Polypharmacy and Medication Adherence in Patients With Type 2 Diabetes

Grant, Richard W.; Devita, Nicole G; Singer, Daniel E.; Meigs, James B.

doi:10.2337/diacare.26.5.1408

Cited by 313 publications

(271 citation statements)

References 39 publications

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“…Finally, diabetes control (as measured by HBA 1c ) improved over time in the once-daily dosing group. Grant et al (2003) conducted an intervention to improve adherence to diabetic care. They used a pharmacist-delivered intervention including review of proper use of the patient's regimen of medications, identification of medication barriers, and medication discrepancy, with reports electronically forwarded to the patient's physician.…”

Section: Diabetesmentioning

confidence: 99%

“…Only two studies in this area (Grant et al 2003;Kardas 2005) used electronic monitoring to measure adherence, which is especially surprising given the availability of blood glucose meters to monitor long periods of blood glucose readings. Based on a few studies in the diabetes and adherence literature, it seems likely that one source of non-adherence is misunderstanding of regimens when multiple doses per day are required.…”

Section: Diabetesmentioning

confidence: 99%

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The impact of medication regimen factors on adherence to chronic treatment: a review of literature

2008

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This article reviews recent literature in chronic illness or long-term health management including asthma, contraception, diabetes, HIV disease, and hypertension/cardiovascular disease, mental disorders, pain, and other diseases to determine the relationship between regimen factors and adherence to medications. The authors conducted an electronic literature search to detect articles published between 1998 and 2007. Articles were included if they pertained to a chronic illness or to contraception, included a clear definition of how adherence was measured, and included regimen factors as primary or secondary explanatory variables. Methodology of the studies varied greatly, as did methods of measuring adherence and regimen factors. Surprisingly few of these articles concerned (1) chronic treatment, (2) regimen factors such as dosing, pill burden, and regimen complexity, and (3) adherence measured in a clear manner. Most studies failed to use state-of-theart methods of measuring adherence. Despite these flaws, a suggestive pattern of the importance of regimen factors, specifically dose frequency and regimen complexity, emerged from this review.

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Section: Diabetesmentioning

confidence: 99%

Section: Diabetesmentioning

confidence: 99%

The impact of medication regimen factors on adherence to chronic treatment: a review of literature

2008

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“…Providers may be inclined to overestimate the degree of medication adherence. 16 Adherence rates are diminished by complex drug regimens, incomplete explanation of benefits and side effects, lack of recognition of a patient's lifestyle, cost of medications, and communication style with patients. 17,18 Adherence to a course of therapy is more likely when a patient understands the reasons for taking a medication and is involved in the decision to prescribe.…”

Section: Decreased Adherencementioning

confidence: 99%

Polypharmacy as a Risk Factor in the Treatment of Type 2 Diabetes

Austin¹

2006

Diabetes Spectrum

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“…T herapeutic approaches to Type 2 diabetes mellitus (T2DM), which currently affects Ϸ6% of adults in the United States (US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA; 2005), are generally polypharmaceutical in nature, targeting effects on insulin sensitivity and elements of the coincident dyslipidemia and cardiovascular diseases (1). However, polypharmacy in these treatment regimens has been cited as a potential additional risk factor (2), with many patients on 4 or more concomitant medications.…”

mentioning

confidence: 99%

Scaffold-based discovery of indeglitazar, a PPAR pan-active anti-diabetic agent

Artis¹,

Lin²,

Zhang³

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

135

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In a search for more effective anti-diabetic treatment, we used a process coupling low-affinity biochemical screening with highthroughput co-crystallography in the design of a series of compounds that selectively modulate the activities of all three peroxisome proliferator-activated receptors (PPARs), PPAR␣, PPAR␥, and PPAR␦. Transcriptional transactivation assays were used to select compounds from this chemical series with a bias toward partial agonism toward PPAR␥, to circumvent the clinically observed side effects of full PPAR␥ agonists. Co-crystallographic characterization of the lead molecule, indeglitazar, in complex with each of the 3 PPARs revealed the structural basis for its PPAR pan-activity and its partial agonistic response toward PPAR␥. Compared with full PPAR␥-agonists, indeglitazar is less potent in promoting adipocyte differentiation and only partially effective in stimulating adiponectin gene expression. Evaluation of the compound in vivo confirmed the reduced adiponectin response in animal models of obesity and diabetes while revealing strong beneficial effects on glucose, triglycerides, cholesterol, body weight, and other metabolic parameters. Indeglitazar has now progressed to Phase II clinical evaluations for Type 2 diabetes mellitus (T2DM).adiponectin ͉ diabetes ͉ partial agonist ͉ PPAR pan-agonist ͉ Scaffold-based drug discovery T herapeutic approaches to Type 2 diabetes mellitus (T2DM), which currently affects Ϸ6% of adults in the United States (US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA; 2005), are generally polypharmaceutical in nature, targeting effects on insulin sensitivity and elements of the coincident dyslipidemia and cardiovascular diseases (1). However, polypharmacy in these treatment regimens has been cited as a potential additional risk factor (2), with many patients on 4 or more concomitant medications. A more effective strategy would be to use a single agent that possesses combined benefits from simultaneous inhibition or stimulation of several related targets, without the risks associated with combination therapy. However, optimizing activities against several targets is a complex design problem that necessitates judicious choice of targets and requires new ways in which therapeutic agents are generated.Two classes of marketed therapeutics, the fibrates (as lipidlowering agents) and the glitazones (as insulin-sensitizing drugs) target related receptors known as PPAR␣ and PPAR␥, respectively, whereas a third member of the subfamily, PPAR␦, has been the target of intense preclinical interest as an avenue for treatment of dyslipidemia (3). A pan-agonist, capable of stimulating the 3 peroxisome proliferator-activated receptors (PPARs) as a group, would be expected to be particularly useful in the treatment of T2DM from the standpoints of both efficacy and reduction in the additional risk factors associated with polypharmacy. Despite the close structural relationship between these 3 receptors, the search for compounds whi...

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Polypharmacy and Medication Adherence in Patients With Type 2 Diabetes

Cited by 313 publications

References 39 publications

The impact of medication regimen factors on adherence to chronic treatment: a review of literature

The impact of medication regimen factors on adherence to chronic treatment: a review of literature

Polypharmacy as a Risk Factor in the Treatment of Type 2 Diabetes

Scaffold-based discovery of indeglitazar, a PPAR pan-active anti-diabetic agent

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