Association between diabetes patients' knowledge about medications and their blood glucose control

doi:10.1016/j.sapharm.2007.01.002

Research in Social and Administrative Pharmacy

Volume 4, Issue 1, March 2008, Pages 37-45

https://doi.org/10.1016/j.sapharm.2007.01.002 Get rights and content

Abstract

Background

Diabetes mellitus is a common chronic disorder frequently resulting in hyperglycemia and numerous long-term complications. Research has shown that improved glycemic control reduces the rate and number of diabetes-related complications. Evidence suggests that patients who are more knowledgeable about diabetes self-care may be more likely to achieve better glycemic control.

Objective

The purpose of this study is to determine the relationship between patients' knowledge about their diabetes medications and their blood glucose control.

Methods

Patients receiving oral pharmacologic treatment for type 2 diabetes mellitus were asked to answer a short questionnaire assessing their knowledge about their medications. Patients were part of an ambulatory care practice in Baltimore, Maryland, that provides primary care medical services to an inner-city, predominantly African American population. A medication knowledge score (number of correct responses to 8 components) was tabulated and correlated to the most recent glycosylated hemoglobin (A1c) (drawn within the previous 90 days). Multivariate models were constructed, with A1c as the outcome and patients' medication knowledge as the independent variable. Potential confounders included in the models were age, sex, education level, number of diabetes medications, and insurance status.

Results

Fifty patients were screened for the study; 44 agreed to participate and met inclusion criteria. Patients' diabetes medication knowledge scores ranged between 1 and 7, with a median score of 5. Older patients (65 years and older) and male patients scored lower than their counterparts. There was a strong inverse association between knowledge score and A1c (r = −0.61; P < .001). Glycosylated hemoglobin was one-half unit lower with each one-unit increase in knowledge score among men; among women A1c was 1.6 units lower for each one-unit increase in knowledge score.

Conclusion

Patients with greater understanding and knowledge of their diabetes medications demonstrated better glycemic control. This cross-sectional association of medication knowledge and A1c was more pronounced in women than in men.

Section snippets

Background

Diabetes mellitus is a common chronic metabolic disorder affecting 20.8 million Americans.¹ Patients with type 1 diabetes mellitus do not secrete insulin, whereas patients with type 2 diabetes mellitus experience insulin resistance and/or diminished insulin secretion. Regardless of the pathogenesis, uncontrolled diabetes is associated with chronic hyperglycemia, leading to the development of long-term microvascular, macrovascular, and neuropathic complications.

A number of studies have

Methods

This study was conducted at an ambulatory care practice in Baltimore, Maryland. The practice, which is part of the University of Maryland Medical System (UMMS), provides primary care medical services to an inner-city, predominantly African American population. One investigator (AP) was assigned to the clinic every Thursday morning from January and October 1999. Patients receiving oral pharmacological treatment for type 2 diabetes mellitus who presented at the clinic at that time were asked to

Results

Fifty patients who had a regularly scheduled appointment with any provider in the clinic on Thursday mornings were approached, and 5 (10%) declined due to time constraints. Forty-five patients with type 2 diabetes mellitus agreed to participate in the project. Because one patient's most recent A1c was measured outside of the 90-day window, his data were excluded from these analyses. Forty-four patients completed the interview process; 24 were women (54.6%), 20 were men (45.5%), and all were

Discussion

Management of diabetes requires lifestyle modification (eg, dietary changes and physical activity) and adherence to other healthful behaviors, such as medication adherence, and timely medical care. To this end, patient self-care is the primary component of effective diabetes management. Health care providers are responsible for providing patients with the knowledge and skills required for the development of an effective diabetes self-care plan, and providing support and encouragement enabling

Conclusion

Patients in our study who had greater understanding and knowledge of their diabetes medications achieved better glycemic control. Although our study was not designed to assess causality, the findings invite additional research in this area; however, even if the association is not causal, our findings suggest that patients' knowledge about medications may be used as a marker for identifying patients who may have difficulty with controlling their diabetes. Thus, clinicians may use our simple

