Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes. Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital Adherence to Glyburide and Metformin and Associated Factors in Type 2 Diabetes in Isfahan, Iran Adherence to self-care practices and empowerment of people with diabetes mellitus: a randomized clinical trial. [Pilot study of two different strategies to reinforce self care behaviors and treatment compliance among type 2 diabetes patients from low income strata]. Effect of pharmaceutical care on medication adherence of patients newly prescribed insulin therapy: a randomized controlled study Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes Active assistance technology reduces glycosylated hemoglobin and weight in individuals with type 2 diabetes: results of a theory-based randomized trial. Adherence to self-care behavior and glycemic effects using structured education Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes Adherence to diabetes control recommendations: impact of nurse telephone calls. Clinical and Behavioral Correlates of Achieving and Maintaining Glycemic Targets in an Underserved Population With Type 2 Diabetes Self-monitoring of blood glucose--psychological aspects relevant to changes in HbA1c in type 2 diabetic patients treated with diet or diet plus oral antidiabetic medication. Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes Polypharmacy and medication adherence in patients with type 2 diabetes.
Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration Background : Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia . Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved . Aims : The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia . Patients and Method : The study consists of two phases . A cross-sectional review of r and omly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview , with pre tested adherence and self management and monitoring tool question er of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic . Result : Oral hypoglycemic agent were prescribed for 351(91.4 ) of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6 % ) . About 312 ( 88.9 % ) patients on oral hypoglycemic agent were on mono therapy , the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3 % ) and metformine 80(25.7 % ) . Only 41.8 % of the patient had adequate glycemic control . The main external factors for non adherence were lack of finance ( 37.1 % ) followed by perceived side effect of drug 29.2 % . Only 6.5 % patient who missed their medications disclosed to physician during consultation . The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied . Conclusion : Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine . While the current prescribing strategy do not achieve glycemic control on majority of the patient . This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design . One hundred and sixty-four participants with poorly controlled diabetes from two setting s were r and omized using computer-generated list into control ( n = 82 ) and intervention ( n = 82 ) groups , of which 151 completed the study . Monthly interventions over 12 weeks addressed the self-care practice s of diet , physical activity , medication adherence and self-monitoring of blood glucose ( SMBG ) . These self-care practice s were assessed at Weeks 0 and 12 using pre- and post- question naires in both groups together with glycated haemoglobin A1c ( HbA1c ) and diabetes knowledge . In the intention-to-treat analysis ( n = 164 ) , the intervention group improved their SMBG ( P = < 0.001 ) , physical activity ( P = 0.001 ) , HbA1c ( P = 0.03 ) , diabetes knowledge ( P = < 0.001 ) and medication adherence . At Week 12 , HbA1c difference adjusted for SMBG frequency , medication adherence and weight change remained significant ( P = 0.03 ) compared with control group . For within group comparisons , diabetes knowledge ( P = < 0.001 ) , HbA1c level ( P = < 0.001 ) , SMBG ( P = < 0.001 ) and medication adherence ( P = 0.008 ) improved from baseline in the intervention group . In the control group , only diabetes knowledge improved ( P = < 0.001 ) . These findings can contribute to the development of self-management diabetes education in Malaysia OBJECTIVE : To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil . METHOD : A r and omized controlled trial with a 6-month follow-up period was performed in 70 adults , aged 45 years or older , with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8 % . Patients in the control group ( CG ) ( n = 36 ) received st and ard care , patients in the intervention group ( IG ) ( n = 34 ) received an individualized pharmacotherapeutic care plan and diabetes education . The primary outcome measure was change in HbA1c . Secondary outcomes included diabetes and medication knowledge , adherence to medication , insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life . Outcomes were evaluated at baseline and 6 months using question naires . RESULTS : Diabetes knowledge , medication knowledge , adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group . At the end of the study , mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group . Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group . CONCLUSION : The program improved health outcomes and result ed in better glycemic control in patients with type 2 diabetes undergoing insulin therapy The purpose of this study was to determine the adherence to oral hypoglycemic medications and associated factors in type 2 Diabetes Mellitus patients who were referred to the Isfahan Endocrinology and Metabolism Research Centre ( IEMRC ) . Convenience sampling was used to enroll 248 patients with type 2 diabetes in a prospect i ve study at IEMRC from January 2007 to January 2008 . Patients had to be on a stable dose of oral hypoglycemic medications ( glyburide and metformin ) or for 3 months prior to the study and willing to participate in consultation sessions with a pharmacist . Pill count and self report methods were used to measure the adherence .  Mean ( SD ) of patients studied was 56.6 ( 8.9 ) years and 62 % were females . The mean ( SD ) duration of diabetes in the study patients was 10.8 ( 6.1 ) years and 81.9 % of them were literate with basic education . Non-adherence rates to metformin and glyburide were recorded in 39.7 % and 35.3 % of the study population respectively . Lower HbA1C levels and higher education were associated with higher adherence rates . Forgetfulness , confusion , fasting , adverse effects , complexity of medication regimen and disruption of routines were most commonly reported causes of non adherence . Prevalence of adherence to these two medications did not differ significantly between pill count ( 62.3 % ) and self report ( 62.8 % ) , ( p > 0.05 ) . Adherence rates did not vary by pill count and self report significantly . It was concluded that good adherence to medications was associated with a lower HbA1C profile ; so it seems that pill count is a useful method in the clinical practice to identify non-adherent patients . Further studies are needed to find out efficient interventions to improve the patient ’s adherence OBJECTIVE To evaluate adherence to self-care and glycemic control and empowerment of people with diabetes mellitus in group education . METHOD Cluster-r and omized clinical trial , with participants with type 2 diabetes mellitus . All people in the sample were linked to Family Health Strategy Units from Divinópolis , state of Minas Gerais , Brazil , during 2014 and 2015 . Data regarding adherence to self-care practice s , empowerment and glycated hemoglobin were collected for comparison of groups in the baseline and of intergroup results before and after interventions . The chosen level of significance was 0.05 . RESULTS The sample had 183 people , with 72 in the intervention group and 111 in the control group . A statistically significant decrease ( < 0.001 ) in the value of glycated hemoglobin and an increase in the scores of adherence to self-care and empowerment scales were found for participants in the intervention group ( < 0.001 ) . CONCLUSION Group education caused an increase in the scores of the scales of adherence to self-care practice s and empowerment , in addition to an improvement in glycemic levels , as shown by glycated hemoglobin results . Brazilian Registry of Clinical Trials : RBR-92j38 t UNLABELLED Long term diabetes self-management behaviors , and strict glycemic control are difficult to achieve in clinical practice . OBJECTIVE Asesss two different reinforcement strategies for diabetes selfcare management , psychological distress and glycemic control in a one year follow up study . METHODS 70 consecutive type 2 diabetic patients , were recruited and r and omly assigned to three study groups . Subjects in the control group ( CG ) continued with their normal treatment schedule . The second group received a reinforcement course at 6 months ( RCG ) and in the third group , patients were contacted monthly by phone ( PHCG ) to promote self-management attitudes and address problems as they arose . A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up . RESULTS At one year follow-up , the three groups significantly increased their diabetes-related knowledge . Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan ( p=0.06 and 0.003 ) . In addition , the PHCG significantly increased ( p<0.0001 ) their adherence to pharmacological treatment . No significant differences were observed in glycemic control , prevalence of depression or diabetes related distress . CONCLUSIONS Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors . Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes Background Poor adherence to insulin medications leads to a high rate of hospital admissions and poor health-related quality of life in the patients with diabetes mellitus . However , few strategies are effective and acceptable in improving medication adherence . The objectives of this study are to evaluate the effectiveness of pharmaceutical care by clinical pharmacists on medication adherence of patients newly prescribed insulin therapy .  Patients and methods A single-center , prospect i ve r and omized controlled study ( pharmaceutical care group and control group ) was performed from January 1 , 2014 to December 30 , 2014 .  