Geographic Variation in Antidiabetic Agent Adherence and Glycemic Control Among Patients with Type 2 Diabetes

Abstract

This study identified gaps in T2DM drug adherence and pinpointed geographic areas that lag in terms of diabetes drug adherence or diabetes control and would benefit from implementing strategies to increase drug adherence.

Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

“…Among the 56 studies assessed as observational study designs, 19 were cross-sectional, of which seven had high risk of bias [ 52 – 58 ], four had a moderate risk of bias [ 59 – 62 ] and eight had low risk of bias [ 63 – 70 ]. 15 were cohort studies; one study had a high risk of bias [ 71 ], five had a medium risk of bias [ 72 – 77 ], and eight had low risk of bias [ 78 – 85 ].…”

“…Such studies tended to consider context within the narrative of diabetes control in their region. 32 studies described the national context in which the study took place [ 25 , 27 , 31 , 33 , 42 , 43 , 48 , 50 , 51 , 54 , 59 – 62 , 66 , 67 , 74 , 80 – 82 , 85 , 86 , 91 , 92 , 96 , 98 , 100 , 104 , 111 , 112 , 115 , 116 ]. This typically involved descriptive statistics to indicate the magnitude and urgency of diabetes as a national challenge, highlighting incidence or prevalence rates and cost burden.…”

“…A study of elderly patients found that privately insured patients were almost twice as likely to report diabetes medication underuse compared to patients in the Veterans Affairs system (p<0.0001) [ 56 ]. Another study using national data [ 62 ] found the highest diabetes control among commercially-insured patients, compared to those covered by Medicare or Medicaid, but adherence was higher among Medicare beneficiaries. Another explored the impact of socioeconomic factors on control among newly-diagnosed patients with diabetes participating in a community-wide screening programme [ 53 ] and found that lack of insurance coverage was predictive of patients failing to seek medical care.…”

“…67 of the 93 studies did not address interdependence and linkages between health system domains [ 25 – 30 , 33 – 40 , 42 – 46 , 48 – 52 , 56 , 59 , 61 , 62 , 65 – 68 , 72 – 78 , 80 – 87 , 89 – 95 , 97 , 98 , 103 – 107 , 115 , 116 ]. Of the studies which did, three considered linkages between human inputs and service delivery [ 69 , 88 , 99 ].…”

Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study

“…Achieving ABC goals for T2DM patients depends on several factors, such as physical activity levels [ 9 ], stress reduction [ 10 ], medication adherence [ 11 ], and meal plans [ 12 ]. These targets form the basis of wide range of interventions implemented by nurses and aimed at improving diabetes care and achieving metabolic control [ 13 ].…”