Adherence to self-care practices, glycemic status and influencing factors in diabetes patients in a tertiary care hospital in Delhi

Basu, Saurav; Garg, Suneela; Sharma, Nandini; Singh, Mongjam Meghachandra; Garg, Sandeep

doi:10.4239/wjd.v9.i5.72

Cited by 44 publications

(53 citation statements)

References 28 publications

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“…Studies in low-resource settings also show a higher prevalence of suboptimal glycemic control in patients on insulin compared to those on OHA despite similar or higher levels of self-reported adherence [555657]. Such findings can arise from overreporting of insulin adherence by patients, inability of patients to procure their prescribed insulin medication (low refill adherence), or the presence of inadequate self-efficacy and minimum health literacy necessary for making correct dose adjustments.…”

Section: Improving the Assessment Of Medication Adherence: Approachesmentioning

confidence: 99%

Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings

Basu¹,

Garg²,

Sharma³

et al. 2019

Tzu Chi Med J

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Improving patient survival and quality of life in chronic diseases requires prolonged and often lifelong medication intake. Less than half of patients with chronic diseases globally are adherent to their prescribed medications which preclude the full benefit of treatment, worsens therapeutic outcomes, accelerates disease progression, and causes enormous economic losses. The accurate assessment of medication adherence is pivotal for both researchers and clinicians. Medication adherence can be assessed through both direct and indirect measures. Indirect measures include both subjective (self-report measures such as questionnaire and interview) and objective (pill count and secondary database analysis) measures and constitute the mainstay of assessing medication adherence. However, the lack of an inexpensive, ubiquitous, universal gold standard for assessment of medication adherence emphasizes the need to utilize a combination of measures to differentiate adherent and nonadherent patients. The global heterogeneity in health systems precludes the development of a universal guideline for evaluating medication adherence. Methods based on the secondary database analysis are mostly ineffectual in low-resource settings lacking electronic pharmacy and insurance databases and allowing refills without updated, valid prescriptions from private pharmacies. This significantly restricts the choices for assessing adherence until digitization of medical data takes root in much of the developing world. Nevertheless, there is ample scope for improving self-report measures of adherence. Effective interview techniques, especially accounting for suboptimal patient health literacy, validation of adherence questionnaires, and avoiding conceptual fallacies in reporting adherence can improve the assessment of medication adherence and promote understanding of its causal factors.

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Section: Improving the Assessment Of Medication Adherence: Approachesmentioning

confidence: 99%

Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings

Basu¹,

Garg²,

Sharma³

et al. 2019

Tzu Chi Med J

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“…Various previous studies reported poor glycemic control (HbA1c >7%) in the range of 67.5 to 78.2% of diabetic patients. 12,13 Poor glycemic control was found significantly associated with duration of diabetes, age of onset, family history, antidiabetic drugs, body mass index, hypertension, lipid and fasting plasma glucose levels. 12 Higher proportion of patients with poor glycemic control at baseline in our study could be because of inadequate antidiabetic medication use and associated complications.…”

Section: Discussionmentioning

confidence: 99%

A study to assess clinical profile of Indian type 2 diabetes mellitus patients treated with Teneligliptin-ASPIRE study

Chadha¹,

Dhediya

Saxena

et al. 2019

Int J Basic Clin Pharmacol

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Background: Teneligliptin is a DPP-4 inhibitor with unique chemical structure. Efficacy and safety of Teneligliptin is well established in the patients with type 2 diabetes mellitus (T2DM) in different randomized controlled trials. However, limited real-world data is available for Teneligliptin pertaining to Indian T2DM patient profile such as demographics, duration of disease, currently prescribed anti-hyperglycemic drugs, initiation of Teneligliptin as monotherapy or as an add on therapy.Methods: A cross-sectional, multicenter, non-interventional study was conducted to understand the demographics and clinical profile of Indian T2DM patients (n=5091) who were prescribed Teneligliptin.Results: Majority of patients were male (65.2%) with family history of T2DM present in 43.45% of cases. Age at onset of T2DM was 51.1±11.6 years. Among the T2DM patients, 36.2% of patients were newly diagnosed and more than half of them (54.7%) were uncontrolled with current anti-hyperglycemic drugs. Mean HbA1c level among these patients was 8.09±1.3%. Mean fasting and postprandial blood glucose levels were 170.2±46.9 mg/dl and 255.3±69.3 mg/dl respectively. Teneligliptin was prescribed as monotherapy in 2165 (41.66 %) of patients while as dual, triple and quadruple therapy in 2346 (46.08%) and 551 (10.82%) and 29 (0.56%) respectively. Among the patients on current anti-hyperglycemic treatment, most commonly prescribed drugs along with Teneligliptin were metformin (43.39%) followed by glimepiride (11%) and voglibose (3.42%).Conclusions: Teneligliptin is preferred as monotherapy and combination with metformin and sulfonylureas (mostly glimepiride) in newly diagnosed and uncontrolled T2DM patients in Indian scenario.

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“…Such health facility congestion can potentially compromise the quality of patient–provider communication that negatively influences patients' diabetes-related knowledge. [ 22 ] Moreover, nearly three in four patients reported missing more than one of their previous six scheduled appointments. In this regard, policy interventions for initiating long-duration dispensing of diabetes-related medications warrant consideration.…”

Section: Discussionmentioning

confidence: 99%

“…This is a cross-sectional analysis of the baseline data from a quasi-experimental trial, part of a larger study that reported on the behavioral aspects of diabetes self-care. [ 22 ]…”

Section: Methodsmentioning

confidence: 99%

The determinants of out-of-pocket health-care expenses for diabetes mellitus patients in India: An examination of a tertiary care government hospital in Delhi

et al. 2020

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Objective: To assess the determinants of out-of-pocket (OOP) expenses on diabetes-related treatment incurred in patients attending outpatient clinics in a tertiary care hospital in Delhi, India. Study Design: A cross-sectional analysis of baseline data from a quasi-experimental study was conducted over 8 months in 2016 in a major tertiary care hospital in Delhi. Methods: The study included 375 diabetes patients up to 65 years of age on treatment for at least a year without significant complications. Data were collected through a patient interview schedule. Results: Of the previous six scheduled appointments, at least two missed appointments were seen in 267 (71.2%) patients. The average patient's OOP expenditure on diabetes-related medicines was ₹63.5 a month, a similar amount was spent on traveling to and from health facilities. Sixty-four (17.1%) patients took antidiabetic medication for <85% of the days in the previous 3 months. Conclusion: There exists a high burden of missed clinic appointments among diabetes patients in tertiary care government health settings in India. This appears to be related to the high cost in terms of both time and money involved in attending appointments for the modest benefit of a dispensation of a 15-day drug refill. Health policy measures focused on strengthening medication coverage need to explore the balance of costs and benefits when determining the frequency of clinical appointments in these settings.

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Adherence to self-care practices, glycemic status and influencing factors in diabetes patients in a tertiary care hospital in Delhi

Cited by 44 publications

References 28 publications

Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings

Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings

A study to assess clinical profile of Indian type 2 diabetes mellitus patients treated with Teneligliptin-ASPIRE study

The determinants of out-of-pocket health-care expenses for diabetes mellitus patients in India: An examination of a tertiary care government hospital in Delhi

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