Medication adherence was measured at the baseline and up to 12 months with Morisky – Green test and computerized dispensed medication history . The absolute change in A1c vs baseline , the change of hospitalization between two groups , and the number of patients to achieve Chinese Diabetes Society ( CDS ) goals at the baseline were the main outcome measures . Results A total of 322 patients were included in the study . After the 12-month interventions , significant improvements in the medication adherence were verified for the pharmaceutical care group according to the Morisky – Green test ( 50.8 % of adherent patients at baseline vs 80.7 % of adherent patients after 12-month interventions ; P<0.01 ) and the computerized dispensed medication history ( 55.2 % at baseline vs 83.3 % after interventions ; P<0.01 ) , while no significant changes were verified in the control group . After follow-up , the pharmaceutical care group showed a greater percent change in A1c ( 2.2±0.4 vs 0.8±0.2 , P<0.05 ) . Conclusion This study provides new evidence from a r and omized controlled trial on the beneficial effect of pharmaceutical care to enhance adherence in patients newly prescribed insulin therapy . Intervention by the pharmacist might potentially improve clinical outcomes on reducing hemoglobin A1c and enhancing the number of patients fulfilling the Chinese Diabetes Society goal on hemoglobin A1c Background Diabetes mellitus is a lifelong chronic condition that requires self-management . Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes . Purpose To assess the effects of a pharmaceutical care ( PC ) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus . Patients and methods A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at r and om to the control ( n=121 ) or intervention ( n=120 ) groups . Participants in the intervention group received PC from an experienced pharmacist , whereas those in the control group were provided the st and ard pharmacy service .  Medication adherence was assessed using the Malaysian Medication Adherence Scale , and glycemic levels ( glycated hemoglobin values and fasting blood glucose [ FBG ] ) of participants were obtained at baseline and after 4 , 8 , and 12 months . Results At baseline , there were no significant differences in demographic data , medication adherence , and glycemic levels between participants in the control and intervention groups . However , statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4 , 8 , and 12 after the provision of PC ( median FBG , 9.0 versus 7.2 mmol/L [ P<0.001 ] ; median glycated hemoglobin level , 9.1 % versus 8.0 % [ P<0.001 ] at 12 months ) . Medication adherence was also significantly associated with the provision of PC , with a higher proportion in the intervention group than in the control group achieving it ( 75.0 % versus 58.7 % ; P=0.007 ) . Conclusion The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes . Therefore , the PC model used in this study should be duplicated in other health care setting s for the benefit of more patients with type 2 diabetes BACKGROUND Type 2 diabetes is an individual health challenge requiring ongoing self-management . Remote patient reporting of relevant health parameters and linked automated feedback via mobile telephone have potential to strengthen self-management and improve outcomes . This research involved development and evaluation of a mobile telephone-based remote patient reporting and automated telephone feedback system , guided by health behavior change theory , aim ed at improving self-management and health status in individuals with type 2 diabetes . SUBJECTS AND METHODS This research comprised a r and omized controlled trial . Inclusion criteria were diagnosis of type 2 diabetes , elevated glycosylated hemoglobin ( HbA1c ) levels ( range , 6.5 - 11 % ) or use of oral diabetes medication , and 30 - 70 years of age . Intervention subjects ( n=24 ) participated in remote patient reporting of health status parameters and linked health behavior change feedback . Control participants ( n=24 ) received st and ard of care including diabetes education and healthcare provider counseling . Patients were followed for approximately 10 months . RESULTS Intervention participants achieved , compared with controls and controlling for baseline , a significantly greater mean reduction in HbA1c of -0.40 % ( 95 % confidence interval [ CI ] -0.67 % to -0.14 % ) versus 0.036 % ( 95 % CI -0.23 % to 0.30 % ) ( P<0.03 ) and significantly greater weight reduction of -2.1 kg ( 95 % CI -3.6 to -0.6 kg ) versus 0.4 kg ( 95 % CI -1.1 to 1.9 kg ) . Nonsignificant trends for greater intervention compared with control improvement in systolic and diastolic blood pressure were observed . CONCLUSIONS Sophisticated information technology platforms for remote patient reporting linked with theory-based health behavior change automated feedback have potential to improve patient outcomes in type 2 diabetes and merit scaled-up research efforts Aims / Introduction The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map ™ ( CM ™ ) vs usual care in a university-based hospital primary care clinic . Material s and Methods This was a r and omized , pragmatic clinical trial . Patients with type 2 diabetes were r and omly assigned to structured education or usual care groups . The primary outcome was the difference in the mean change of glycated hemoglobin ( HbA1c ) from baseline to 12 months . Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes . Results A total of 245 patients were r and omly assigned to two groups ( CM ™ group n = 121 ; usual care group , n = 116 ) . The absolute reduction of HbA1c was significantly greater in the CM ™ group at 3 and 6 months ( Δ = −0.59 % and Δ = −1.13 % , P < 0.01 ) , but the difference was no longer statistically significant at 9 and 12 months ( Δ = −0.43 % and Δ = −0.49 % ) , based on an intention-to-treat analysis . A per- protocol analysis showed the significant change was maintained at 12 months ( Δ = −0.67 % ) . In the intervention group , greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours ™ framework ( AADE7 ) behavioral goals at 3 months , in particular being active , problem-solving , reducing risk and health coping . Conclusions In type 2 diabetic patients with suboptimally controlled glucose , there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM ™ education program compared with outcomes achieved in patients receiving usual care Background : Diabetes mellitus ( DM ) requires continuous medical care , patients ’ self-management , education , and adherence to prescribed medication to reduce the risk of long-term complications . The aim of this study was to assess the benefits of an education program on diabetes , patient self-management , adherence to medication , anxiety , depression and glycemic control in type 2 diabetics in Saudi Arabia . Material s and Methods : This was a prospect i ve study , conducted among 104 diabetic patients at a major tertiary hospital in Riyadh , Saudi Arabia , between May 2011 and October 2012 .  Education material s given to diabetic patients included pamphlets/h and outs written in Arabic , the national language . Special videotapes about DM were made and distributed to all participants . In addition , specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged . Patients were interviewed using a structured interview schedule both during the baseline , and after 6 months of the program . The interview schedule included , socio-demographics , clinical characteristics , diabetes self-management , adherence to medication , anxiety , and depression . Glycemic control was considered poor , if hemoglobin A1c ( HbA1c ) was ≥ 7 % . Results : The mean age of the study population was 57.3 ± 14.4 years . Seventy one were males ( 68.3 % ) and 33 ( 31.7 % ) were females . After six months of the diabetes education program , there were significant improvements in patients ’ dietary plan ( P = 0.0001 ) , physical exercise ( P = 0.0001 ) , self-monitoring of blood glucose ( SMBG ) ( P = 0.0001 ) , HbA1c ( P = 0.04 ) , adherence to medication ( P = 0.007 ) , and depression ( P = 0.03 ) . Conclusions : Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan , physical exercise , SMBG , adherence to medication , HbA1c and depression BACKGROUND Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications . AIM The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin ( HbA1c ) levels and adherence to diabetes control recommendations . METHODS A r and omized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls .  Twenty patients were r and omly assigned to an intervention group and 16 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA1c < 7 % ) . The intervention was applied to the intervention group for 12 weeks , and consisted of continued education and reinforcement of diet , exercise , medication adjustment recommendations , as well as frequent self-monitoring of blood glucose levels . Telephone intervention was performed twice per week for the first month and then weekly for the second and third month . Participants were requested to write self-management logs including blood glucose levels , diet and an exercise diary . A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail . All medication adjustments were communicated to participants ' doctors . The HbA1c and diabetes adherence were measured before and after the intervention . RESULTS Patients in the intervention group had a mean decrease of 1.2 % in HbA1c levels and those in the control group had a mean increase of 0.6 % in HbA1c levels . The intervention group had greater diet and blood glucose testing adherence than the control group . CONCLUSION These findings indicate that a nurse telephone intervention can improve HbA1c , and diet and blood glucose testing adherence OBJECTIVE —In an underserved Latino area , we established a disease-management program and proved its effectiveness . However , many patients still remained above target . This study was design ed to evaluate which factors are associated with reaching program goals . RESEARCH DESIGN AND METHODS —This was a r and omized , prospect i ve , observational study in which patients enrolled in our program were followed for 2 years with outcomes , measures , and question naires assessed at baseline and at 6 , 12 , and 24 months . RESULTS —Overall , A1C fell by 1 % . Adherence to medication was the strongest predictor of reaching the target A1C of < 8 % ; baseline A1C was also predictive . Knowledge scores increased in those who reached target , but the measures of self-efficacy and empowerment did not change for either group . CONCLUSIONS —Diabetes management is effective in a lower-income Latino population . However , adherence was suboptimal even when medications were provided on-site for free . Further research into barriers associated with medication adherence is needed OBJECTIVE To investigate the influence of psychological aspects on glycemic control in type 2 diabetic patients treated with diet alone or diet plus oral antidiabetic medication using meal-related self-monitoring of blood glucose ( SMBG ) .  These psychological aspects refer to the process of self-management including the tendency to structure situations and activate re sources ( self-perception ) , to accept options for action ( self-reflection ) and to believe in self-efficacy ( self-regulation ) . METHODS In a r and omized controlled 6-month group comparison study , one group ( n = 113 ; mean age 58.7 years ) used a blood glucose monitoring device  , kept a blood glucose/eating diary and received st and ardized counseling focusing on self-perception , self-reflection and self-regulation .  