Patients’ Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE

Background: Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. Methods: This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. Results: A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor’s and Master’s degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. Conclusion: The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.

Soluble lectin-like oxidized low-density lipoprotein receptor-1 [sLOX-1] levels in serum of normal volunteers and type 2 Diabetics

Oxidative stress is increased in diabetes mellitus and is thought to be involved in the pathogenesis of the chronic complications of diabetes. Oxidized low density lipoprotein [LDL] causes endothelial activation, injury and dysfunction. Serum oxidized LDL receptors [sLOX-1] levels have been reported to be associated with atherosclerosis and diabetic vasculopathy. To compare soluble Lectin-like Oxidized Low Density Lipoprotein receptor-1 [sLOX-1] levels in serum of type 2 Diabetes mellitus patients with normal volunteers; and to study its association with other biochemical parameters. Study participants included in this pilot study were males and females aged 25-50 years. Fasting blood specimens were collected from 21 normal volunteers and 51 type 2 diabetic patients visiting the outpatient department of the Gulf Medical College Hospital, Ajman, UAE. All diabetics included were on Metformin. None of them had renal, cardiovascular or liver disease. Routine biochemical investigations [Lipid profile, Fasting Plasma Glucose, HbA1C] were performed on Roche Cobas 6000 analyzer. Serum Total Antioxidant status was estimated using a kit from Sigma Aldrich, USA. sLOX-1 level in serum was estimated using Human LOX-1 ELISA Kit from Cell Biolabs, USA. Statistical analysis was done on IBM SPSS software version21. Serum sLOX-1 levels did not follow a [normal] statistical distribution in the population. No difference in the serum sLOX-1 levels was seen between the normal and diabetic participants. sLOX-1 levels did not correlate with age, BMI, fasting glucose, total-, LDL- or HDL-Cholesterol, triglyceride levels or total antioxidant status. However, within the diabetic population, sLOX-1 levels correlated weakly but significantly with the duration of diabetes. Since sLOX-1 levels in serum showed high variability in the population and did not follow a normal distribution, further studies with larger sample sizes are needed. Correlation of sLOX-1 levels with duration of diabetes is interesting and needs to be investigated further

case of optic nerve hydrops with tolosa hunt syndrome: a case report

A 36-year old female patient presented with complaints of discomfort in left eye associated with mild morning pain since 3 days duration. Patient had history of facial nerve paresis in the right side, few year back that recovered spontaneously. On examination, the visual acuity was 6/6 in the right eye and 6/6P in the left eye. Anterior segment of both eyes was normal in both eyes. Fundus examination of the right eye was normal while of the left eye showed mild disc oedema. Patient was kept under observation and was reviewed in two days. She complained of persistent discomfort in the left eye and double vision. On examination the visual acuity, color vision was normal. She developed abduction weakness and elevation deficit in the left eye. The disc oedema had increased in the left eye. She underwent MRI of Brain and orbit, which showed optic nerve hydrops in the left side. Neurological examination was normal except for the findings noted above. With consultation with neurologist and internist she was started on tablet acetazolamide 250 mg thrice a day and intravenous methylprednisolone IgM daily for 3 days. The initial MRI features were suggestive for Optic nerve hydrops due to Benign Intracranial Hypertension when a follow up MRA / MRV showed features of optic nerve hydrops with Tolosa Hunt Syndrome. The optic nerve hydrops presenting with Tolosa Hunt Syndrome is unusual in our case

Total antioxidant status and lipid parameters among patients of hypothyroidism

To determine i] the total antioxidant status in hypothyroid patients and ii] its association with hormonal and lipid parameters. Total antioxidant status [TAS], lipid and thyroid hormone profile was determined in patients [n=27] with Hypothyroidism referred for laboratory assessment of thyroid function in GMCH. Normal volunteers [n=24] served as the control group. Data was analyzed on SPSS 19.0 software. The TAS in normal volunteers was found to be 1.65 +/- 0.32 mmol/L while in patients with subclinical [N=12] and overt Hypothyroidism [N=15] it was found to be 1.25 +/- 0.23 and 1.28 +/- 0.23 mmol/L respectively. While the difference in TAS between the normal and the over hypothyroid group was significant [p<0.001], no significant difference could be observed between the subgroups within the hypothyroid state. TAS was found to be significantly lower in patients with low T3 [<3.1 nmol/L], however no such association was seen with low T4 levels. Serum TSH level was found to correlate strongly and significantly with total cholesterol and LDL levels. TAS was lower in patients with high serum cholesterol levels [p<0.001] but no difference was seen with LDL levels. TAS is significantly lower in patients with both subclinical and overt hypothyroidism compared to normal. TAS levels seem to be associated with low T3 but not T4 levels. While the result appear to show a trend, the sample size is very small and more work is needed. The study is still in progress

