude extract yield was 4.16% based on weight seaweed. Ion chromatography purification with DEAE-Sepharose resin provided a yield of 14.8% of crude extract. The monomer analysis of C. lentillifera from the crude extract and purified extract revealed that galactose monomers were dominant and glucose was a minor component. The total carbohydrate and sulfate contents of purified C. lentillifera were higher than those of crude C. lentillifera. Bioactivity tests revealed that purified polysaccharides had higher antidiabetic activity against α-glucosidase enzyme than crude ones with IC50 values of 134.81± 2.0 µg/mL. Purified sulfated polysaccharides of C. lentillifera could potentially be used as an antidiabetic medication.

Correlates of Insulin Selection as a First-Line Pharmacological Treatment for Gestational Diabetes

Objective The aim of this study was to investigate prenatal factors associated with insulin prescription as a first-line pharmacotherapy for gestational diabetes mellitus (GDM; compared with oral antidiabetic medication) after failed medical nutrition therapy. Methods This is a retrospective cohort study of 437 women with a singleton pregnancy and diagnosis of A2GDM (GDM requiring pharmacotherapy), delivering in a university hospital between 2015 and 2019. Maternal sociodemographic and clinical characteristics, as well as GDM-related factors, including provider type that manages GDM, were compared between women who received insulin versus oral antidiabetic medication (metformin or glyburide) as the first-line pharmacotherapy using univariable and multivariable analyses. Results In univariable analysis, maternal age, race and ethnicity, insurance, chronic hypertension, gestational age at GDM diagnosis, glucose level after 50-g glucose loading test, and provider type were associated with insulin prescription. In multivariable analysis, after adjusting for sociodemographic and clinical maternal factors, GDM characteristics and provider type, Hispanic ethnicity (0.26, 95% confidence interval [CI]: 0.09–0.73), and lack of insurance (0.34, 95% CI: 0.13–0.89) remained associated with lower odds of insulin prescription, whereas endocrinology management of GDM (compared with obstetrics and gynecology [OBGYN]) (8.07, 95% CI: 3.27–19.90) remained associated with higher odds of insulin prescription. Conclusion Women of Hispanic ethnicity and women with no insurance were less likely to receive insulin and more likely to receive oral antidiabetic medication for GDM pharmacotherapy, while management by endocrinology was associated with higher odds of insulin prescription.This finding deserves more investigation to understand if differences are due to patient choice or a health disparity in the choice of pharmacologic agent for A2GDM. Key Points

Complexity of antidiabetic medication regimen is associated with increased diabetes-related distress in persons with type 2 diabetes mellitus

IntroductionDiabetes-related distress is present in a high proportion of people with type 2 diabetes mellitus. We hypothesized that complexity of the antidiabetic medication regimen is a factor that is associated with diabetes-related distress.Research design and methodsThis was a retrospective study including a group of 74 patients managed at a tertiary care center. Patients with type 1 diabetes mellitus, steroid-induced diabetes, post-transplant diabetes, and other types of diabetes were excluded. Patients were screened using the Diabetes Distress Scale-2 (DDS-2). A Diabetes Medication Complexity Scoring (DMCS) system was developed to objectively assess the diabetes medication complexity. Based on DMCS, participants were categorized into three groups: low (n=26), moderate (n=22), and high (n=26) medication complexity.ResultsComplexity groups were similar in sociodemographic characteristics, diabetes duration, body mass index, and blood pressure as well as the prevalence of hypertension, hyperlipidemia and hypoglycemic episodes. However, there were significant differences for HbA1c with higher HbA1c in the high and moderate complexity groups than in the low group (p=0.006). The microvascular complications were also more common in higher complexity groups (p=0.003). The prevalence of diabetes-related distress (DDS-2 ≥6) was 34.6% in the low, 36.4% in the moderate and 69.2% in the high complexity groups (p=0.021). There were significant differences in DDS-2 score among complexity groups (p=0.009), with higher DDS-2 score in the high complexity group compared with the moderate (p=0.008) and low complexity groups (p=0.009). The difference in DDS-2 score remained significant after adjusting for HbA1c (p=0.024) but did not reach statistical significance after controlling for both HbA1c and microvascular complications (p=0.163).ConclusionsA complex antidiabetic medication regimen may be associated with high levels of diabetes-related distress.

Effect of Long-Term Proton Pump Inhibitor Use on Glycemic Control in Patients with Type Two Diabetes Mellitus

There have been conflicting results regarding the effect of proton pump inhibitors (PPIs) as an adjunctive therapy to oral antidiabetic medication (OAM) in those with type 2 diabetes (T2DM). PPIs increase gastrin levels, causing a rise in insulin. No studies have evaluated the duration of PPI therapy and its effect on glycemic control. Medical records across 8 hospitals between 2007 and 2016 were reviewed for 14,602 patients with T2DM (not on insulin therapy) taking PPIs. Values of HbA1c (baseline, follow-up, and the difference between the two) in those prescribed with PPIs and years of therapy were compared to HbA1c values of those who had no record of PPI use. Baseline and follow-up HbA1c for patients on PPIs were 6.8 and 7.0, respectively, compared to 7.1 and 7.2 in their untreated counterparts ( p < 0.001 in both comparisons). For both groups, an increase in baseline HbA1c was seen with time. Those on PPI had an increase in HbA1c of 0.16 compared to 0.08 in those not prescribed PPI. Our results show no relationship between the length of PPI therapy and HbA1c reduction.