Factors associated with non-adherence to insulin in Type 1 and Type 2 diabetes mellitus patients in Western region of Algeria, Tlemcen: a cross-sectional study.

Introduction: adherence to drugs is critical for achieving the best clinical results in the treatment of chronic diseases. Adherence to chronic drugs might be influenced by beliefs about medications and other variables. The goal of this study was to assess relevant determinants of medication adherence in Algerian population with insulin-dependent diabetes. Methods: from July 1st 2019 to February 29th 2020, a cross-sectional study was conducted. Participants who had been on insulin for at least 6 months were recruited from Tlemcen (Algeria) clinics in secondary care settings. Patients were invited to a face-to-face interview, in order to complete out the Morisky Medication Adherence Scale-8 (MMAS) tools to report their attitudes towards medication adherence and views about their insulin. The recruited patients' socio-demographic data was also collected. The related determinants of chronic drug non-adherence in the tested population were identified using a stepwise binary logistical regression model. Results: in this study, 147 patients out of 400 were not adhering to their insulin therapy (36.5%). Insulin non-adherence was linked to single status (AOR=2.088, CI=1.180-3.694), non-insurance (AOR=2.949, CI=1.323-6.572), number of daily insulin injections (AOR=1.269, CI=1.033-1.559), unawareness of the insulin regimen (AOR=3.528, CI=1.453-8.565), hypertension (AOR= 3.497, CI=1.98-6.154) and the non-practice of self-monitoring of blood glucose (SMBG) (AOR=2.635, CI=1.472-4.718). Conclusion: insulin adherence in Algerians is still well below international standards. This study improved the understanding of the factors affecting the non-adherence to insulin among diabetics and may be used as a baseline to target; throughout educational programs; the sub-populations identified as non-adherents.

Insulin injection technique in the western region of Algeria, Tlemcen.

INTRODUCTION: Algeria has more than 1.7 million diabetic patients on to whom a descriptive assessment particularly on the insulin usage behaviors has not yet been initiated, although is needed. This study aims to provide a descriptive analysis of how Algerian diabetic patients perceive and apply insulin injection techniques. METHODS: using the "patient" questionnaire within the Injection Technique Questionnaire (ITQ) 2016 survey, this study assessed the insulin injection practices of 100 patients recruited over a seven-month period in western Algeria at the Tlemcen University Hospital Center. The results of this study are compared to those of the ITQ 2016 survey. RESULTS: pens are the instruments of injection for 98% of Algerians who continue to use mostly long needles of 6- and 8-mm, although 4mm needles are the recommended safer option. Insulin analogues (fast and basal) are plebiscite. Arms and thighs are the preferred injection sites; the abdomen (the preferred site elsewhere) is neglected for reasons to be investigated. The correct re-suspension technique for cloudy insulin is unknown. Extensive pen needle re-use (10+ times) for over half of the patients exposes them to both higher intramuscular (IM) injection risk and lipohypertrophy (LH). Injection training is performed in Algeria by the diabetologist. CONCLUSION: this study describes for the first time Algerian patients´ insulin injection technique. It highlights their skills and identifies many deficiencies which patients and professionals must correct given the issues in this area.

Relationship between age at onset and clinical characteristics of Behçet's disease.

INTRODUCTION: This study compares the clinical characteristics and treatment modalities of Behçet's disease patients by age of onset at the Dr. Tidjani Damerdji University Hospital Center in Tlemcen, Algeria. METHODS: Data from patients treated for Behçet's disease between January 1990 and December 2016 were analyzed retrospectively. All patients that fulfilled the diagnostic criteria laid down by the International Study Group for Behçet's Disease were included in the study. Patients with early-onset disease (≤ 30 years) were compared to those with late-onset disease (> 30 years). RESULTS: Among the 77 patients whose data were collected for the study, 80.5% weremale and the mean age at onset was 27.2 ± 7 years. Approximately 60% of the patients had early-onset disease, and those patients exhibited more frequent intermediate uveitis (52.9% vs. 22.7%, p = 0.03), posterior uveitis (54.3% vs. 23.8%, p = 0.03), and panuveitis (45.7% vs. 14.3%, p = 0.01) compared to those with late-onset disease. Azathioprine (57.5% vs. 26.9%, p = 0.01) and biological therapy (15% vs. 0%, p = 0.03) were used more frequently in the early-onset group. CONCLUSIONS: Early-onset Behçet's disease was associated with more frequent and more severe ocular features. Furthermore, azathioprine and biological therapy were more often used in that group of patients.

Safety of Interferon Alpha-2a in Patients with Severe Ophthalmic Behçet's Disease: Response to Bielefeld et al.'s Letter.

Thyroid dysfunction is a common and severe side-effect encountered in up to 40% of patients treated with IFN-alpha-2a. The main two mechanisms by which IFN-alpha-2a induces thyroid dysfunction can be categorized as autoimmune and non-autoimmune disease. In the first subgroup, thyroid antibodies are found before treatment initiation, and then patients develop thyroiditis. In the second subgroup, IFN-alpha-2a induces thyroiditis by a direct cytotoxic effect on the thyroid gland; in this case, thyroid antibodies are usually negative. To avoid such complications, patients should undergo routine thyroid screening (thyroid-stimulating hormone and thyroid antibodies) prior to IFN-alpha-2a initiation, during the treatment period, and 6 months after treatment withdrawal.