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Medication Adherence Among Diabetic Patients

Improving Diabetes Medication Adherence: Successful, Scalable Interventions

Improving Diabetes Medication Adherence: Successful, Scalable Interventions

Improving diabetes medication adherence: successful, scalable interventions 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA 2Department of Medicine, Duke University, Durham, NC, USA 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA 2Department of Medicine, Duke University, Durham, NC, USA 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA 2Department of Medicine, Duke University, Durham, NC, USA 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA 2Department of Medicine, Duke University, Durham, NC, USA 7School of Nursing, Duke University, Durham, NC, USA 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA 2Department of Medicine, Duke University, Durham, NC, USA 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA 6CVS Caremark Corporation, Duke University, Durham, NC, USA 7School of Nursing, Duke University, Durham, NC, USA 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA 9North Carolina Community Care Networks, Raleigh, NC, USA 10Pfizer, In Continue reading >>

Patient-centered Care, Diabetes Empowerment, And Type 2 Diabetes Medication Adherence Among American Indian Patients

Patient-centered Care, Diabetes Empowerment, And Type 2 Diabetes Medication Adherence Among American Indian Patients

Patient-Centered Care, Diabetes Empowerment, and Type 2 Diabetes Medication Adherence Among American Indian Patients University of Minnesota Medical School, Duluth, MN Corresponding author: Melissa L. Walls, mlwalls{at}d.umn.edu Clinical Diabetes 2017 Dec; 35(5): 281-285. IN BRIEF Type 2 diabetes has been labeled an epidemic in many American Indian communities. Thus, identifying factors that improve medication adherence for American Indian patients is crucial. We found significant and positive relationships among patient-centered care, medication adherence, and diabetes empowerment. In addition, diabetes empowerment partially mediated the relationship between patient-centered care and medication adherence. 2017 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. Continue reading >>

Factors Influencing Long-term Medication Non-adherence Among Diabetes And Hypertensive Patients In Ghana: A Qualitative Investigation

Factors Influencing Long-term Medication Non-adherence Among Diabetes And Hypertensive Patients In Ghana: A Qualitative Investigation

Factors influencing long-term medication non-adherence among diabetes and hypertensive patients in Ghana: A qualitative investigation Contributed equally to this work with: Roger A. Atinga, Lily Yarney, Narissa Minta Gavu Roles Conceptualization, Formal analysis, Investigation, Methodology, Writing original draft, Writing review & editing Affiliation Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana Contributed equally to this work with: Roger A. Atinga, Lily Yarney, Narissa Minta Gavu Roles Conceptualization, Formal analysis, Methodology, Writing original draft, Writing review & editing Affiliation Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana Contributed equally to this work with: Roger A. Atinga, Lily Yarney, Narissa Minta Gavu Roles Investigation, Writing original draft Affiliation Medical Department, Korle-Bu Teaching Hospital, Accra, Ghana Continue reading >>

Treatment Adherence And Factors Contributing To Non Adherence Among Type 2 Diabetes Mellitus Patients In A Tertiary Care Hospital: A Cross Sectional Study | S. | International Journal Of Basic & Clinical Pharmacology

Treatment Adherence And Factors Contributing To Non Adherence Among Type 2 Diabetes Mellitus Patients In A Tertiary Care Hospital: A Cross Sectional Study | S. | International Journal Of Basic & Clinical Pharmacology

DOI: Treatment adherence and factors contributing to non adherence among type 2 diabetes mellitus patients in a tertiary care hospital: a cross sectional study Kavitha S., Nalini G. K., Suresh R. M., Sahana G. N., Deepak P., Jayashree V. Nagaral Background: Diabetes mellitus (DM) is the most common endocrine disorder and major global public health problem. Lack of adherence to antidiabetic medication has lead to suboptimal blood sugar control, treatment failure, accelerated development of complications and increased mortality, thus medication adherence plays an important role in disease control. Hence present study was taken to evaluate the treatment adherence and factors affecting non adherence among Type 2 diabetes mellitus patients. Methods: A cross sectional study carried out by Department of Pharmacology and Medicine, Hassan Institute of Medical Sciences, Hassan. Total 150 patients of type 2 diabetes were recruited after taking their informed consent. Adherence to treatment and factors associated with non adherence has been assessed during a personal interview with each patient using standardized questionnaire. Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to anti diabetic treatment. Other reasons contributing to non-adherence to treatment were forget fullness (86.66 %), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11 %) and lack of assistance (48.88 %). Conclusions: Results showed that patients in the area of study were moderately adherent to a Continue reading >>

