Adherence of Patients with Diabetes to a Lifestyle Advice and Management Plan in Basra, Southern Iraq

<b><i>Background:</i></b> Poor adherence to treatment regimens is a complex problem, especially for those with chronic illnesses. Noncompliance is believed to be the most common reason for treatment failure in diabetic patients, leading to the absence of metabolic control and accelerating disease-related complications. Data on the adherence of people with diabetes in Iraq are lacking. <b><i>Objectives:</i></b> The purpose of this study was to measure the rate of adherence among Iraqi patients with diabetes. <b><i>Methods:</i></b> This was a cross-sectional study conducted in the Specialized Endocrine and Diabetes Center in Basra, southern Iraq, during the period from June to August 2018. Data were collected by completing an interviewing questionnaire consisting of 13 questions. <b><i>Results:</i></b> A total of 231 patients were included in the study (54.5% were female). Mean age was 51.85 ± 13.55 years. 65.4% of the participants were taking their medications at the right times. The most common reason for not taking their medication (48.8%) was difficulty in remembering the dosage times. 40.7% of the participants were sedentary. Only one-third of the patients followed their doctors’ instructions regarding diet. <b><i>Conclusions:</i></b> The rate of adherence to medication regimens and lifestyle advice was unsatisfactory in this study group. The awareness of diabetic patients and their caring physicians about the importance of adherence to therapy, exercise, and diet should be emphasized.

Analysis of Cardiovascular Fitness, Sleep Quality, Depression, Fatigue, and Quality of Life among Individuals with Respect to the Glycated Hemoglobin Level in Type 2 Diabetes Mellitus

<b><i>Background:</i></b> Diabetes as a metabolic disorder can affect the various systems of the body, resulting in a decrease in cardiovascular fitness, sleep quality, and life quality that can lead to depression and fatigue. <b><i>Aim:</i></b> We analyzed cardiovascular fitness, sleep quality, depression, fatigue, and quality of life among individuals with a glycated hemoglobin (HBA1C) level &#x3e;6.5% and ≤6.5%, as well as the relationship among glycated hemoglobin, maximal oxygen consumption (VO₂max), obesity, sleep quality, depression, and duration of diabetes. <b><i>Method:</i></b> HBA1C (mean: 5.90 ± 0.93%) was studied in a total of 70 subjects (mean age: 62.37 ± 7.5 years). The 2 study groups were as follows: group A, HBA1C &#x3e;6.5%, and group B, HBA1C ≤6.5%. BMI, VO₂max, quality of sleep and life, depression, and fatigue were assessed in both groups. <b><i>Results:</i></b> There was a statistically significant difference between the groups at a significance level of <i>p</i> &#x3c; 0.001. Group A had a lower cardiovascular fitness, a poor sleep quality, and increased depression compared to group B. A statistically significant negative linear correlation was found between VO₂max and glycated hemoglobin, and a significant positive linear correlation was found between glycated hemoglobin and duration of diabetes, poor quality of sleep, and depression for all subjects, which was insignificant in the groups. <b><i>Conclusions:</i></b> A long duration of diabetes and an increased glycemic status may influence cardiovascular fitness, sleep quality, and life quality, leading to depression and fatigue.

A Systematic Review and Meta-Analysis of Randomised Controlled Trials, Contrasting the Safety Profile between Sodium-Glucose Cotransporter-2 Inhibitors and Placebo in Type 1 Diabetes Mellitus Patients

<b><i>Background:</i></b> This study aims to contrast the side effects of treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i) and placebo in insulin-treated adult type 1 diabetes mellitus (T1DM) patients. <b><i>Methods:</i></b> Double-blinded randomized controlled trials that compare the above outcome were searched in electronic databases. Next, the risk of bias in eligible studies was assessed, and comparable outcomes were compared by a random-effects meta-analysis. <b><i>Results:</i></b> Seven eligible papers comprising about 3,900 participants were studied. All trials suffered from an unclear risk of detection bias and performance bias. In comparison with the placebo group, the risk of genital infection (RR = 3.22, <i>p</i> &#x3c; 0.001, 95% CI 2.31–4.49, <i>I</i>² = 0%) and diabetic ketoacidosis (RR = 2.66, <i>p</i> = 0.002, 95% CI 1.45–4.89, <i>I</i>² = 0%) was higher in the SGLT2i-treated group. <b><i>Conclusion:</i></b> SGLT2i treatment increased the risk of genital infection and diabetic ketoacidosis in adult insulin-treated T1DM patients.