Perspectives in Clinical Research

: 2018  |  Volume : 9  |  Issue : 2  |  Page : 108--109

Author's reply

Chetna Desai 
 Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India

Correspondence Address:
Dr. Chetna Desai
Department of Pharmacology, B. J. Medical College, Ahmedabad - 380 016, Gujarat

How to cite this article:
Desai C. Author's reply.Perspect Clin Res 2018;9:108-109

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Desai C. Author's reply. Perspect Clin Res [serial online] 2018 [cited 2019 Oct 18 ];9:108-109
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I read the reader queries to our article [1] with considerable interest. The reader states that, while measures for improving quality of life (QOL) should be treated as an essential part of diabetic care, two concerns regarding the methodology and conclusion of the study need clarification. Please find the point-wise clarifications to these queries:

Query 1: The authors sought to answer the research question that whether antidiabetic drug treatment improves the QOL and other biochemical parameters in patients of diabetes mellitus (DM). However, the mean duration of diabetes in the subjects was over 10 years, so most subjects were likely to be on treatment before enrollment in the Chaturvedi et al. study. In this regard, for the study to have answered, the desired research question should have preferably included only newly diagnosed DM patients who were previously not on standard antidiabetic treatment consisting of either oral hypoglycemic agents (OHAs) or insulin. This is because QOL and metabolic outcomes in DM patients are not constant but are likely to show variation with time depending on patient factors such as level of stress, extent of medical adherence, change in drug therapy, or onset of any diabetes-related complications.[2] Among the previously diagnosed patients on antidiabetic treatment, therapeutic outcomes such as glycemic control are likely to improve on increasing adherence to medication, self-care practices, reducing stress, and intensification of drug therapy using newer OHAs or insulin.[3] The Chaturvedi et al. study should report the change in the determinants of the above study outcomes during the 6-month period of observation.

Clarification: The main research question for authors was to evaluate the impact of antidiabetic medications on patients' QOL. We wanted to study the impact of different regimens including OHAs and insulin. Furthermore, the study also aimed to evaluate any possible correlation between the duration of diabetes and number of drugs prescribed or complexity of regimen and their impact on QOL. For the above-mentioned reasons, we included newly diagnosed patients as well as patients receiving antidiabetic treatment for many years.

Query 2: The authors concluded that using fewer medicines offers better treatment satisfaction and QOL in patient. Nevertheless, the authors' finding could be due to confounding since patients with recent onset of DM need fewer medicines to manage their diabetes and are less likely to suffer diabetes-related complications compared to DM patients with long duration of diabetes.[4] Moreover, the failure to sufficiently intensify the antidiabetic treatment in patients with poor glycemic control poses the risk of therapeutic inertia and likelihood of adverse health outcomes.[5]

Clarification: This could be a possible answer to the higher QOL in patients taking fewer medicines. Indeed, diabetes management is a complex process. Regular use of medicines and maintenance of dietary precautions to achieve a good glycemic control does impact diabetic patients' QOL. The therapeutic inertia in treatment of diabetes is a common phenomenon. Both doctors and patients are usually responsible for it. The chronicity of treatment and out-of-pocket expenditure are major causes for patients' inertia for the treatment, whereas risk of hypoglycemia with intensive regimen is the main reason of therapeutic inertia for clinicians.

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1Chaturvedi R, Desai C, Patel P, Shah A, Dikshit RK. An evaluation of the impact of antidiabetic medication on treatment satisfaction and quality of life in patients of diabetes mellitus. Perspect Clin Res 2018;9:15-22.
2Trikkalinou A, Papazafiropoulou AK, Melidonis A. Type 2 diabetes and quality of life. World J Diabetes 2017;8:120-9.
3Basu S, Khobragade M, Kumar A, Raut DK. Medical adherence and its predictors in diabetes mellitus patients attending government hospitals in the Indian Capital, Delhi, 2013: A cross sectional study. Int J Diabetes Dev Ctries 2015;35 Suppl 2:95.
4Hayashino Y, Izumi K, Okamura S, Nishimura R, Origasa H, Tajima N, et al. Duration of diabetes and types of diabetes therapy in Japanese patients with type 2 diabetes: The Japan diabetes complication and its prevention prospective study 3 (JDCP study 3). J Diabetes Investig 2017;8:243-9.
5Bailey CJ. Under-treatment of type 2 diabetes: Causes and outcomes of clinical inertia. Int J Clin Pract 2016;70:988-95.