Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication. Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD). Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD. Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population. RESUMEN Las complicaciones macrovasculares son frecuentes en pacientes diabéticos hipertensos. Se cree que un apropiado tratamiento antihipertensivo y un control estrecho de la presión arterial previenen o retrasan estas complicaciones. Objetivo: Evaluar los patrones de utilización de antihipertensivos y el control de la presión arterial (PA) en pacientes diabéticos hipertensos con y sin enfermedad isquémica cardiaca (EIC). Métodos: Estudio de cohorte retrospectivo de todos los pacientes diabéticos hipertensos que acudieron al centro médico Al-watani desde agosto 2006 a agosto 2007. Se compararon las proporciones de pacientes que recibían 1,2,3 o 4 o más medicamentos, y por separado los pacientes con y sin EIC. El control de presión arterial (menor o igual a 130/80 mmHg) se comparó en los pacientes recibiendo ningún tratamiento, monoterapia o tratamiento de combinación y por separado los que tenían o no EIC. Resultados: Se incluyeron en el estudio 255 pacientes; su media de edad era de 64,4 (DE=11,4) años. Sesenta y uno (23,9%) de los pacientes incluidos estaban en la presión arterial deseada. Más del 60% del total recibían inhibidores de la enzima convertidor de la angiotensina (IECA)/Antagonistas del receptor de angiotensina (ARA), seguidos de diuréticos (40,8%), bloqueantes de canales de calcio (25,1%), y betabloqueantes (12,5%). La mayoría (más del 55%) estaban en monoterapia o sin tratamiento. Más del 55% de los pacientes con la PA controlada utilizaban IECA. Más de la mitad (50,8%) de los pacientes con la PA controlada estaban con tratamiento de combinación, mientras que el 42,3% de los pacientes con PA descontrolada estaban con tratamiento combinado (p=0,24). Alcanzaron la PA deseada más pacientes del grupo EIC que del grupo no-EIC (p=0,019). La comparación entre los grupos EIC y no-EIC indicó que no había diferencia significativa en la utilización de ningún grupo de medicamentos con los IECA, siendo estos los más utilizados en los dos grupos. Conclusión: Los patrones de utilización de antihipertensivos fueron generalmente no consistentes con las recomendaciones internacionales. Las posibles mejoras incluyen aumentar las combinaciones de los IECA, disminuir la proporciona de pacientes no tratados, y aumentar la proporción de pacientes con PA controlada en esta población.
Aims The main aims of the study were to investigate
the prevalence of pre-diabetes and diabetes mellitus (DM) in patients with
schizophrenia, to compare it with those published in the general population,
and to assess significant associations with dysglycemia defined as having
either pre-DM or DM.
Methods A cross-sectional study carried out in 4
governmental primary psychiatric healthcare centers in Northern West-Bank,
Palestine. Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were
measured. The World Health Organization (WHO) criteria for defining pre-DM and
DM were used. Dysglycemia was defined as FBG >110 mg/dl.
Results Based
on WHO criteria, 27 patients (10.8%) had diabetes and 34 (13.6%) had
pre-diabetes. The prevalence of DM in patients with schizophrenia was not
significantly higher than that reported in the general population of Palestine.
However, the prevalence of pre-DM was significantly higher than that reported
in the general population of Palestine. Regression analysis showed that advancing
age and abnormal waist circumference were significant predictors of dysglycemia
in patients with schizophrenia.
Conclusions This study confirmed the
high prevalence of dysglycemia in patients with schizophrenia, supporting the
need for monitoring of blood glucose in this category of patients. The presence
of primary risk factors is more important in the development of dysglycemia in
patients with schizophrenia than exposure to antipsychotic drugs.
Diabetes mellitus is a chronic progressive disease characterized by numerous health complications. Medication adherence is an important determinant of therapeutic outcome. Few studies on medication adherence have been published from the Arab countries. Therefore, the objective of this pilot study was to assess hypoglycemic medication adherence and its association with treatment satisfaction.
Military Medical Services clinic in Nablus, Palestine.
This is a cross sectional descriptive study. A convenience sample of 131 diabetic patients was studied. The 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Questionnaire for Medication were used to assess adherence and treatment satisfaction, respectively. Statistical Package for Social Sciences was used for statistical analysis.
Level of adherence, treatment satisfaction and association between adherence and treatment satisfaction among diabetic patients.
