Adherence in adults with type 1 diabetes mellitus correlates with treatment satisfaction but not with adverse events

Tereza Hendrychova,1 Magda Vytrisalova,1 Alena Smahelova,2 Jiri Vlcek,1 Ales Antonin Kubena1 1Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic; 2Diabetes Center, Department of Gerontology and Metabolism, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic Purpose: Diabetes self-care and self-monitoring adherence has a positive effect on the metabolic control of the disease. The aim of this study was to analyze the adherence to self-care recommendations and to identify its correlates in adults with type 1 diabetes mellitus. Patients and methods: One hundred and eleven patients with type 1 diabetes were enrolled in an observational cross-sectional study conducted at the Diabetes Center of the University Hospital in Hradec Králové, Czech Republic. Diabetes self-care adherence was measured by the Self Care Inventory-Revised, and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire-status version. Additional data were collected from self-administered questionnaires and medical records. The Mann–Whitney test, Spearman correlations, and multiple linear regressions were used in the statistical analysis. Results: The mean age of patients was 42.4 years; 59.5% of them were females and 53.2% of all patients used an insulin pump. The mean glycosylated hemoglobin (HbA1c) was 66.2 ± 15.3 mmol/mol and the mean insulin dosage was 0.6 ± 0.3 IU insulin/kg/day. The number of hypoglycemic episodes (including severe) that patients had in the last month before taking the survey was 3.6 ± 3.2. Self-care adherence was associated with treatment satisfaction (0.495; P = 0.004) along with frequency of self-monitoring of before meal blood glucose (0.267; P = 0.003). It was not associated with the incidence of hypoglycemic events or any other insulin therapy-related problems or with socio-demographic or clinical characteristics. Conclusion: Treatment satisfaction is one of the key factors that need to be targeted to maximize benefits to patients. Self-care adherence in adults with type 1 diabetes did not correlate with socio-demographic and clinical characteristics, nor with adverse events. Keywords: treatment adherence, self-care inventory revised, diabetes treatment satisfaction questionnaire, self-monitorin

Drug holidays: the most frequent type of noncompliance with calcium plus vitamin D supplementation in persistent patients with osteoporosis

Tereza Touskova,1 Magda Vytrisalova,1 Vladimir Palicka,2 Tereza Hendrychova,1 Leos Fuksa,1 Radka Holcova,1 Jana Konopacova,1 Ales Antonin Kubena1 1Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, 2Osteocentre, Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic Purpose: All current recommendations include calcium and vitamin D (Ca–D) as an integrated part of osteoporosis treatment. The purpose of this pilot study was to analyze compliance with a fixed combination of Ca–D in women persistent with the treatment.Patients and methods: An observational study was carried out in three osteocenters in the Czech Republic. Women with osteoporosis ≥55 years of age concurrently treated with oral ibandronate were eligible. Compliance was evaluated in a period of 3 months by Medication Event Monitoring System (MEMS), tablet count, and self-report. Nonpersistence was defined as a MEMS-based gap in the use of Ca–D to be 30 days or more.Results: A total of 73 patients were monitored, of which 49 patients were analyzed (target population). Based on MEMS, mean overall compliance was 71%; good compliance (≥80%) was observed in 59% of the patients. As many as 71% of the patients took drug holidays (≥3 consecutive days without intake); overall compliance of these patients was 59% and was slightly lower on Fridays and weekends. Patients without drug holidays were fully compliant (did not omit individual doses). Compliance differed according to daily time at which the patients mostly used the Ca–D. Afternoon/evening takers showed a mean overall compliance of 82% while morning/night takers only 51% (P=0.049). Based on MEMS, tablet count, and self-report, compliance ≥75% was observed in 59%, 100%, and 87% of the patients, respectively. Outcomes obtained by the three methods were not associated with each other. Undesirable concurrent ingestion of Ca–D and ibandronate was present only twice.Conclusion: Despite almost perfect self-reported and tablet count-based compliance, MEMS-based compliance was relatively poor. Consecutive supplementation-free days were common; more than two-thirds of the patients took at least one drug holiday. This pilot study showed drug holiday to be the most important type of noncompliance with Ca–D in those who are persistent with the treatment. Keywords: patient compliance, medication adherence, Medication Event Monitoring System (MEMS), drug holidays, osteoporosis, calcium supplementation, self-report&nbsp

