Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes

Figures & data

Table 1 Characteristics of participants

Demographic data (N=241)	Frequency (%)		χ^2 (P-value)	z value# (P-value)
	Control (n=121)	Intervention (n=120)
Sex
Male	56 (46.3%)	50 (41.7%)	0.521 (0.471)
Female	65 (53.7%)	70 (58.3%)
Age in years, mean ± SD (median)	58.5±8.3 (59.0)	59.7±9.5 (59.5)		−1.132 (0.258)
21–50	20 (16.5%)	17 (14.2%)	1.505 (0.471)
51–60	53 (43.8%)	46 (38.3%)
61–75	48 (39.7%)	57 (47.5%)
Ethnic group
Malay	47 (38.8%)	61 (50.8%)	4.830 (0.089)@
Chinese	23 (19.0%)	26 (21.7%)
Indian	47 (38.8%)	32 (26.7%)
Others	4 (3.3%)	1 (0.8%)
Marital Status
Single	4 (3.3%)	4 (3.3%)	3.089 (0.378)
Married	97 (80.2%)	98 (81.7%)
Divorced	7 (5.8%)	2 (1.7%)
Widower	13 (10.7%)	16 (13.3%)
Level of education
None and primary	13 (10.7%)	8 (6.7%)	6.637 (0.084)
Secondary	75 (62.0%)	61 (50.8%)
Diploma	16 (13.2%)	27 (22.5%)
Tertiary and postgraduate	17 (14.0%)	24 (20.0%)
Working status
Yes	50 (41.3%)	48 (40.0%)	0.044 (0.834)
No	71 (58.7%)	72 (60.0%)
Income per month
≤ RM1,000 (USD$309)	48 (39.7%)	49 (40.8%)	6.826 (0.234)
RM1,001–3,000 (USD$310–$929)	45 (37.2%)	47 (39.2%)
RM3,001–5,000 (USD$930–$1,548)	24 (19.8%)	14 (11.7%)
≥ RM5,001 (USD$1,549)	4 (3.3%)	10 (8.3%)
Body mass index in kg/m^2@@, mean ± SD (median)	29.1±7.0 (28.4)	29.3±6.3 (28.0)		−0.288 (0.773)
Underweight to healthy weight	27 (23.5)	21 (18.4)	1.917 (0.383)
Overweight	44 (38.3)	58 (50.9)
Obese	44 (38.3)	35 (30.7)
Number of times patient exercises in a week
≤ Once a week	43 (35.5%)	35 (29.2%)	2.208 (0.331)
Twice a week	10 (8.3%)	16 (13.3%)
≥ Three times a week	68 (56.2%)	69 (57.5%)
Duration of diabetes in years, mean ± SD (median)	16.3±8.0 (15.0)	16.3±8.0 (15.0)		−0.112 (0.911)
0–10 years	28 (23.1%)	30 (25.0%)	0.623 (0.732)
11–20 years	52 (43.0%)	55 (45.8%)
>20 years	41 (33.9%)	35 (29.2%)
Number of concurrent diseases
0	38 (31.4%)	30 (25.0%)	2.578 (0.765)
1	31 (25.6%)	41 (34.2%)
2	34 (28.1%)	33 (29.5%)
>3	18 (14.9%)	16 (13.3%)
Number of prescribed medications, mean ± SD (median)	6.1±2.2 (6.0)	6.4±2.1 (6.0)		−0.247 (0.805)
0–5 types	47 (38.8%)	41 (34.2%)	0.568 (0.451)
≥6 types	74 (61.2%)	79 (65.8%)
Medications prescribed at baseline
Alpha-glucosidase inhibitor	9 (3.5%)	17 (6.7%)	0.287^ (0.866)
Biguanide	108 (41.9%)	105 (41.2%)
Dipeptidyl peptidase-4 inihibitor	2 (0.8%)	0 (0%)
Meglitinide	1 (0.4%)	0 (0%)
Medications prescribed at baseline
Sulphonylurea	39 (15.1%)	36 (14.1%)
Thiazolidinedione	3 (1.2%)	2 (0.8%)
Insulin	96 (37.2%)	95 (37.3%)
Incretin mimetic	0 (0%)	0 (0%)
Medications prescribed at the twelfth month
Alpha-glucosidase inhibitor	3 (1.2%)	11 (4.5%)	2.024^ (0.567)
Biguanide	103 (41.9%)	94 (38.5%)
Dipeptidyl peptidase-4 inhibitor	6 (2.4%)	7 (2.9%)
Meglitinide	0 (0%)	0 (0%0
Sulphonylurea	32 (13.0%)	35 (14.3%)
Thiazolidinedione	1 (0.4%)	0 (0%)
Insulin	100 (40.7%)	95 (38.9%)
Incretin mimetic	1 (0.4%)	2 (0.8%)

Notes:

# Mann–Whitney U-test is used for continuous variables; χ², chi-square test used for categorical variables

@ chi-square value was obtained by omitting the ethnic group “Others”

@@ healthy weight range, 18.5–24.9 kg/m²; overweight, 25–29.9 kg/m²; obese, ≥30 kg/m²

^ chi-square value was obtained by analyzing the major classes of antidiabetes agents (biguanide, sulfonylurea, and insulin), as the sample size for the other classes was very small.