According to MMAS-8, 50 patients (38.5%) had a high adherence, 58 (44.6%) had a medium adherence and 22 (16.9%) had a low adherence rate. The mean scores of satisfaction domains were 71 ± 17.6 and 95 ± 16.4 for effectiveness (EFF) and side effects (SE), respectively. Adherence score was a positively and significantly correlated with EFF satisfaction domain (P < 0.01) and age (P = 0.01). Similar significant correlation was found between adherence level and duration of illness (P = 0.047). However, adherence was not significantly associated with gender (P = 0.2), number of hypoglycemic medications (P = 0.5) or SE satisfaction domain (P = 0.2).
The majority of diabetic patients in this pilot study were non-adherent. Improving patients' treatment satisfaction will improve treatment adherence.
The main aims of the study were to investigate the prevalence of pre-diabetes and diabetes mellitus (DM) in patients with schizophrenia, to compare it with those published in the general population, and to assess significant associations with dysglycemia defined as having either pre-DM or DM.
A cross-sectional study carried out in 4 governmental primary psychiatric healthcare centers in Northern West-Bank, Palestine. Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were measured. The World Health Organization (WHO) criteria for defining pre-DM and DM were used. Dysglycemia was defined as FBG >110 mg/dl.
Based on WHO criteria, 27 patients (10.8%) had diabetes and 34 (13.6%) had pre-diabetes. The prevalence of DM in patients with schizophrenia was not significantly higher than that reported in the general population of Palestine. However, the prevalence of pre-DM was significantly higher than that reported in the general population of Palestine. Regression analysis showed that advancing age and abnormal waist circumference were significant predictors of dysglycemia in patients with schizophrenia.
This study confirmed the high prevalence of dysglycemia in patients with schizophrenia, supporting the need for monitoring of blood glucose in this category of patients. The presence of primary risk factors is more important in the development of dysglycemia in patients with schizophrenia than exposure to antipsychotic drugs.
Aims The main aims of the study were to investigate the
prevalence of pre-diabetes and diabetes mellitus (DM) in patients with
schizophrenia, to compare it with those published in the general
population, and to assess significant associations with dysglycemia
defined as having either pre-DM or DM.
Methods
A cross-sectional study carried out in 4 governmental primary psychiatric healthcare centers in Northern West-Bank, Palestine. Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were measured. The World Health Organization (WHO) criteria for defining pre-DM and DM were used. Dysglycemia was defined as FBG >110mg/dl.
Results
Based
on WHO criteria, 27 patients (10.8%) had diabetes and 34 (13.6%) had
pre-diabetes. The prevalence of DM in patients with schizophrenia was
not significantly higher than that reported in the general population of
Palestine. However, the prevalence of pre-DM was significantly higher
than that reported in the general population of Palestine. Regression
analysis showed that advancing age and abnormal waist circumference were
significant predictors of dysglycemia in patients with schizophrenia.
Conclusions
This
study confirmed the high prevalence of dysglycemia in patients with
schizophrenia, supporting the need for monitoring of blood glucose in
this category of patients. The presence of primary risk factors is more
important in the development of dysglycemia in patients with
schizophrenia than exposure to antipsychotic drugs.
Objectives
Diabetes mellitus is a chronic progressive disease characterized by numerous health complications. Medication adherence is an important determinant of therapeutic outcome. Few studies on medication adherence have been published from the Arab countries. Therefore, the objective of this pilot study was to assess hypoglycemic medication adherence and its association with treatment satisfaction.
Setting
Military Medical Services clinic in Nablus, Palestine.
Methods
This is a cross sectional descriptive study. A convenience sample of 131 diabetic patients was studied. The 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Questionnaire for Medication were used to assess adherence and treatment satisfaction, respectively. Statistical Package for Social Sciences was used for statistical analysis.
Main
Outcome measure Level of adherence, treatment satisfaction and association between adherence and treatment satisfaction among diabetic patients.
Results
According to MMAS-8, 50 patients (38.5%) had a high adherence, 58 (44.6%) had a medium adherence and 22 (16.9%) had a low adherence rate. The mean scores of satisfaction domains were 71 ± 17.6 and 95 ± 16.4 for effectiveness (EFF) and side effects (SE), respectively. Adherence score was a positively and significantly correlated with EFF satisfaction domain (P < 0.01) and age (P = 0.01). Similar significant correlation was found between adherence level and duration of illness (P = 0.047). However, adherence was not significantly associated with gender (P = 0.2), number of hypoglycemic medications (P = 0.5) or SE satisfaction domain (P = 0.2).
Discussion and conclusion
The majority of diabetic patients in this pilot study were non-adherent. Improving patients' treatment satisfaction will improve treatment adherence.