A control group ( n = 110 ; mean age 60.5 years ) received non-st and ardized counseling on diet and lifestyle . RESULTS Statistically significant endpoint differences between the SMBG and the control group were seen in glycemic control ( p = 0.0086 ) and the well-being item ' depression ' ( p = 0.032 ) . All aspects of counseling were influenced by SMBG with the extent of self-perception and self-reflection gradually increasing over time . Three HbA1c response types were identified among SMBG patients : continuous-achievers , late-achievers and non-achievers . CONCLUSION This study identified processes ( structuring the situation and activating re sources , accepting options for action and believing in self-efficacy ) which lead to a change in the metabolic profile . SMBG coupled with structured counseling provided patients with a tool for taking on more self-control and result ed in an improved outlook on life . PRACTICE IMPLICATION S This short-term intervention involved a structured counseling algorithm which requires 5 - 10 min of physician-patient contact and a structured documentation of metabolic control by the patient and can be taught by a diabetes training team within 4 h. The identification of the different response types might be of importance in clinical practice as it enables the physician to determine the right counseling option In recent years , great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes . Studies have reported that nurses , compared to other healthcare professionals , are more likely to promote preventive healthcare seeking behaviors . The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin . A two-arm parallel-group r and omized controlled trial with the blinded outcome assessors was design ed . One hundred forty-two adults with type 2 diabetes were r and omized to receive either usual diabetes care ( control group ) or usual care plus a nurse-led diabetes self-management education ( intervention group ) . Duration of the intervention was 12 weeks . The primary outcome was glycosylated hemoglobin ( HbA1c values ) . Secondary outcomes were changes in blood pressure , body weight , lipid profiles , self-efficacy ( efficacy expectation and outcome expectation ) , self-management behaviors , quality of life , social support , and depression . Outcome measures were assessed at baseline and at 12-week and 24-week postr and omizations . Patients in the intervention group showed significant improvement in HbA1c , blood pressure , body weight , efficacy expectation , outcome expectation , and diabetes self-management behaviors . The beneficial effect of a nurse-led intervention continued to accrue beyond the end of the trial result ing in sustained improvements in clinical , lifestyle , and psychosocial outcomes . This trial is registered with I RCT 2016062528627N1 OBJECTIVE To determine medication adherence and predictors of suboptimal adherence in a community cohort of patients with diabetes and to test the hypothesis that adherence decreases with increased number of medicines prescribed . RESEARCH DESIGN AND METHODS A total of 128 r and omly selected patients with type 2 diabetes from a single community health center responded to a pharmacist-administered question naire regarding medication use . Survey data were linked to clinical data available from the electronic medical record . We assessed self-reported adherence rates for each diabetes-related medicine , barriers and attitudes regarding medication use , and HbA(1c ) , total cholesterol , and blood pressure levels . RESULTS Patients were taking a mean of 4.1 ( + /-1.9 ) diabetes-related medicines . The average 7-day adherence was 6.7 + /- 1.1 days . Total number of medicines prescribed was not correlated with medication adherence . Adherence was significantly lower for medicines not felt to be improving current or future health ( 6.1 vs. 6.9 days out of 7 , P < 0.001 ) . Among patients on three or more medicines , 71 % ( 15 of 21 patients ) with suboptimal adherence were perfectly adherent with all but one medicine . Side effects were the most commonly reported problem with medication use . Of 29 medicines causing side effects that interfered with adherence , 24 ( 83 % ) did so for > 1 month , and only 7 ( 24 % ) were reported to the patient 's primary care physician . CONCLUSIONS In this sample , patients reported very high medication adherence rates regardless of number of medicines prescribed . Among patients on multiple medicines , most patients with suboptimal adherence were perfectly adherent to all but one medicine . Unreported side effects and a lack of confidence in immediate or future benefits were significant predictors of suboptimal adherence . Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia , hypertension , and hyperlipidemia
Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions .
Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence .
Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence .
Educational interventions focusing on self-management strategies appear more likely to achieve positive outcomes .
EXECUTIVE SUMMARY Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self-management , has been shown to improve glycaemic control .
However compliance with oral medication adherence remains poor .
Educating people with Type 2 diabetes is an important strategy to enhance self-management ability , including medication-taking behaviour .
Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes .
Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes-related complications .