Frontiers | Medications Adherence And Associated Factors Among Patients With Type 2 Diabetes Mellitus In The Gaza Strip, Palestine | Endocrinology

Frontiers | Medications Adherence And Associated Factors Among Patients With Type 2 Diabetes Mellitus In The Gaza Strip, Palestine | Endocrinology

Front. Endocrinol., 09 June 2017 | Medications Adherence and Associated Factors among Patients with Type 2 Diabetes Mellitus in the Gaza Strip, Palestine 1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences International campus, Tehran, Iran 2Quality Improvement and Infection Control Office, Shifa Medical Complex, Gaza Strip, Palestine 3Directorate General of International Cooperation, Ministry of Health, Gaza Strip, Palestine 4Director of Chronic Diseases Department, Al Rimal Martyrs Health Center, Ministry of Health, Gaza Strip, Palestine 5Department of Research, Directorate General of Human Resources Development, Ministry of Health, Gaza Strip, Palestine Aim: The aim of this study was to evaluate the adherence to anti-diabetic medications among patients with type 2 diabetes mellitus (DM) seeking medical care in the Gaza Strip, Palestine. Methods: A cross-sectional study was conducted among 369 primary care patients with type 2 DM from October to December 2016. Adherence to medications was measured using the Morisky Medication Adherence Scale (MMAS-4). Socio-demographic and clinical variables, providerpatient relationship, health literacy, and health belief were examined for each patient. Univariate, binary logistic regression and multiple linear regression were applied to determine the independent factors influencing adherence to anti-diabetic medications using SPSS version 22. Results: Of all the respondents, 214 (58%), 146 (39.5%), and nine (2.5%) had high (MMAS score = 0), medium (MMAS score = 1 + 2), and low (MMAS score 3) adherence to anti-diabetic medications, respectively. Factors that were independently associated with adherence to anti-diabetic medications were as follows: female gender [odds ratio ( Continue reading >>

Assessment Of Medication Adherence Among Type 2 Diabetic Patients In Quetta City, Pakistan

Assessment Of Medication Adherence Among Type 2 Diabetic Patients In Quetta City, Pakistan

Assessment of medication adherence among type 2 diabetic patients in Quetta city, Pakistan Accepted author version posted online: 08 May 2017 Get access/doi/full/10.1080/00325481.2017.1328251?needAccess=true Objectives: Type 2 diabetes (T2DM) is a growing burden among all countries including Pakistan, with medication adherence very important to improve care. However, little is known about medication adherence in Pakistan and potential predictors among T2DM patients to provide future guidance. This needs to be addressed. Consequently, the present study sought to assess medication adherence among type 2 diabetic patients in Quetta city, Pakistan. Methods: Questionnaire based, descriptive study among 300 Pakistani patients attending public and private hospitals aged 18years and above, having a confirmed diagnosis of T2DM, without additional co-morbidities were targeted. Descriptive statistics were used to describe demographic and disease characteristics. The association between socio-demographic data and study variables was compared through the Mann Whitney/Kruskal Wallis test (where applicable). The factors that were significantly associated with medication adherence were further assessed by logistic regression analysis. Results: 55.6% of patients had high adherence although overall patients reported moderate adherence. Age, gender, education, diabetes-related knowledge and treatment satisfaction were significantly associated with medication adherence. Older males with only primary education and with poor diabetes-related knowledge had the lowest adherence. Conclusions: This study presents a model that is associated with medication adherence among T2DM patients, with disease-related knowledge as a significant predictor of likely adherence. Results of the current study re Continue reading >>

Comparison Of Medication Adherence Among Patients In Type 2 Diabetes

Comparison Of Medication Adherence Among Patients In Type 2 Diabetes

Comparison of Medication Adherence Among Patients in Type 2 Diabetes Authors: News Author: Liam Davenport; CME Author: Charles P. Vega, MD Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s) Family Physicians - maximum of 0.25 AAFP Prescribed credit(s) ABIM Diplomates - maximum of 0.25 ABIM MOC points Nurses - 0.25 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology) Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs) This article is intended for endocrinologists, nurses, pharmacists, and other clinicians who treat and manage patients with type 2 diabetes mellitus. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Assess how adherence to antidepressants affects outcomes of diabetes Compare rates of adherence to different treatments for type 2 diabetes As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Liam Davenport has disclosed no relevant financial relationships. Health Sciences Clinical Professor, University of California, Irvine, Department of Family Medicine; Continue reading >>