Fat- and fiber-related diet behavior among type 2 diabetes patients from distinct regions

Tereza Hendrychova,1 Magda Vytrisalova,1 Abdullah Alwarafi,2 Jurjen Duintjer Tebbens,3,4 Helena Vankatova,1 Sandra Leal,5 Ales Antonin Kubena,1 Alena Smahelova,6 Jiri Vlcek1 1Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic; 2Faculty of Dentistry, Ibb University, Ibb, Yemen; 3Department of Biophysics and Physical Chemics, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic; 4Institute of Computer Science, Academy of Sciences of the Czech Republic, Prague, Czech Republic; 5Department of Clinical Pharmacy, El Rio Community Health Center, Tucson, AZ, USA; 6Diabetes Center, Department of Gerontology and Metabolism, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic Purpose: Diet and eating habits are of key importance in patients with type 2 diabetes mellitus (T2DM). The purpose of this comparative study was to analyze fat- and fiber-related behavior (FFB) in patients with T2DM from distinct cultural areas. Patients and methods: Observational study was carried out in the Czech Republic (CR) (n=200), the US (n=207), and Yemen (n=200). Patients completed the Fat- and Fiber-related Diet Behavior Questionnaire (FFBQ). Results: Differences in all aspects of FFB among countries were found (P<0.05). The best fat-related behavior reported was from patients from the CR. Patients from the US showed the worst fat-related behavior in total. On the other hand, patients from the US reported the best fiber-related behavior. Patients from Yemen reached the worst scores in all fat-related domains. Patients from all studied countries reported the best results in the “modify meat” and “avoid fat as flavoring” and the worst in the “substitute high fiber” subscales. Conclusion: Professionals involved in the diet education of T2DM patients should be aware of the specificity of diet in their country when advising patients keeping general recommendations. We suggest them to be as specific as possible and concentrate on fiber-related behavior. Keywords: type 2 diabetes mellitus, fat-related behavior, fiber-related behavior, Fat- and Fiber-related Diet Behavior Questionnaire, geographical differenc

Awareness of osteoporosis among female head of household : an Iranian experience

Summary: More than 81 of the studied women had a poor knowledge of different aspects of osteoporosis and its complications, suggesting that more educational programs targeting women in particular are needed to help improve the osteoporosis practice in the societies and reduce the burden of the disease. Purpose: The family structure has changed considerably in the past decade. But, women from Iran and many countries in the region and even families with similar cultural background living in other parts of the world are still responsible for childcare as well as the lifestyle adapted by the family. The present study was conducted to assess the awareness of the female head of household of osteoporosis and its complications. Methods: As part of a population-based study in two Iranian cities, Arak and Sannandaj, to study osteoporosis and its risk factors, a questionnaire on the knowledge of female head of households of osteoporosis and its complications was completed. The subsample filled out the knowledge survey along with the questionnaire on their demographic data, socioeconomic status (SES), reproductive factors, bone-related lifestyle habits, family and personal medical history, medication use, and compliance with osteoporosis medication (if used) as well as a FFQ filled out for all the 2100 participants. They also underwent a bone mineral density (BMD) test, and their serum levels of vitamin D were calculated. These data were then used to assess the factors affecting their awareness level. Results: The knowledge of 81.3 (473) of the studied women was found to be poor on different aspects of osteoporosis and its complications. Multivariate analysis revealed that each level increase in vit D intake tertile increases the chance of higher awareness level in K-Total by 1.5 times. Each level increase in physical activity tertile was associated with a 30.6 lower chance of having a good knowledge. Conclusion: Considering the poor awareness level of the studied women and their poor practice of bone healthy behavior, one could conclude that more programs are needed or the content/delivery style of the existing ones should be optimized. © 2017, International Osteoporosis Foundation and National Osteoporosis Foundation