Glycemic control and associated factors in patients with type 1 diabetes mellitus in primary care in Southeastern Brazil

Abstract Diabetes is a self-managed condition with knowledge, attitudes and practices that can influence the overall treatment and outcomes delay the complications of diabetes. However, the few reported studies published point out that: low education level, poor adherence to pharmacotherapy and diet recommendations, infrequent monitoring of blood glucose, and insulin dosage regimen are associated with higher hemoglobin levels. This study aimed to assess the knowledge, adherence medication, and complexity of pharmacotherapy in T1DM patients in Brazil. A cross-sectional study was conducted involving 156 T1DM patients who were attending in primary care. Logistic regression analyses were conducted to assess the variables associated with glycemic control. The overall assessments of T1DM patients for the glycemic control were bad (121, 77.6%). However, T1DM patients with high MedTake Test (OR=2.4, CI=1.1-5.7) and Morisky-Green Test (OR= 2.5, CI=1.1-6.1), and in the use of dosage insulin (>40 units, OR=0.3, CI=0.1-0.7) and postprandial glucose (100-125mg/dl, OR=3.8, CI=1.1-14.6) had better glycemic control compared to uncontrolled patients. Glycemic control in Brazilians adults with T1DM is low. We suggested the screening patients with low MedTake and Morisky-Green Tests, increasing patient knowledge as part of a complex intervention that may lead to substantially improved treatment outcomes in primary care

Patient's lack of understanding producing insulin drug-interactions in Southeast Brazilian primary care clinics.

Detrimental drug-drug interactions (DDIs) in Diabetic patients could be from the simultaneous use of multiple drugs, polypharmacy. Brazilian public health studies evaluating the practical knowledge about drug interactions are scarce. This study's objective is to identify drug interactions and prevalence of detrimental DDIs in diabetic patients attending Brazilian basic health system clinics. METHODS: Patients using insulin between the age of 18-90 years were selected to complete the MedTake questionnaire, to evaluate the indication, dosage, regimen and drug interaction. The MedTake test was employed. For each medicine, the test was scored as the percentage of correct actions and compared with printed instructions one single researcher downloaded all the data was from the municipality's computerized system. RESULTS: The median age of recruits was 60.2 ±â€¯14.3 and MedTake test scores were low 60.3 ±â€¯20. One hundred patients missed the correct dose question, 40 missed why they were prescribed the drug, indication and 65 missed the therapeutic regimen. These diabetes patients did not know the DDIs between insulin combined with other medicines. Drugs that had more interaction with insulin were: acetylsalicylic acid (40%), enalapril (18%), losartan (32%) and hydrochlorothiazide (23%). CONCLUSIONS: Diabetes patients without practical knowledge about insulin interacting with other pharmaceutical drugs that can produce DDIs with other medicines illustrates a need to develop education programs for diabetics.

Heart failure is associated with non-adherence to pharmacotherapy in elderly with type 2 diabetes mellitus in public health system Brazilians.

The rising prevalence of T2DM poses a serious threat to human health and the viability of many health care systems around the world. Non-adherence to therapeutic in the T2DM is high, and Brazilian studies of public heath for to identify new variables are scares. The present study explored cardiovascular consequences associated with compliance and non-adherence among T2DM in Brazilian patients seeking medical care in Brazilian basic health unit clinics. METHODS: This is a cross-sectional study carried out in a city the interior of Sao Paulo state, with patients with T2DM, being municipal PHS users. Data were collected from the computerized system of the municipality for a one single researcher and patient records, and analyzed using the IBM SPSS v.18 statistical package. The response variables was categorized in adherent MGT (>80) and non-adherent MGT (≤80). RESULTS: The mean age of patients was 63.6 ±â€¯9.5 with predominance for the sex male 66.4% and 42% of patients with T2DM do not adherence to treatment. We found an associated odds ratio (OR) = 2.3 (1.1-5.1) between heart failure and non-adherence in patients with T2DM. CONCLUSION: Heart failure is a factor associated with non-adherence to treatment in patients with T2DM and in the practice clinical, the screening for heart failure and interventions may improve adherence to pharmacotherapy.

Hipertensão Arterial Resistente: uma oportunidade para o farmacêutico desenvolver o cuidado farmacêutico / Resistant Hypertension: an opportunity for the pharmaceutical develop pharmaceutical care

A hipertensão arterial resistente (HAR) ocorre quando há falta de controle da pressão arterial com o uso de ≥3 fármacos anti-hipertensivos distintos, em doses máximas, e toleradas após a exclusão da hipertensão secundária. O Cuidado Farmacêutico (CF) permite a interação do farmacêutico com o paciente, reduzindo os problemas referentes à farmacoterapia e agravamentos devido ao acompanhamento farmacoterapêutico. Neste contexto, o objetivo desta revisão é discutir a farmacoterapia e interações medicamentosas em pacientes com HAR e propor medidas para aumentar a adesão ao tratamento. Os métodos de busca para o estudo foram obtidos em livros e bases de dados eletrônicas como Science Direct, PubMed e SciELO. O CF melhorou o controle da pressão arterial, a adesão ao tratamento e a qualidade de vida dos pacientes com HAR. Apesar de a farmacoterapia estar bem estabelecida, o CF, somado às medidas não farmacológicas, e o uso dos pictogramas podem ser usados para ajudar no controle da HAR.

Resistant hypertension (RH) occurs when there is lack of blood pressure control with the use of ≥3 antihypertensive of different classes after exclusion of secondary hypertension. Pharmaceutical Care (PC) allows pharmacist interaction with the patient and reduces problems related to pharmacotherapy due to pharmacotherapeutic follow-up. In this context, this review aims to discuss pharmacotherapy and drug interaction in patients with RH proposing measures to increase adherence to treatment. Methods of the search for the study were obtained from books and electronic databases such as Science Direct, PubMed and SciELO. PC improved blood pressure control, adherence to treatment and quality of life of patients with RH. Although pharmacotherapy is well established, the AF adds the non-pharmacological measures and the use of pictograms can be used to help in the control of HAR.