Assessing The Association Between Medication Adherence And Glycemic Control

Assessing The Association Between Medication Adherence And Glycemic Control

Assessing the Association Between Medication Adherence and Glycemic Control Among a population of adult patients with type 2 diabetes, adherence to oral hypoglycemic medications isindependently associated with poor glycemic control, even after adjusting for patient-level covariates. David M. Mosen, PhD, MPH; Harry Glauber, MB, BCh; Ashley B. Stoneburner, MPH; and Adrianne C. Feldstein, MD, MS Objectives: We studied the independent association of adher- ence to oral hypoglycemic medications with poor glycemic con- trol among a population of adults with type 2 diabetes (T2D), adjusting for demographics, health behaviors, and clinical and treatment characteristics. Study Design: This was a retrospective cohort design. Methods: We studied a population of Kaiser Permanente Northwest (KPNW) members with T2D who either had: 1) good glycemic control (glycated hemoglobin [A1C] <8.0%; n = 15,891) or 2) poor glycemic control (A1C >9.0%; n = 3709). The primary independent variable was medication adherence to 1 or more oral hypoglycemic medications. High medication adherence was defined as at least 80% of days covered in the 12 months prior to the A1C test date (yes vs no). Multiple logistic regression was used to analyze the independent association of medication adherence with poor glycemic control, adjusting for demographics, health behaviors, medical comorbidities, healthcare utilization, receipt of diabetes care management services, and intensity of diabetes treatments. All measures were constructed via KPNWs electronic heath record. Results: Increased adherence to oral hypoglycemic medications was associated with a lower likelihood (OR, 0.54; 95% CI, 0.50-0.59; P <.0001) of having poor glycemic control, after adjusting for demographics, health behaviors, comorbidities, healthc Continue reading >>

Assessment Of Medication Adherence Among Type 2 Diabetic Patients In Quetta City, Pakistan

Assessment Of Medication Adherence Among Type 2 Diabetic Patients In Quetta City, Pakistan

Assessment of medication adherence among type 2 diabetic patients in Quetta city, Pakistan Iqbal, Qaiser and Bashir, Sajid and Iqbal, Javeid and Iftikhar, Shehla and Godman, Brian (2017)Assessment of medication adherence among type 2 diabetic patients in Quetta city, Pakistan. Postgraduate Medicine , 129 (6). pp. 637-643. ISSN 1941-9260 Text (Iqbal-etal-PM-2017-Assessment-of-medication-adherence-among-type-2-diabetic-patients) Official URL: Aims: Type 2 diabetes (T2DM) is a growing burden among all countries including Pakistan, with medication adherence very important. However, little is known about medication adherence in Pakistan and potential predictors among T2DM patients to provide future guidance. This needs to be addressed. Consequently, the present study sought to assess medication adherence among type 2 diabetic patients in Quetta city, Pakistan. Methods: Questionnaire based, descriptive study among 300 Pakistani patients attending public and private hospitals aged 18 years and above, having a confirmed diagnosis of T2DM, without additional co-morbidities were targeted. Descriptive statistics were used to describe demographic and disease characteristics. The association between socio-demographic data and study variables was compared through Man Whitney / Kruskal Wallis test (where applicable). The factors that were significantly associated with medication adherence were further assessed by logistic regression analysis. Results: 55.6% of patients had high adherence although overall patients reported moderate adherence. Age, gender, education, diabetes-related knowledge and treatment satisfaction were significantly associated with medication adherence. Older males with only primary education and with poor diabetes-related knowledge had the lowest adherence. Conc Continue reading >>

