The Way of Compliance or Adherence to Medication in Type 2 Diabetes - Essay Example

Aspect of Compliance Treatment in Relation to the Diagnosis of Type 2 Diabetes” Aim: The motive of this article is to assess and evaluate the confrontations and obstructions that are posed on the way of compliance or adherence of medication in type 2 diabetes. Methods: Literature available on PubMed, the Cochrane Collaborative, databases related to Health and Psychological Instruments with topics encompassing diabetes, medication, OHA (Oral Hypoglycemia Agents), OAA (Oral Antihyperglycemic Agents), Oral antidiabetic agents, insulin, adherence, medication taking, compliance, fears, treatment and electronic monitoring. Those published between 1957 and 2010 are considered, with all age groups. Conclusion: various hurdles paving the way for poor patient compliance with diabetes mellitus have been reported, research displays that these obstacles can be easily dissolved with proper education and by creating an understanding for the adherence to the regimen. Introduction The present era witnesses a great deal of stress in every aspect of life. This results in increased incidence of hypertension, or cardiovascular diseases (CVD). Stress also induces dyslipidaemia and diabetes. Research and various clinical findings formulate that appropriate treatment is essential to decrease the incidence of morbidity and mortality happening due to all these ailments. It is essential to understand that all these conditions require lifelong treatment. Compliance with medicine is most essential to procure health benefits and to curtail the forthcoming consequences in terms of economic burden, wastage of time and money and other associated diseases with these ailments (Putzer, 2004). The present era witness a remarkable mount in occurrence and pervasiveness of type 2 diabetes in both pediatric and adult groups due to outbreak of overweight resulting in obesity, sedentary life style, resistance towards insulin and other metabolic conditions. It is therefore imperative to screen patients who show high-risk for diabetes and pre-diabetes. This step not only ensures on time diagnosis and exact classification but also ensures rapid onset of treatment and hence decreased risk for complications (Putzer, 2004). In order to avoid these complications it is essential that lifestyle modifications encompassing, modifications in diet, loss of weight and an appropriate schedule of physical exercise to sustain glycemic control. When these interventions fail then oral anti-diabetic agents are added as a part of regimen. It is established that type 2 diabetes cases require insulin therapy. When insulin or its analog is administered, there is a decrease in hypoglycemia. In severe cases when oral agents are also not able to procure enough control over the glycemic index, insulin therapy is given (Putzer, 2004). The situation is alarming in USA, as 45% of the pediatric patients are being diagnosed with type 2 diabetes (American Diabetes Association) as compared to the results of 1990s when only 1- 2% of children are diagnosed with type 2 diabetes (Gahagan, 2003). It is evident that all over the world, diabetes as a result of stress and depression is gaining prevalence resulting in enhanced expenditure on healthcare facilities, disabilities, diminished work productivity and premature death. It is observed that adults suffering from diabetes display two- folds of depression as compared to non-diabetic adults (Egedeand, 2003). The situation requires serious attention as it may lead to devastating consequences, the present literature review encompass the reasons to find the advances required for patient compliance with the line of medications. The disease leads to various complications causing microvascular complication of neuropathy, retinopathy and also nephropathy. These complications are the resultant of duration of diabetes and overall glycemic control. It is evident that type 2 diabetes mellitus (DM) require insulin and hence the compliance encompasses reduced resistance for insulin and enhanced insulin secretion. Research states that α-glucosidase inhibitors potentially reduce the absorption of carbohydrates, as a consequence there is a fall in postprandial hyperglycemia; on the other hand thiazolidinediones enhances insulin sensitivity, particularly in muscle and in adipocytes, whereas metformin reduces liver gluconeogenesis and sulfonylureas causes protracted augmentation in insulin secretion while meglitinide results in fast but fleeting enhancements in secretion (Haffer, 1988; Kaplan, 1989; Vague, 1956). Thus, type 2- diabetes is a metabolic syndrome with a gamut of paradigms including hyperglycemia, obesity, and resistance for insulin, complex dyslipidaemia, atherosclerosis and endothelial dysfunction. Type 2 diabetes is a metabolic syndrome as insulin plays an imperative role in metabolism, obesity leads to enhanced insulin resistance. Research investigates the augmentation of obesity; in 1991 only 7 states of USA displayed obesity over 15% while same percentage was recorded in around 50 states. This augmentation of obesity is directly related to type 2 diabetes, hypertension and coronary heart disease (Haffer, 1988; Kaplan, 1989; Vague, 1956). Complications of diabetes are directly linked to coronary heart disease and hypertension. This is due to hyperinsulinemia and resistance towards insulin. Various reports from the literature states that resistance for insulin is responsible for pathology of obesity, hypertension, type 2 diabetes and thus increases the risk of heart diseases (Kannel, 1967; Sowers, 1981; Tyroler, 1975), thereby establishing a fact that for type 2 diabetes a high level of glycemic control is required with appropriate reduction in weight and high level of control of Hyperlipidaemia and hypertension to avoid any long term complications. The drive of this article is to prevent complications of diabetes and to observe the significance of line of treatment that is provided to the patient and patient’s adherence to the medication, the compliance of the patient, as non-compliance results in failure of the treatment (Wishner, 2000), it is therefore studies related to compliance with medication is becoming a topic of research and new findings are coming up to improve the compliance of the patient with the regimen. It was observed that in the