Poor guideline adherence in type 1 diabetes education in real-world clinical practice: Evidence from a multicentre, national survey

Liu, Bingwen; Huang, Fansu; Wu, Xinyin; Xie, Yuting; Xu, Rong; Huang, Jin; Li, Juan; Yang, Xilin; Li, Xia; Zhang, Zhou

doi:10.1016/j.pec.2021.04.010

Cited by 6 publications

(9 citation statements)

References 37 publications

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“…The need for adequate training on how to inject insulin correctly was also raised in this study. A multicentre study in China concluded that poor practices that resulted from insufficient insulin education could be attributed to healthcare professionals’ lack of training, unfamiliarity with guidelines, lack of time and absence of appropriate educational tools 34. Many children in this study were still relying on their parents for insulin injections.…”

Section: Discussionmentioning

confidence: 87%

“…Another study reported that less than one-third of the participants showed a good knowledge of the insulin-to-carbohydrate ratio and insulin sensitivity factor. The main attributing factor was found to be a lack of training on these aspects by the healthcare providers 34…”

Section: Discussionmentioning

confidence: 99%

“…The main attributing factor was found to be a lack of training on these aspects by the healthcare providers. 34 …”

Section: Discussionmentioning

confidence: 99%

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Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study

Muhammed Elamin,

Muhamad Arshad,

Md Redzuan

et al. 2024

BMJ Open

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ObjectiveThe objective of this study is to explore the information needs related to insulin therapy in children and adolescents with type 1 diabetes mellitus (T1DM) from the children’s perspectives as well as their caregivers.DesignQualitative study; semistructured interviews. To identify emerging themes relating to information needs, open coding and thematic analysis were employed.SettingParticipants were recruited from a tertiary care children’s hospital in Kuala Lumpur, Malaysia and a specialist hospital in Riyadh, Saudi Arabia.ParticipantsThirty one children with a mean age of 11.5 years (SD=1.9) and their caregivers were interviewed. Seventeen participants were from Malaysia and 14 were from Saudi Arabia.ResultsFour themes of information emerged from the interviews, including information related to (1) hypoglycaemia and hyperglycaemia, (2) insulin therapy, (3) injection technique and (4) other information needs pertaining to continuous glucose monitoring, access to peer groups and future advances in insulin therapy.ConclusionThis study provided valuable insights into the information needs related to T1DM and insulin therapy among children and adolescents with T1DM that should be considered by stakeholders in the development of age-appropriate education materials. Such materials will assist children and adolescents to better manage their life-long T1DM condition from adolescence until adulthood.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study

Muhammed Elamin,

Muhamad Arshad,

Md Redzuan

et al. 2024

BMJ Open

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“…This is reflected by the application rate of GLP-1 RAs and SGLT-2i increasing but is still generally low, the proportion of interventions by endocrinologists for patients with substandard blood pressure to adjust the antihypertensive regimen during hospitalization is low, suggesting a deficiency in clinical patient blood pressure management, the overall intervention rate for patients with substandard LDL cholesterol was too low, suggesting insufficient clinical attention to LDL cholesterol standard attainment, especially for patients with ASCVD and inadequate use of antiplatelet agents in patients with ASCVD. Evidence-based medicine guidelines are increasingly published and sanctioned but may have low adherence ( 26 , 27 ). Several previous studies investigating the attainment of cardiovascular risk factors in outpatients with diabetes have shown low rates of attainment of glucose, blood pressure, and lipids in outpatients ( 28 , 29 ), the triple control rate for glycemia, blood pressure, and lipids was 11.2% in China ( 28 ) and 24% in the US ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Gaps of Medication Treatment Management Between Guidelines and Real-World for Inpatients With Type 2 Diabetes in China From Pharmacist’s Perspective

et al. 2022

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BackgroundThe prevalence of diabetes mellitus remains high in China, and more cardiovascular and cerebrovascular adverse events due to diabetes mellitus are likely to occur in the future.ObjectiveTo analyze the gap between the current pharmacotherapy management and the guidelines for inpatients with type 2 diabetes mellitus from the perspective of pharmacists so as to provide a reference for optimal pharmacotherapy management methods and models for patients with type 2 diabetes mellitus.MethodsThe study was a cross-sectional observational study. The study was conducted by investigating and analyzing the use of glucose-lowering drugs, adjustment of blood pressure management strategy, lipid management, weight management, and application of antiplatelet drugs in type 2 diabetes inpatients.ResultsA total of 1086 patients with type 2 diabetes were included. Metformin, glycosidase inhibitors, and basal insulin were the most used among type 2 diabetes inpatients. The use of SGLT-2, GLP-1 RAs, DPP-4, and metformin all showed significant increase. SGLT-2 inhibitors (SGLT-2i) showed the fastest increase from 2020 to 2021 (14.5% vs. 39.6%); However, the application rate of SGLT-2i was low among patients with combined ASCVD, renal insufficiency, and diabetic nephropathy (46.4%, 40.9%, and 45.8% respectively). For patients with substandard blood pressure at admission, the average rate of intervention by endocrinologists for adjusting the antihypertensive regimen during hospitalization was 55.6%, and the application rate of ACEI/ARB drugs reached 64.4%. The application rate of statins among patients with type 2 diabetes was still relatively high, at 78.8%. However, the overall intervention rate for patients with suboptimal LDL-c was only 24.1%. The application rate of antiplatelet agents for patients with ASCVD was 77.6%, which was higher than that for patients without ASCVD.ConclusionThere is still a gap between the practice of medication treatment management of Chinese inpatients with type 2 diabetes and the guidelines, especially in the application of GLP-1RAs and SGLT-2i in patients with concomitant ASCVD, diabetic nephropathy, and renal insufficiency. Meanwhile, physicians and pharmacists should pay more attention on achieving blood pressure and LDL-c standards in type 2 diabetic patients and provide timely interventions.

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“…However, any additional activities and costs associated with educational programmes for different insulin regimens must be factored into their overall costs when making funding decisions within public healthcare systems (Christie et al, 2016). This includes the cost for any associated educational and other activities including appropriate tools among patients with diabetes and any caregivers to enhance adherence to prescribed medicines (Christie et al, 2016;Iqbal et al, 2017;Kyokunzire et al, 2018;Liu et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

et al. 2022

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There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.

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Poor guideline adherence in type 1 diabetes education in real-world clinical practice: Evidence from a multicentre, national survey

Cited by 6 publications

References 37 publications

Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study

Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study

Gaps of Medication Treatment Management Between Guidelines and Real-World for Inpatients With Type 2 Diabetes in China From Pharmacist’s Perspective

Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

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