Adherence To Therapies In Patients With Type 2 Diabetes

Adherence To Therapies In Patients With Type 2 Diabetes

Go to: Introduction The prevalence of type 2 diabetes mellitus is increasing globally and has become a major public health problem. In the USA, a study of 17,306 people over 20 years of age showed that those diagnosed with diabetes increased significantly from 6.5% in the 1999–2002 period to 7.8% in 2003–2006 [1]. In 2011, 366 million people worldwide had diabetes and it is predicted that by 2030, this figure will be 552 million [2]. Diabetes is currently among the top five causes of death in most high-income countries and resulted in 4.6 million deaths globally in 2011. The majority of cases of diabetes mellitus are type 2, and the greatest numbers of people with this disease are aged from 40 to 59 years [2]. The increase in type 2 diabetes is associated with obesity, hypertension, and an increasingly elderly population. Over the last 18 years in the USA, the proportion of adults in the age group 40–74 years with a body mass index ≥30 kg/m2 has increased from 28% to 36%, while the proportion undergoing physical activity 12 times a month or more has decreased from 53% to 43%, exacerbating the obesity problem [3]. However, despite strong clinical recommendations for individuals with a history of diabetes to adopt a healthier lifestyle, adherence to improved diet and exercise is poor [3]. Although type 2 diabetes usually occurs in people over the age of 40 years, it is becoming increasingly common in children, adolescents and young adults due to reduced physical activity and unhealthy eating patterns, leading to obesity [4]. The majority of patients with type 2 diabetes fail to control glycemia with diet and exercise and require pharmacotherapy—in general, initially monotherapy with an oral hypoglycemic agents (OHA); however, owing to the progressive nature of t Continue reading >>

Medication Adherence Among Diabetic And Hypertensive Patients In Al-qassim Region Of Saudi Arabia

Medication Adherence Among Diabetic And Hypertensive Patients In Al-qassim Region Of Saudi Arabia

Non-adherence to medication is often an unrecognized risk factor that contributes to failure of the therapeutic plan. The purpose of the study was to identify factors related to high, medium and low medication adherence among adult Saudi patients with hypertension and diabetes mellitus. This study is designed as a descriptive cross sectional survey and was conducted in three tertiary care hospitals of Al-Qassim province of Saudi Arabia. The data was collected using the 8-item Morisky Medication Adherence Scale (MMAS-8) and analyzed by SPSS. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); 8 (high). Of the 396 patients interviewed, 52% reported low adherence to prescribed medication. Multinomial logistic regression analysis was conducted. Gender, age, literacy level, duration of illness and type of chronic disease were negatively associated with medication adherence. The study shows very high proportion of low and medium adherence on long term medication, which may be responsible for the failure of achieving therapeutic outcome. Further investigation is required to evaluate the applicability of MMAS-8 as a tool of measuring medication adherence among Saudi patients with chronic diseases. Adherence enhancing strategies should also be evaluated in separate patients group. Continue reading >>

Adherence And Associated Factors Towards Antidiabetic Medication Among Type Ii Diabetic Patients On Follow-up At University Of Gondar Hospital, Northwest Ethiopia

Adherence And Associated Factors Towards Antidiabetic Medication Among Type Ii Diabetic Patients On Follow-up At University Of Gondar Hospital, Northwest Ethiopia

Adherence and Associated Factors towards Antidiabetic Medication among Type II Diabetic Patients on Follow-Up at University of Gondar Hospital, Northwest Ethiopia Department of Nursing, University of Gondar, P.O. Box 196, Gondar, Ethiopia Received 7 September 2015; Revised 18 December 2015; Accepted 22 December 2015 Copyright 2016 Mastewal Abebaw et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The prevalence of diabetes mellitus (DM) is rising worldwide and is more in the developing countries which unfortunately are already suffering from communicable diseases. The aim of this study was to assess adherence and associated factors towards antidiabetic medication among type II diabetic patients in University of Gondar Hospital, Diabetic Clinic, Gondar, Northwest Ethiopia. Methods. Institutional based cross-sectional study was conducted. Systematic sampling technique was used. Morisky Medication Adherence Scale (MMAS) scores were used for labeling patients as adherent or nonadherent. Data were entered and analyzed using SPSS version 20. To see the association of variables logistic regression with OR and 95% CI was done. Results. A total of 288 study participants were interviewed with response rate of 100%. The level of adherence was found to be 85.1%. Factors found to be significantly associated with antidiabetic medication adherence were level of education (AOR = 14.27, 95% CI = 3.0, 67.82), duration of diabetes (AOR = 6.10, 95% CI = 2.03, 18.34), and knowledge about DM and its medications (AOR = 28.05, 95% CI = 8.96, 87.8). Conclusions and Recommendations. Large proportion of respondents Continue reading >>

