Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes

Donnelly, Louise A.; Morris, Andrew D.; Evans, Josie

doi:10.1093/qjmed/hcm031

Cited by 203 publications

(195 citation statements)

References 16 publications

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“…Esses resultados parecem indicar que quanto maior a frequência das doses, maior a adesão, divergindo da literatura (2,4,6) . No estudo que objetivou estimar a adesão medicamentosa de adultos norte-americanos com DM2 e sua relação com a quantidade de fármacos prescritos (20) , não houve associação entre a quantidade de medicamentos e a taxa de adesão.…”

Section: Adesão Ao Tratamento Medicamentosounclassified

“…No estudo que objetivou estimar a adesão medicamentosa de adultos norte-americanos com DM2 e sua relação com a quantidade de fármacos prescritos (20) , não houve associação entre a quantidade de medicamentos e a taxa de adesão. Ao contrário da presente investigação, estudos relacionados à adesão terapêutica entre pessoas com DM mostram uma correlação negativa entre a complexidade do regime medicamentoso e a adesão das pessoas, ou seja, à medida que o número de medicamentos e/ou de doses aumenta, a adesão diminui (4,6,21) . Contudo, dois estudos de revisão (4,22) sobre a adesão medicamentosa no DM, sendo um de revisão sistemática da literatura (22) , apontam que, apesar de uma única dosagem diária favorecer a adesão (4,22) , o risco de super dosagem torna-se maior devido ao esquecimento (22) .…”

Section: Adesão Ao Tratamento Medicamentosounclassified

“…À medida que o número de medicamentos e/ou de doses aumenta, a adesão diminui. A frequência das doses parece ser um fator mais importante para a não adesão do que a quantidade de diferentes fármacos a serem tomados diariamente (4,6) . Estudo transversal, realizado entre 46 adultos brasileiros com DM, em que um dos objetivos foi estimar a prevalência da adesão medicamentosa segundo fatores inerentes à pessoa, ao relacionamento profissional-paciente, ao esquema terapêutico e à doença, por meio de instrumento de autorrelato, mostrou que a prevalência da adesão foi maior (81,1%) entre as pessoas que não referiram mudanças na vida diária para o cumprimento do tratamento (5) .…”

Section: Introductionunclassified

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Adherence of people with type 2 diabetes mellitus to drug treatment

Boas¹,

Foss‐Freitas²,

Pace³

2014

Revista Brasileira De Enfermagem

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RESUMOEstudo seccional de abordagem quantitativa que objetivou avaliar a adesão ao tratamento medicamentoso entre pessoas com diabetes mellitus, e sua relação com variáveis clínicas, de tratamento e controle metabólico. A amostra constituiu-se de 162 pessoas com diabetes mellitus tipo 2 em seguimento ambulatorial. Para a coleta dos dados, foram utilizadas a Medida de Adesão aos Tratamentos e a consulta aos prontuários dos participantes. Obteve-se elevada adesão ao tratamento medicamentoso. Para um p<0,05, obteve-se correlação inversa com a pressão arterial diastólica e correlação direta com a frequência diária de administração de insulina e de antidiabéticos orais. Não houve correlações estatisticamente signifi cantes entre adesão e variáveis de controle metabólico. Os resultados divergem da literatura no que se refere à taxa de adesão ao tratamento medicamentoso em doenças crônicas, bem como na correlação entre adesão e complexidade do regime medicamentoso, o que aponta para a necessidade de mais estudos sobre essa temática. Descritores: Diabetes Mellitus; Cooperação do Paciente; Cuidados de Enfermagem. ABSTRACTThis cross-sectional and quantitative study aimed to evaluate the adherence to drug treatment of the people with diabetes mellitus and its relation to clinical, treatment and metabolic control variables. Sample consisted of 162 people with type 2 diabetes mellitus on follow-up outpatient care. The Measure of Treatment Adherence and consultation to the participants' medical records were used for data collection. A high adherence to drug treatment was obtained. For a p<0.05, it was obtained an inverse correlation with diastolic blood pressure and a direct correlation with the frequency of daily administration of insulin and oral antidiabetic agents. There were no statistically signifi cant correlations between adherence and metabolic control variables. Results diverge from the literature regarding the adherence to drug treatment in chronic diseases, as well as in the correlation between adherence and complexity of drug regimen, which points to the need for more studies on this theme. Key words: Diabetes Mellitus; Patient Compliance; Nursing Care. RESUMENEstudio transversal de enfoque cuantitativo que objetivó evaluar la adhesión al tratamiento medicamentoso de las personas con diabetes mellitus y su relación con variables clínicas, tratamiento y control metabólico. La muestra consistió en 162 personas con diabetes mellitus tipo 2 en seguimiento ambulatorio. Para recolección de datos fueron utilizadas la Medida de Adhesión a Tratamientos y consulta a los registros médicos de los participantes. Se obtuvo una alta adhesión al tratamiento medicamentoso. Para uno p<0,05, se obtuvo una correlación inversa con la presión arterial diastólica y una correlación directa con la frecuencia diaria de administración de insulina y antidiabéticos orales. No hubo correlación estadísticamente signifi cativa entre adherencia y variables de control metabólico. Resultados difi eren de la literatura en relación a la tasa de adhe...

