Patterns of Adherence to Oral Hypoglycemic Agents: Patterns, Correlates, and Outcomes

Despite the development of effective pharmacological therapy to prevent both macrovascular and microvascular complications and adverse events, diabetes control remains sub-optimal. Poor adherence to recommended regimens is a causal factor in preventable morbidity and mortality in diabetic patients. Sub-groups of patients with differing longitudinal profiles of adherence may yield differing treatment outcomes. Identifying characteristics associated with longitudinal profiles can potentially alert clinicians to patients at risk for poor clinical outcomes allowing for early intervention and follow-up. Furthermore, few studies have examined the role of adherence improvements as a mediator of intervention effect on glycemic control. In this work we sought to identify patterns, correlates and outcomes of adherence to oral hypoglycemic agents. We also assessed whether adherence improvements mediated a brief interventions effect on glycemic control. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Adherence was assessed using the Medication Event Monitoring System. Hemoglobin A1c assays were used to measure glycemic control as the clinical outcome. Individual patient residential data was geo-coded at the tract level. Three patterns of adherence to oral hypoglycemic agents were identified: adherent, increasing adherence, and nonadherent. Both individual and neighborhood level factors were identified that were associated with patterns of adherence. Patients with an increasing adherence pattern were more likely to have a Hemoglobin A1c (HbA1c) \u3c 7% (adjusted odds ratio = 14.52, 95% CI [2.54, 82.99]) at 12 weeks in comparison with patients with the nonadherent pattern. Across the whole sample, longitudinal adherence profiles mediated 35.2 % (13.2, 81.0 %) of the effect of a brief adherence intervention on glycemic control [from odds ratio (OR) = 8.48, 95 % confidence interval (CI) (3.24, 22.2) to 4.00, 95 % CI (1.34, 11.93)]. These findings imply that the identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions

A Brief Adherence Intervention that Improved Glycemic Control: Mediation by Patterns of Adherence

This study examined whether longitudinal adherence profiles mediated the relationship between a brief adherence intervention and glycemic control among patients with type 2 diabetes. Adherence was assessed using the Medication Event Monitoring System. Longitudinal analysis via growth curve mixture modeling was carried out to classify patients according to patterns of adherence to oral hypoglycemic agents. Hemoglobin A1c assays were used to measure glycemic control as the clinical outcome. Across the whole sample, longitudinal adherence profiles mediated 35.2% (13.2, 81.0%) of the effect of a brief adherence intervention on glycemic control [from odds ratio (OR) = 8.48, 95% confidence interval (CI) (3.24, 22.2) to 4.00, 95% CI (1.34, 11.93)]. Our results suggest that patients in the intervention had better glycemic control largely due to their greater likelihood of adherence to oral hypoglycemic agents

Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

Researchers sought to examine whether there are patterns of oral hypoglycemic-agent adherence among primary-care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p \u3c .05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c) \u3c 7%; adjusted odds ratio = 14.52, 95% CI (2.54, 82.99) at 12 weeks, in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions

Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

Researchers sought to examine whether there are patterns of oral hypoglycemic-agent adherence among primary-care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p \u3c .05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c) \u3c 7%; adjusted odds ratio = 14.52, 95% CI (2.54, 82.99) at 12 weeks, in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions

Neighborhood Social Environment and Patterns of Adherence to Oral Hypoglycemic Agents among Patients with Type 2 Diabetes Mellitus

This study examined whether neighborhood social environment was related to patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus. Residents in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage, compared to residents in neighborhoods with one or no high features present, were significantly more likely to have an adherent pattern compared to a nonadherent pattern. Neighborhood social environment may influence patterns of adherence. Reliance on a multilevel contextual framework, extending beyond the individual, to promote diabetic self-management activities may be essential for notable public health improvements

