Adherence to antidiabetic treatment and impaired hypoglycemia awareness in type 2 diabetes mellitus assessed in Spanish community pharmacies: the ADHIFAC study

Abstract

IntroductionAdherence to treatment and hypoglycemia awareness are strongly linked to glycemic control and hypoglycemia risk in people with type 2 diabetes mellitus (T2DM). Community pharmacies are suitable facilities to detect these conditions, and should be involved in the strategies to minimize the associated risks and burden.Research design and methodsThis cross-sectional study conducted at community pharmacies across Spain assessed the prevalence of low adherence to antidiabetic treatments, the frequency of impaired hypoglycemia awareness, and their predictive factors. Adherence was measured with the 8-item Morisky Medication Adherence Scale (MMAS-8) and electronic records of dispensed treatments. The Clarke questionnaire was used to assess impaired hypoglycemia awareness. Healthcare counseling provided in the pharmacy was collected.ResultsSeventy-nine pharmacists and 618 subjects with T2DM participated in the study. Mean age in the overall T2DM population was 67 years, being the majority (69%) pensioners. Adherence was high in 41% of participants, medium in 35%, and low in 24% according to the MMAS-8. Impaired hypoglycemia awareness was observed in 25% of participants. Main determinants of low adherence were the level of education, the number of treatments per patient, hypoglycemia awareness, and the type of pharmacy. Predictive factors of impaired hypoglycemia awareness were the level of education, information on diabetes-related complications, adherence levels, and the type of pharmacy. The proportion of participants who had healthcare counseling was 71% in the overall population and 100% in subjects with impaired hypoglycemia awareness and low adherence. Healthcare counseling comprised diabetes education (69%), pharmacotherapeutic assessment (20%), and physician referrals (11%).ConclusionLack of adherence to antidiabetic treatments and impaired hypoglycemia awareness are frequent and correlate in T2DM. Community pharmacies can detect these conditions and should have an active role in the design of strategies to minimize them.

Long-Term Sulfonylurea Use and Impaired Awareness of Hypoglycemia Among Patients With Type 2 Diabetes in Taiwan

“…In Asia, the prevalence of IAH determined by the Gold and Clarke questionnaires among people with insulin-treated type 2 diabetes collected from hospitals was 19.6% and 13.7%, respectively, in Singapore, but that from clinics was between 5.93% and 17.01% in Jordan. 11,12 Among people with insulinand oral antihyperglycemic-treated type 2 diabetes, the prevalence of IAH based on the Clarke questionnaire was 25% in Spain 15 and 52.1% in the Kingdom of Saudi Arabia. 23 All of these studies showed that IAH prevalence was higher among patients treated with insulin, with or without oral antihyperglycemic agents, than among those treated with insulin only.…”

“…The factors associated with IAH in type 2 diabetes included lower education, 15 nonpartnered status, 13 high body mass index, 13 diabetes-related comorbidities, 15 lower medication adherence, 15,16 use of complex insulin regimens, 13 higher frequency of hypoglycemia in the past 6 months, and severe hypoglycemia events in the past year. 12 Oral antihyperglycemic agents, especially sulfonylureas, carry high risk for hypoglycemia with long-term use.…”