Use of antihypertensive medications in patients with diabetes in Ajman, UAE

Optimal reduction in blood pressure with antihypertensive agents helps to prevent diabetic microvascular and macrovascular complications. The objective of the study was to evaluate the current utilization pattern of antihypertensive medications among patients with diabetes and co-existent hypertension as per the JNC 7th Report guidelines. A cross sectional survey was carried out among patients with diabetes attending the Outpatient Department of Internal Medicine at a tertiary care hospital in Ajman. Medical records of the patients were used to obtain diagnostic, demographic and drug use information. Unvariate analysis was performed using Chi square and t-test followed by logistic regression to compute independent predictors. Of 132 patients with diabetes, uncomplicated hypertension [HTN] was coexistent in 107 [81%] patients. Males constituted 49.5% of the total. The mean age of patients with HTN was [55.1 +/- 10.1], which was higher than that in those without HTN [49.6 +/- 9.9] [p<0.05]. 51.4% of patients with HTN were between 45-60 years of age. A higher number of patients with HTN had duration of diabetes < 5 years than those >5 years [p<0.05]. While adjusting the significant factors, only the duration of diabetes [adjusted OR 1.06; CI [1.003-1.116]] was statistically significant among patient with HTN. 68 [62.6%] prescriptions contained one antihypertensive drug, 29 [30%] two drugs and 8 [7.4%] no anti-hypertensive drug. Angiotensin converting enzyme inhibitors/ angiotensin receptor blockers [ACEI/ ARBs] followed by diuretics were commonly prescribed. ARBs with diuretics were the most frequent two drug combination. The antihypertensive utilization pattern was similar in both gender and age groups. The results represent the current prescribing trend for anti-hypertensive agents among patients with diabetes, which is in accordance with JNC-7 recommendations

Age and gender-based utilization pattern of anti-diabetic drugs in Ajman, UAE

Diabetes is a chronic multi-system metabolic disease associated with morbidity and mortality and cost to the society. Pharmacotherapy is an integral part of the management of diabetes. Factors like age, gender, Body Mass Index [BMI] and coexisting illnesses determine the prescription. The objective of the study was to evaluate the drug usage pattern of anti-diabetic drugs in different age groups and gender. A cross sectional epidemiological survey of all prescriptions of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman was conducted for a duration of 3 months. The socio-demographic and drug information was obtained by researchers with the help of a questionnaire. 54.8% patients were males and 45.2% were females. The mean age of patients with diabetes was 54.09 +/- 10.24 years. 128 patients were type 2 diabetes. Metformin combinations were the commonly prescribed anti-diabetic drug. Insulin prescription was noted in 14 patients, the commonest being Human Insulin. Metformin combinations were commonly prescribed in both genders. For patients below 45 years and those between 45-60 years of age metformin combinations were the commonest prescribed, while among patients above 60 years of age sulfonylureas were the most commonly prescribed. The utilization pattern of anti diabetic drugs varied among different age groups and gender. Metformin combination with newer antidiabetic medications were commonly utilized

Patients' adherence to anti-diabetic medications and factors associated with adherence

Anti-diabetic drug therapy plays a pivotal role in the glycemic control patients with diabetes. Patient with chronic diseases such as diabetes often discontinue their medications for various reasons which could lead to ineffective control of blood glucose levels. The objective of the study was to assess the patient adherence of anti-diabetic drug therapy and explore the reasons for non-adherence. This was a cross sectional survey of patients with diabetes attending the Outpatient department of Internal Medicine of Gulf Medical College Hospital and Research Centre, Ajman carried out over a period of three months. Data on patient adherence, knowledge of anti-diabetic drugs and patient-provider relationship were collected with the help of a researcher-administered questionnaire. A total of 132 patients were included [63 males and 69 females]. The mean age of the subjects was 54.09 +/- 10.24 years. Patient adherence rate to anti-diabetic drugs was 84%. Adherence was similar among male and female patients. Based on the educational status, patients with schooling showed non-adherence. The most common reason for non-adherence was forgetfulness. Only 2.3% of the patients took self-medication and alternative therapies in addition to the medications prescribed. The majority of the patients had good patient-physician relationship. The patients had good knowledge of diabetes and anti-diabetic medications, received from their doctor or as self-learned. It is crucial that health providers assess adherence of patients to drug therapy in the event of poor glucose control and presumed failure of the prescribed therapeutic regimen. Additionally, the health care providers should practice patient counseling on medication adherence for effective management of diabetes

Self-rated health status, BMI, blood pressure and felt health needs among entry year medical university students in Ajman, UAE

To assess the self-rated health status and its association with BMI and blood pressure, and felt health needs of the entry year medical university students. This was part of a larger study including hypertension and health behavior among GMU students. The study used information collected on overall self-rated health, and physical, mental and social health using rating scales and multiple response questions. The participants also indicated their felt health needs. Height, weight and blood pressure were measured. Among the 110 participants 93.7% rated their health to be good or very good; 57.3% considered themselves to have good figure and 26.4% higher than normal weight; 69.1% were moderate to highly active; though 52.8% were anxious to very anxious, 94.6% could manage their daily stress; 91% had close family members or friends. Almost two thirds expressed the need for opportunity for physical activity and one third dietary counseling. More pre-hypertensives and hypertensives [41.5%] than normal [17.4%] considered themselves to be fat, and less "very active" than "moderately or mildly active". Out of 7 very anxious five were pre-hypertensive/hypertensive. Among the pre-hypertensive / hypertensives 9.7% were not able to manage daily stress compared to 3% of normal; 12.2% considered themselves to have poor health compared to 1.4% of normal. Among the 48 overweight [BMI>25] participants 52.1% rated themselves to be fat and 41.7% normal, only 3 considered their health to be poor and 25% considered health to be very good. The majority rated their health as good. While 43.6% were overweight only 26.4% perceived themselves to be so. Student Welfare needs to consider a program for the felt needs of physical activity for the future health providers