Abbreviation: N, total participants in the study; n, number of participants in each group; SD, standard deviation.

Figure 1 Comparison of FBG between control and intervention groups over time (shown as median in the graph).

Notes: z-value, Mann–Whitney U-test, *statistically significant at P<0.05; **P<0.01.
Abbreviations: FBG, fasting blood glucose; C, control group; I, intervention group; n, number of participants in each group.

Figure 2 Comparison of HbA_1c values between control and intervention groups over time (shown as median in the graph).

Notes: z-value, Mann–Whitney U-test, *statistically significant at P<0.05; **P<0.01.
Abbreviations: HbA_1c, glycated hemoglobin; C, control group; I, intervention group; n, number of participants in each group.

Table 2 Comparison of medication adherence between control and intervention groups based on three levels of adherence

Medication adherence	Frequency (%)		χ^2 (P-value)
	Control	Intervention
Baseline	n=121	n=120	1.900 (0.387)
Low adherence	43 (35.5%)	36 (30.0%)
Medium adherence	43 (35.5%)	53 (44.2%)
High adherence	35 (28.9%)	31 (25.8%)
Month 4	n=109	n=115	7.310 (0.026)*
Low adherence	48 (44.0%)	31 (27.0%)
Medium adherence	35 (32.1%)	52 (44.3%)
High adherence	26 (23.9%)	33 (28.7%)
Month 8	n=110	n=102	7.289 (0.026)*
Low adherence	46 (41.8%)	25 (24.5%)
Medium adherence	33 (30.0%)	37 (36.3%)
High adherence	31 (28.2%)	40 (39.2%)
Month 12	n=121	n=120	8.182 (0.017)*
Low adherence	50 (41.3%)	30 (25.0%)
Medium adherence	41 (33.9%)	45 (37.5%)
High adherence	30 (24.8%)	45 (37.5%)

Notes:

* Statistically significant at P<0.05. χ², chi-square test.

Abbreviations: n, total number of participants in each group.

Table 3 Comparison of medication adherence between control and intervention groups when classified as nonadherence and adherence

Adherence/nonadherence	Frequency (%)		χ^2 (P-value)
	Control	Intervention
Baseline	n=121	n=120	0.838 (0.360)
Nonadherence	43 (35.0%)	36 (30.0%)
Adherence	78 (64.5%)	84 (70.0%)
Month 4	n=109	n=115	7.151 (0.007)*
Nonadherence	48 (44.0%)	31 (27.0%)
Adherence	61 (56.0%)	84 (73.0%)
Month 8	n=110	n=102	7.118 (0.008)*
Nonadherence	46 (41.8%)	25 (24.5%)
Adherence	64 (58.2%)	77 (75.5%)
Month 12	n=121	n=120	7.238 (0.007)*
Nonadherence	50 (41.3%)	30 (25.0%)
Adherence	71 (58.7%)	90 (75.0%)

Notes: χ², chi-square test,

* statistically significant at P<0.01.

Table 4 Comparison of fasting blood glucose and glycated hemoglobin (HbA_1c) within control and intervention groups over the study period

Differences	Fasting blood glucose (z-value # [P-value])		HbA1c (z-value# [P-value])
	Control	Intervention	Control	Intervention
Baseline–4 months	−0.761 (0.446)	−3.968 (<0.001)*	−1.780 (0.075)	−8.595 (<0.001)*
Baseline–8 months	−1.451 (0.147)	−2.784 (0.005)*	−0.831 (0.406)	−7.157 (<0.001)*
Baseline–12 months	−1.134 (0.257)	−5.909 (<0.001)*	−1.115 (0.265)	−8.265 (<0.001)*
4 months–8 months	−0.109 (0.913)	−0.511 (0.609)	−0.823 (0.411)	−2.728 (0.006)*
4 months–12 months	−0.008 (0.994)	−2.980 (0.003)*	−0.554 (0.580)	−4.831 (<0.001)*
8 months–12 months	−0.268 (0.788)	−3.264 (0.001)*	−0.159 (0.874)	−4.884 (<0.001)*

Notes:

# z-value, Wilcoxon signed-rank test

* statistically significant at P<0.01.

Abbreviation: HbA_1c, glycated hemoglobin.