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Diabetic patients with a poor understanding of the disease have shown higher hospitalization rates for unstable diabetes.5 In contrast, patients with excellent knowledge and understanding of diabetes can adhere to the principles of self-management and have documented better glycemic control along with better health outcomes.6 Regarding optimum management of the problem, it requires an individual to be aware and be familiar with the nature and consequence of the disease, its risk factors, management, and chronic complications.7
Diabetes mellitus (DM) is a complex disease that affects many organ systems, resulting in problems such as the deteriorating health of the population and rising health care costs. Awareness about diabetes and its complications is important to reduce diabetes-related morbidity and mortality. Thus, this study aimed to assess the knowledge of DM and its chronic complications and associated factors among diabetic patients in University of Gondar Compressive Specialized Hospital, Gondar (UoGCSH), Northwest Ethiopia.
A cross-sectional study was employed at the diabetic care service of UoGCSH from August 1, 2021–September 10, 2021. Interview-guided self-administered questionnaire and a chart review were used for data collection. Univariate and multivariate logistic regression was computed to know the association between variables.
The knowledge score regarding diabetes was 85.6% in this study whereas the knowledge score about the chronic complications of diabetes was 58.8%. Age being 26–45 years old (AOR = 0.333,95% CI:0.12–0.918), educational status being able to read and write (AOR = 0.253, 95% CI:0.094–0.683), duration of diabetes diagnosis greater than 10 years (AOR = 2.827, 95% CI:1.458–5.481), and occupational status of being a daily laborer (AOR = 2.531, 95% CI:1.030–6.221) were significantly associated with knowledge regarding chronic complications of DM.
This study demonstrated higher knowledge scores regarding DM and its chronic complications. Age, educational status, duration of diabetes diagnosis, and occupational status have a significant association with knowledge of subjects regarding chronic complications.
Considerations for systematic reviews of quantitative surveys: Learnings from a systematic review of the Patients’ Attitudes Towards Deprescribing questionnaire
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This commentary looks at the process of conducting a systematic review of surveys and validated questionnaires. Surveys and other questionnaire style tools are often used in the field of social and administrative pharmacy, to capture beliefs, attitudes and experiences of patients and healthcare professionals (including pharmacists). Currently, there is little guidance available on how to conduct a systematic review of these types of studies. Considerations related to the process of a systematic review are highlighted, including identification of articles, data extraction, assessing quality of articles and synthesis and analysis of data.
Effectiveness of a pharmacist-led structured group-based intervention in improving medication adherence and glycaemic control among type 2 diabetes mellitus patients: A randomized controlled trial
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Cronbach's alpha for the dimensions on medication adherence, knowledge about medications, attitude towards medication adherence, subjective norms towards medication adherence, perceived behavioural control towards medication adherence and intention to adhere were 0.932, 0.659, 0.746, 0.865, 0.92 and 0.902, respectively (Supplementary material 1). Specifically, measurement of knowledge about medications50 consists of five questions answers based on a 5-point Likert scale. The original question 4 is a double-barrelled question and was split into two questions, thus this measure became six questions.
A pharmacist-led structured group-based intervention (MEDIHEALTH) was formulated to improve medication adherence among Malay type 2 diabetes mellitus (T2DM) patients in the Malaysian state of Sarawak.
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A two group and parallel randomised controlled trial with a twelve months follow-up period was conducted at two primary health clinics in Malaysia that were surrounded by Malay communities. Malay T2DM patients whose HbA1c was >7% and total score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was <26 were recruited and parallelly randomised to the MEDIHEALTH or usual care (control) groups. The extended theory of planned behaviour was employed to test the mechanism of impact. Repeated measure analysis of variance was used to assess the difference in the estimated marginal mean of the SEAMS scores and HbA1c level between the intervention and control groups at different times.
A total of 142 participants were recruited and randomised; three from the intervention group and eight from the control group withdrew before receiving any treatment. Hence, 68 participants in the intervention group and 63 in the control group were included for analyses. The MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p < 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at one, three, six and twelve months post-intervention (p < 0.001). These improvements were mediated by enhancements in perceived behavioural control and knowledge about medications.
The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients.
Effect of diabetes self-management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: Systematic review and meta-analysis of randomized controlled trials
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Type 2 Diabetes mellitus (T2DM) has been a global public health issue causing in physical, financial and psychosocial crises. The aim of this systematic review and meta-analysis (SRMA) was to evaluate the Diabetes Self-Management Education or Support (DSME/S) on glycosylated hemoglobin (HbA1c) among T2DM patients.
This SRMA was made according to preferred reporting Items for systematic review and Meta-analysis (PRISMA) guidelines. The relevant articles were searched from four databases: Cochrane Library, MEDLINE (EBSCOhost), MEDLINE/PubMed and SCOPUS. Quality assessment was carried out. Pooled standard mean difference in HbA1c were calculated to obtain the effect size with random effect assumption. Subgroup analysis was conducted for assessing heterogeneity among the studies.
A total of 1312 studies were identified from databases. Among these 25 studies met inclusion criteria. From these 20 were included in the meta-analysis. In meta-analysis a pooled standard mean difference in HbA1c was −0.604 (95% confidence interval = −0.854 -0.353, I² = 90.3, p < 0.001). In subgroup analysis a significant reduction was seen among studies with less than four months, upper middle followed by lower middle income countries (LMICs), Western Pacific (WP) followed by Middle Eastern and Northern African (MENA) regions with moderate to substantial heterogeneity.
However, there is paucity of studies in underdeveloped countries. Therefore, further studies validated to these contexts are needed to evaluate the DSME effectiveness.
PROSPERO database CRD42020124236.
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View all citing articles on Scopus

^d: Tel.: +1 410 706 6989; fax: +1 410 706 5394.

^e: Tel.: +1 603 672 4126.

^f: At the time this project was completed, Dr Powers was completing a Primary Care Pharmacy Residency at the University of Maryland School of Pharmacy in Baltimore, Maryland.

^g: Tel.: +1 410 706 3266; fax: +1 410 706 1736.

View full text

Original ResearchAssociation between diabetes patients' knowledge about medications and their blood glucose control

Abstract

Background

Objective

Methods

Results

Conclusion

Section snippets

Background

Methods

Results

Discussion

Conclusion

Am Heart J

Am J Cardiol

J Am Pharm Assoc

American Diabetes Association Home Page

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus

N Engl J Med

Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

Lancet

Effect of intensive blood-glucose control with metformin on complications in over-weight patients with type 2 diabetes (UKPDS 34)

Lancet

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38)

BMJ

Efficacy of atenolol and captopril in reducing risk of both macrovascular and microvascular complications in type 2 diabetes (UKPDS 39)

BMJ

Standards of medical care in diabetes

Diabetes Care

Randomized, controlled trial of diabetic patient education: improved knowledge without improved metabolic status

Diabetes Care

Putting diabetes to the test: analyzing glycemic control based on patients' diabetes knowledge

Diabetes Care

Original Research
Association between diabetes patients' knowledge about medications and their blood glucose control