Drinkers don’t take their medications often enough

alcoholA recent study by Bryson et al. has found that moderate to severe alcohol misuse increases the likelihood that patients won’t take their medication properly.

Many patients do not take their medications as often as they should – i.e. on at least 80% of the days they are supposed to.  In fact, a recent study found that over the space of a year, 40% of patients taking cardiovascular or diabetes medications didn’t take their medications often enough.  Such ‘medication nonadherence’ is associated with worsening of disease, increased health care costs, and even death.

Bryson et al. looked at more than 20,000 patients who were receiving treatment for high blood pressure, high cholesterol levels, or diabetes.  All participants undertook a three-point questionnaire to evaluate their alcohol use on the basis of frequency and typical quantity of drinking during the past year, and the frequency of heavy episodic drinking (at least 6 drinks per occasion).  Medication adherence over the space of a year was measured by how often patients went back to their pharmacy for a refill.

Among patients taking medication for high blood pressure or high cholesterol levels, nonadherence increased as the severity of alcohol misuse increased.  Compared with patients who did not drink, the proportion of patients who did not stick to their cardiovascular medications was significantly higher among those who moderately or severely misused alcohol.  Interestingly, there was no difference in adherence to diabetes medications between diabetic patients who did not drink and those who did.

This research might seem like it’s straight from the department of the obvious: “Of course people with alcohol problems don’t take their medications properly!”  There are a couple of key findings that are important to bear in mind though.  For one, the authors were able to assess alcohol consumption with a brief questionnaire , unlike previous studies on this subject that used lengthy, time consuming interviews.  Thus the approach used in this study could be used easily in clinical practice.

In addition, a fair few studies have examined the problem of medication nonadherence, but most have found that the factors responsible for nonadherence are ones that would be very difficult to modify, such as older age (over 80 years old) or low socioeconomic status.  The study by Bryson et al. is important because it identifies a modifiable factor responsible for medication nonadherence.  Counsel a patient to cut their drinking and, in theory, they should be more likely to take their medication properly, which would keep their condition in check and enable them to get on with their life unhindered.

————————————————————————————————-
Bryson CL et al. (2008) Alcohol screening scores and medication nonadherence. Ann Intern Med 149 (11): 795-803. PMID: 19047026

Continue Reading

November 14th is World Diabetes Day

Tomorrow the International Diabetes Federation (IDF) is leading World Diabetes Day, the primary global awareness campaign of the diabetes world.

World Diabetes Day is celebrated annually November 14th, the birthday of Frederick Banting, who in 1922, along with Charles Best, conceived the idea that led to the discovery of insulin.

The theme for this year and for 2007 is ‘Diabetes in Children and Adolescents’. The incidence of type 1 diabetes in children is increasing at a rate of 3% each year and is increasing fastest in preschool children (a rate of 5% per year). Type 2 diabetes has been reported in children as young as 8 years old. Over half of all children with diabetes develop complications – such as heart disease and blindness – within 15 years.

The World Diabetes Day 2007-2008 campaign aims to:
• Increase the number of children supported by the IDF Life for Child Program, a international aid endeavor that provides life-saving medication to children with diabetes in developing countries.
• Raise awareness of the warning signs of diabetes.
• Encourage initiatives to reduce diabetic ketoacidosis.
• Promote healthy lifestyles to help prevent type 2 diabetes in children.

One of the key events of is the lighting of buildings and monuments in blue – the colour of the diabetes circle. In 2008, the aim is to encourage a total of 500 monuments and iconic buildings to light up to mark World Diabetes Day. The owners of the London Eye have already pledged to light up their monument; the Sears Tower in Chicago, Niagara Falls on the US/Canada border and the Alamo in Texas are also going blue. You can see pictures of buildings that were lit up in 2007 on the IDF Flickr page.

The global diabetes community is organizing a range of activities, including radio and television programmes, public information meetings, poster and leaflet campaigns, newspaper and magazine articles, events for kids, and walks, runs, and bicycle races.

Members of the public encouraged to show their support of diabetes awareness by lighting blue World Diabetes candles; a percentage of the sales of these candles will go to support children with diabetes on the Life for a Child Program.

The World Diabetes Day website includes lists of activities in various cities worldwide, so check it out and get involved!

Continue Reading

Diabetes gonna get you

About 10 days ago Diabetes UK launched their biggest ever UK public awareness campaign – Beware the silent assassin. I first got wind of the campaign when I spotted this arresting poster at Old Street tube station in east London.

The campaign has been launched on the back of research by Mori showing that people tend to underestimate the severity of the complications associated with diabetes; for example, only 29% of adults are aware of the link between diabetes and heart disease, and only 46% appreciate that diabetes shortens life expectancy. Diabetes UK says, “This research tells us that the public see diabetes as rather mild and easily managed – something of an inconvenience rather than the serious condition it can be.”

In addition, an estimated 500,000 people in the UK have the condition but are not aware of it, so are at risk of being diagnosed too late to prevent the complications of diabetes. “Dealing with the diabetes time-bomb is a matter of urgency if we want to prevent millions of people from facing a grim future of ill-health,” said Douglas Smallwood, Chief Executive of Diabetes UK.

The ‘hard-hitting campaign’ launched by the charity aims to spook the public into realizing that diabetes is serious condition that can potentially cause heart disease, stroke, amputations, kidney failure and blindness.

The images, which will appear on outdoor posters as well as in newspapers and magazines, feature an ominous ghostly figure – the specter of undiagnosed diabetes presumably – pouncing on unsuspecting members of the public. The ads also include secondary warning messages such as:
– Diabetes causes more deaths than breast and prostate cancer combined.
– The death certificate will say heart attack. It was really diabetes.
– Diabetes causes heart disease, stroke, amputations, kidney failure and blindness.
So far so portentous.

The campaign also encourages people at risk of developing type 2 diabetes, i.e. the overweight, to make changes in their lifestyle to avoid a future of chronic disease. As the blurb states, “With early diagnosis and by leading a healthier lifestyle and improving diabetes control, the risk of developing these serious complications can be minimised. “

The adverts refer readers to a microsite developed especially for the campaign, which has quizzes to help users establish their risk of developing diabetes and gives information and support on managing the condition.

I personally feel that these adverts suggest that diabetes could to strike you dead on the spot – assassinate you – the way heart disease might, but is this really the case? On the other hand, a campaign educating our increasingly overweight population that diabetes is a serious and mostly preventable disease is certainly needed, and it is quite likely that striking adverts such as these will get people thinking more seriously about their health.

Continue Reading