year 2005, a survey was conducted with 1267 patients under the program “Taking Control of Your Diabetes” and came out with the surprising results; out of 56% studied 28.2% of individuals with diabetes mellitus as they were not willing to take the therapy. This is due to several reasons 55% said it to be personal malfunction, while 50.8% said due to pain when taking an injection, whereas 46.7% as they thought that insulin dependency increases severity of illness, on the other hand 45% thought if they start it then there is going to be a permanence of therapy and 45.2% thought it to be restrictive in nature (Polonsky, 2005). Based on the area studied and geographical distribution the distribution of non-compliance varied. Another research states that 72% patient stick to the medication regimen according to Diabetes Audit and Research in Tayside, Scotland/Medicine Monitoring Unit study (Morris, 1997). Although it is observed that pharmacologic therapy for type 2 DM encompasses lifestyle modification and also changes in nutrition and physical activities and when all these interventions fail in diminishing the A1C levels are given insulin or its analog. Compliance also encompass patient’s obedience for physician’s instructions, patients’ voluntary role in pursuing medications (Lutfey, 1999). It is therefore essential that patient and physician relationship be in hormony as poor or lack of communication results in poor compliance. As the DM is highly sensitive in nature, with diversity in treatment options, communication amongst healthcare professionals and patient should be congenial for appropriate care. On the other hand a lot of care and communication is required for the healthcare provider and the minority. Lack of communication persists due to potential disparities owing to language barriers, level of education and differences in culture and food habits. It is therefore essential that some kind of perfection is desired in the health care communication. This is imposed either through camping where audio-visual aids are used to educate the patient, for those who are less educated, an educational film could be a great help, if the group of the patients is well educated then educational materials be provided. All these parameter could throw great impact on the treatment and adherence to the regimen of type 2 diabetes patient. Various research studies have been carried out to understand the patient compliance but not much could be procured because of inappropriate methodology available. The present article attempts to provide a literature review of the research being conducted for patient compliance for the type 2 diabetes. This incorporates medicines- antihypertensive, lipid lowering or oral antidiabetic medications. This enables an understanding towards the medical significance of patient compliance with the treatment of type 2 diabetes. Methods Searching: studies encompassing OHA, OAA and insulin were focused. Various related terms were focused encompassing diabetes, medication, OHA (Oral Hypoglycemia Agents), OAA (Oral Antihyperglycemic Agents), Oral antidiabetic agents, insulin, adherence, medication taking, compliance, fears, treatment and electronic monitoring. Those published between 1990 and 2010 are considered, with all age groups. Selection: Individuals belonging to all ages were studied general studies were not included. Moreover the standards established by National Service Framework (NSF) for Diabetes has laid 12 standards for the primary care trusts which emphasize upon the close co-operation amongst primary care and specialist services. Results According to this diabetes framework sets on two specific targets: 1. Eye screening 2. Registers It is based on the following themes: leadership and accountability involving and empowering patients audit and information technology Workforce planning. The foundation has laid 12 standards : Standard 1: Preventing Type 2 Diabetes: aims at reducing the diabetes patients by creating awareness in mass. It is based on the fact ‘Prevention is always better than cure’. It includes promotion of healthy living, placement of nurses, teachers, fitness instructors, pharmacists. Inculcation of healthy lifestyles especially mental health promotion is imperative in the present era of stress. This should be incorporated in schools and elderly care centers. This is to be promoted as an individual and also in group. “Diet and exercise” should be promoted in group to induce healthy eating habits and to burst out stress. The groups encompass schools prisons and club houses where people can have an open discussion and talks. Moreover, as a group and cognitive development “Diabetes Awareness Day” be celebrated. Open discussions be promoted, encompassing seminars and group activities that promote awareness for reducing obesity and inducing healthy eating and healthy living. Standard 2: Identifying people with diabetes in the crowd who don’t even know that they are suffering from diabetes through screening tests. Moreover it is important to have a follow-up of those diagnosed and those previously diagnosed with weakened glucose tolerance. This follow-up should also be with women who possess the history of gestational diabetes. Screening should also be done for inpatients for glycosuria. It is imperative that people belonging to primary care and community staff be educated in appropriate manner. Recognition of susceptible population is highly essential. It is also important that this group should be educated about the intensity of the disease and repercussions of non- compliance with medication regimen. This will put some psychological impact on the patient and patient will follow the regimen to greater extent. Screening is also performed for overweight population in school or community for diabetes, as overweight enhances the chances to get diabetes. Standard 3: Empowering people with diabetes. It is essential that diabetics should not feel as physically compromised, they need to be empowered by making them understand their potentials and skills so that they feel motivated and remain enthusiastic. Standard 4: Clinical care of adults with diabetes: improving the quality of life of people with diabetes to minimize the potential risk of long-term complications related to diabetes. For this education is highly imperative about the kind of care and precautions they should