Effects of gain—loss frames on satisfaction with self–other outcome-differences

This research concerned satisfaction with outcome-differences (advantageous inequity, equity, or disadvantageous inequity) as a function of the individual's gain or loss frame, other's gain or loss frame, the cooperative or noncooperative nature of the relationship, and their interactions. After reading a scenario, subjects rated on a satisfaction-dissatisfaction soak a series of outcome-pairs providing themselves and another party with outcomes. Consistent with Equity Theory, results showed that gain framed individuals found equity more pleasing than advantageous inequity, which in turn was preferred over disadvantageous inequity, but only when the decision making context was cooperative rather than noncooperative. In a noncooperative context, gain framed individuals were as pleased with equity as with advantageous inequity. Contrary to Equity Theory, but consistent with Prospect Theory, loss framed individuals were relatively insensitive to outcome-differences and the nature of the relationship. Results finally suggested that advantageous inequity was preferred less when the other party had a loss rather than gain frame, albeit only under cooperative circumstances

In vivo inhibition of angiogenesis by interleukin-13 gene therapy in a rat model of rheumatoid arthritis

Objective Interleukin-13 (IL-13) is a pleiotropic cytokine that can affect vessel formation, an important component of the rheumatoid arthritis (RA) synovial tissue pannus. The purpose of this study was to use a gene therapy approach to investigate the role of IL-13 in angiogenesis in vivo, using a rat adjuvant-induced arthritis model of RA. Methods Ankle joints of female rats were injected preventatively with an adenovirus vector containing human IL-13 (AxCAIL-13), a control vector with no insert (AxCANI), or phosphate buffered saline (PBS). Joints were harvested at the peak of arthritis, and histologic and biochemical features were evaluated. Results AxCAIL-13–treated joint homogenates had lower hemoglobin levels, suggesting reduced joint vascularity, and both endothelial cell migration and tube formation were significantly inhibited ( P < 0.05). Similarly, AxCAIL-13 inhibited capillary sprouting in the rat aortic ring assay and vessel growth in the Matrigel plug in vivo assay. IL-13 gene delivery resulted in up-regulation and association of phosphorylated ERK-1/2 and protein kinase CΑ/ΒII, suggesting a novel pathway in IL-13–mediated angiostasis. The angiostatic effect of AxCAIL-13 was associated with down-regulation of proangiogenic cytokines (IL-18, cytokine-induced neutrophil chemoattractant 1/CXCL1, lipopolysaccharide-induced CXC chemokine/CXCL5) and up-regulation of the angiogenesis inhibitor endostatin. The expression and activity of matrix metalloproteinases 2 and 9, which participate in angiogenesis, was impaired in response to IL-13 as compared with AxCANI and PBS treatment. Conclusion Our findings support a role for IL-13 as an in vivo antiangiogenic factor and provide a rationale for its use in RA to control pathologic neovascularization.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56107/1/22823_ftp.pd

Is the left-right scale a valid measure of ideology? Individual-level variation in associations with "left" and "right" and left-right self-placement

In order to measure ideology, political scientists heavily rely on the so-called left-right scale. Left and right are, however, abstract political concepts and may trigger different associations among respondents. If these associations vary systematically with other variables this may induce bias in the empirical study of ideology. We illustrate this problem using a unique survey that asked respondents open-ended questions regarding the meanings they attribute to the concepts "left" and "right". We assess and categorize this textual data using topic modeling techniques. Our analysis shows that variation in respondents’ associations is systematically related to their self-placement on the left-right scale and also to variables such as education and respondents’ cultural background (East vs. West Germany). Our findings indicate that the interpersonal comparability of the left-right scale across individuals is impaired. More generally, our study suggests that we need more research on how respondents interpret various abstract concepts that we regularly use in survey questions

An everlasting pioneer: the story of Antirrhinum research

Despite the tremendous success of Arabidopsis thaliana, no single model can represent the vast range of form that is seen in the ~250,000 existing species of flowering plants (angiosperms). Here, we consider the history and future of an alternative angiosperm model — the snapdragon Antirrhinum majus. We ask what made Antirrhinum attractive to the earliest students of variation and inheritance, and how its use led to landmark advances in plant genetics and to our present understanding of plant development. Finally, we show how the wide diversity of Antirrhinum species, combined with classical and molecular genetics — the two traditional strengths of Antirrhinum — provide an opportunity for developmental, evolutionary and ecological approaches. These factors make A. majus an ideal comparative angiosperm