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Section: Adesão Ao Tratamento Medicamentosounclassified

Section: Introductionunclassified

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Adherence of people with type 2 diabetes mellitus to drug treatment

Boas¹,

Foss‐Freitas²,

Pace³

2014

Revista Brasileira De Enfermagem

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“…BBT is a more complex treatment regimen requiring multiple daily injections, and was associated with an increased risk of hypoglycaemia and weight gain, which have all been shown to reduce patient adherence and quality of life 5, 16, 42, 43. Reduced patient adherence, in turn, may lead to impaired glycaemic control and extra economic burden in real‐world clinical practice (as opposed to the controlled, clinical trial setting of the DUAL VII study) 16, 18, 19. Further studies are needed to evaluate any long‐term, real‐world difference in patient adherence between IDegLira and BBT and any subsequent clinical impact that these differences may have.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the multiple daily injections required represent a more complex treatment regimen. These factors have been linked to reduced patient adherence, leading to impaired glycaemic control 5, 16, 17, 18, 19, 20, 21…”

Section: Introductionmentioning

confidence: 99%

The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): A short‐term cost‐effectiveness analysis in the UK setting

Drummond

Malkin²,

Preez

et al. 2018

Diabetes Obesity Metabolism

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AimTo evaluate the cost‐effectiveness of IDegLira versus basal‐bolus therapy (BBT) with insulin glargine U100 plus up to 4 times daily insulin aspart for the management of type 2 diabetes in the UK.MethodsA Microsoft Excel model was used to evaluate the cost‐utility of IDegLira versus BBT over a 1‐year time horizon. Clinical input data were taken from the treat‐to‐target DUAL VII trial, conducted in patients unable to achieve adequate glycaemic control (HbA1c <7.0%) with basal insulin, with IDegLira associated with lower rates of hypoglycaemia and reduced body mass index (BMI) in comparison with BBT, with similar HbA1c reductions. Costs (expressed in GBP) and event‐related disutilities were taken from published sources. Extensive sensitivity analyses were performed.ResultsIDegLira was associated with an improvement of 0.05 quality‐adjusted life years (QALYs) versus BBT, due to reductions in non‐severe hypoglycaemic episodes and BMI with IDegLira. Costs were higher with IDegLira by GBP 303 per patient, leading to an incremental cost‐effectiveness ratio (ICER) of GBP 5924 per QALY gained for IDegLira versus BBT. ICERs remained below GBP 20 000 per QALY gained across a range of sensitivity analyses.ConclusionsIDegLira is a cost‐effective alternative to BBT with insulin glargine U100 plus insulin aspart, providing equivalent glycaemic control with a simpler treatment regimen for patients with type 2 diabetes inadequately controlled on basal insulin in the UK.

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Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control

Crowley

Tarkington²,

Bosworth

et al. 2022

JAMA Intern Med

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IMPORTANCE Persistently poorly controlled type 2 diabetes (PPDM) is common and causes poor outcomes. Comprehensive telehealth interventions could help address PPDM, but effectiveness is uncertain, and barriers impede use in clinical practice.OBJECTIVE To address evidence gaps preventing use of comprehensive telehealth for PPDM by comparing a practical, comprehensive telehealth intervention to a simpler telehealth approach.DESIGN, SETTING, AND PARTICIPANTS This active-comparator, parallel-arm, randomized clinical trial was conducted in 2 Veterans Affairs health care systems. From December 2018 to January 2020, 1128 outpatients with PPDM were assessed for eligibility and 200 were randomized; PPDM was defined as maintenance of hemoglobin A 1c (HbA 1c ) level of 8.5% or higher for 1 year or longer despite engagement with clinic-based primary care and/or diabetes specialty care. Data analyses were preformed between March 2021 and May 2022.INTERVENTIONS Each 12-month intervention was nurse-delivered and used only clinical staffing/resources. The comprehensive telehealth group (n = 101) received telemonitoring, self-management support, diet/activity support, medication management, and depression support. Patients assigned to the simpler intervention (n = 99) received telemonitoring and care coordination.MAIN OUTCOMES AND MEASURES Primary (HbA 1c ) and secondary outcomes (diabetes distress, diabetes self-care, self-efficacy, body mass index, depression symptoms) were analyzed over 12 months using intent-to-treat linear mixed longitudinal models. Sensitivity analyses with multiple imputation and inclusion of clinical data examined the impact of missing HbA 1c measurements. Adverse events and intervention costs were examined. RESULTSThe population (n = 200) had a mean (SD) age of 57.8 (8.2) years; 45 (22.5%) were women, 144 (72.0%) were of Black race, and 11 (5.5%) were of Hispanic/Latinx ethnicity. From baseline to 12 months, HbA 1c change was −1.59% (10.17% to 8.58%) in the comprehensive telehealth group and −0.98% (10.17% to 9.19%) in the telemonitoring/care coordination group, for an estimated mean difference of −0.61% (95% CI, −1.12% to −0.11%; P = .02). Sensitivity analyses showed similar results. At 12 months, patients receiving comprehensive telehealth had significantly greater improvements in diabetes distress, diabetes self-care, and self-efficacy; no differences in body mass index or depression were seen. Adverse events were similar between groups. Comprehensive telehealth cost an additional $1519 per patient per year to deliver.CONCLUSIONS AND RELEVANCE This randomized clinical trial found that compared with telemonitoring/care coordination, comprehensive telehealth improved multiple outcomes in patients with PPDM at a reasonable additional cost. This study supports consideration of comprehensive telehealth implementation for PPDM in systems with appropriate infrastructure and may enhance the value of telehealth during the COVID-19 pandemic and beyond.

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Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes

Abstract: Adherence to insulin appears poor in these type 2 diabetes patients, and there was a significant relationship between adherence and long-term metabolic control.

Cited by 203 publications

References 16 publications

Adherence of people with type 2 diabetes mellitus to drug treatment

Adherence of people with type 2 diabetes mellitus to drug treatment

The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): A short‐term cost‐effectiveness analysis in the UK setting

Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control

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