Assessment Of Patient Medication Adherence Among The Type 2 Diabetes Mellitus Population With Peripheral Diabetic Neuropathy In South India - Sciencedirect

Assessment Of Patient Medication Adherence Among The Type 2 Diabetes Mellitus Population With Peripheral Diabetic Neuropathy In South India - Sciencedirect

Volume 12, Issue 2 , April 2017, Pages 164-168 Assessment of patient medication adherence among the type 2 diabetes mellitus population with peripheral diabetic neuropathy in South India The present study attempted to explore the relationship between non-adherence with medication and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus (DM) in a private hospital located in South India. A prospective study was carried out from January 2015 to December 2015. This study included 86 type 2 DM patients with diabetic peripheral neuropathy. The patients were followed-up for three months, once a month. Blood samples were taken to test for fasting blood sugar (FBS), postprandial blood sugar (PPBS) and HbA1c. A Morisky scale questionnaire was used to assess patients' medication adherence and a biothesiometer was used to screen the degree to which patients were affected by diabetic peripheral neuropathy. Patient counselling, which focused on the need for maintaining glycaemic control and the importance of medication adherence, was carried out during each follow-up. Of the 120 screened subjects, 86 patients were included in the present study. A majority (76.7%) were overweight, and 51% had DM for the past 1115 years. ANOVA was used to compare patients' glycaemic status, peripheral diabetic neuropathy screening and medication adherence in all three follow-up visits, and p<0.0001 was considered as significant. Significant improvement in medication adherence and reduction of the peripheral diabetic neuropathy severity (p<0.0001) were observed from patients' first to third visits. Patient education is prudent for improving medication adherence, a result that can potentially promote optimal glycaemic control and can reduce the prevalence of diabetic peripheral neuro Continue reading >>

Poor Medication Adherence In Type 2 Diabetes: Recognizing The Scope Of The Problem And Its Key Contributors

Poor Medication Adherence In Type 2 Diabetes: Recognizing The Scope Of The Problem And Its Key Contributors

Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors At least 45% of patients with type 2 diabetes (T2D) fail to achieve adequate glycemic control (HbA1c <7%). One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals), patient demographic factors (eg, young age, low education level, and low income level), critical patient beliefs about their medications (eg, perceived treatment inefficacy), and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia). Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative m Continue reading >>

Medication Adherence And Improved Outcomes Among Patients With Type 2 Diabetes

Medication Adherence And Improved Outcomes Among Patients With Type 2 Diabetes

Sarah E. Curtis, MPH; Kristina S. Boye, PhD; Maureen J. Lage, PhD; and Luis-Emilio Garcia-Perez, MD, PhD Adherence to glucose-lowering agents was associated with a significant reduction in use of acute care resources without any increased total medical costs. ABSTRACT Objectives: Examine the association between adherence to glucose-lowering agents (GLAs) and patient outcomes in an adult type 2 diabetes (T2D) population. Methods: Truven’s Commercial Claims and Encounters database supplied data from July 1, 2009, to June 30, 2014. Patients 18 to 64 years with T2D were included if they received a GLA from July 1, 2010, through June 30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and adherence, defined as proportion of days covered 80% or more. Outcomes included all-cause medical costs, acute care resource utilization, and acute complications. Results: Although there was no statistically significant difference in total costs when comparing adherent and nonadherent patients ($38,633 vs $38,357; P = .0720), acute care costs ($12,153 vs $8233; P <.0001) and outpatient costs ($16,964 vs $15,457; P <.0001) were significantly lower for adherent patients. Adherence was also associated with a lower probability of hospitalization (22.71% vs 17.65%; P <.0001) and emergency department (ED) visits (45.61% vs 38.47%; P <.0001), fewer hospitalizations (0.40 vs 0.27; P <.0001) and ED visits (1.23 vs 0.83; P <.0001), and a shorter hospital length of stay (2.16 vs 1.25 days; P <.0001). Adherent patients were also less likely to be diagnosed with an acute complication in the 3-year post period (12.54% vs 9.64%; P <.0001). Conclusions: Compared with nonadherence, adherence to GLAs among patients with T2D was associated with a significant reduction i Continue reading >>

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