take, a regular check-ups. Follow-up of the patient is essential especially those staying in house or custody, special care be given to the patients who are physically weak. Standard 5 and 6: Clinical care of children and young people. It is imperative that clinical care must be taken for the diabetics. It is essential for the physician to take care of patients and generate trust in them to count on doctor and follow the instructions given by the doctor. This will help in adherence to the regimen. Standard 7: To take care of Diabetic emergencies to seek help of trained staff and skilled hands along with the education of the patient. The patient must be provided with all the means like phone numbers of physician or associates and caretakers, they should be prepared for any kind of emergencies and to take action when the time demands. Standard 8: Caring for people in hospital, paying great emphasis on quality of food that is being provided to the hospitalized individuals. In this case team work plays the crucial role between ward nurse, practice nurse, district nurse and diabetes specialist nurse as combined efforts do play crucial role in patient’s compliance with the medication regimen. A healthy and congenial atmosphere thus helps to build confidence in the patient. Standard 9: Diabetes and pregnancy. Any history of having diabetes during pregnancy increases the chances for diabetes in future. These cases should take utmost precautions and in case if any symptoms appear they should contact their physician. Standard 10, 11 & 12: Detecting and managing complications, to reduce the complications that re induced as a result of poor compliance. This encompasses use of national diabetes dataset to understand and assess the condition of heart, eyes, feet and kidneys of the patients. Special care should be provided to those who undergo complications. It is therefore imperative that patient be educated to provide an immediate response to the health conditions (An RCN guide to the National Service Framework for Diabetes). Therefore appropriate attention and cautions through proper education will help the patient to adhere to the medication regimen. Discussion It is important to understand that special thoughtfulness should be specified to the treatment of any child or an adolescent with type 2 diabetes, this is done in accordance to meticulous awareness for physical, mellowness, and emotional development; community atmosphere; and assets and funds. Children and adolescents should not be treated as younger adults. The use of adult-appropriate diabetes educational resources is often not supportive; also the use of type 1 diabetes educational resources for children or adolescents with type 2 diabetes is unsuitable. It is always perfect to put efforts that match a younger patients level of assurance with a suitably planned therapy, allowing for any potential to enhance the probability of faithfulness and compliance to therapy. Although it is not always likely because of geographic distances and variation in accessibility of resources, the participation of a physician’s team is imperative. The appearance of type 2 diabetes in childhood and adolescence is distressing, particularly when one believes that the long-term public health and communal implications as these patients progress to chronic complications, potentially at a very young chronological age. It must be considered and kept as a part of education that prevention is always better than cure. Counting on newer and more authoritative oral agents and also insulin analogs are more advantageous for physiological delivery of insulin, insulin infusion devices, and precise and less enveloping methods of assessing glycemic control, and therefore offer great and promising future of diabetes in patients. The following table discusses the hurdles that occur in the path of compliance for diabetes: Adapted from LaRosa. Available: http://www.actos.com/diabetesinsightcenter/compliance.aspx It is observed that non- compliance is a widespread issue that creates obstacles in the regimen of type 2 diabetes. It is reported that Fixed-dose combinations (FDCs) are shown to enhance the compliance of the patient and therefore plays an imperative role in the effectiveness of treatment. Moreover constant investigation and monitoring of the patient helps in determining the compliance of the patient, whereas blood glucose values remind the patient to adhere to the regimen. Fixed dose combination helps in maintaining patient compliance to diabetes: Adapted from: Diabetes Insight Centre. Conclusion All these developments be taken care of with precision and with appropriate measures a compliance could be established but it is a long way to go. We are just at the tip of the iceberg in maintaining the compliance of patient with medication regimen. Future looks to belong to a group of educated people who eat healthy to stay healthy. With the above discussion it is clear that fixed combination therapy plays vital role in adherence of the patient with the therapy. Recently insulin inhaler is also available in the market and this is a great boon to the diabetes patients to maintain compliance to avoid further complications that occur as repercussions of poor compliance of the patient with the treatment regimen. The patient must be made aware about the consequences of type 2 diabetes to maintain compliance with the therapy. 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H., Fisher, L., Guzman, S., Villa-Caballero, L., Edelman, S.V. 2005. Psychological insulin resistance in patients with type 2 diabetes: the scope of the problem. Diabetes Care, 28(1), 2543 -2546. Putzer, G., Roetzheim, R., Ramirez, A. M., Sneed, K., Brownlee, H. J., Campbell, R. J. 2004. Compliance with Recommendations for Lipid Management among patients with Type 2 Diabetes in an Academic Family Practice. The Journal of the American Board of Family Practice, 17, 101-107. Sowers, J. R., Tuck, M. L. 1981. Hypertension associated with diabetes mellitus, hypercalcemic disorders, acromegaly and thyroid disease. Clin Endocrinol Metab, 10, 631-56. Tyroler, H. A., Heydon, S., Harnes, C, G. 1975. Weight and hypertension. Evans County study of blacks and whites. In: Paul O (ed), Epidemiology and Control of Hypertension. New York: Stratton International, 177.   Vague, J. 1956. 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