Two new studies have been launched to help address the high rates of diabetes in New Zealand.
Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces.
According to data from the Ministry of Health, it is estimated that the number of Kiwis diagnosed with diabetes exceeds 200,000 (predominantly type 2 diabetes), with a further 100,000 people who are living with diabetes undiagnosed.
The prevalence of diabetes in Māori and Pacific populations is around three times higher than among other New Zealanders. Counties Manukau DHB has the highest prevalence of all diabetes in New Zealand with around 8% of the country’s diabetics based in that region.
The first of the new trials will use an app to help monitor the level of adherence to diabetes medicine among South Aucklanders, who have a specific haemoglobin marker called HbA1c - which can indicate a greater risk of developing diabetes-related complications.
Outpatients from the Counties Manukau DHB who have diabetes will have their prescriptions delivered to them by courier - helping to overcome some of the common barriers to accessing a pharmacy. Reporting from the app will identify patients who are not keeping up with the level of medication prescribed by their doctor allowing them to be followed up by an HCP.
Pharmacist Din Redzepagic from Zoom Pharmacy whose company designed the app, says there are a number of reasons diabetics may not have access to prescription medication.
“Diabetes is notorious for poor medicine adherence. The disease is asymptomatic which means those living with the disease don't feel the high levels of blood sugar. As a result they don't feel they need to take the medication and even when they do, they feel exactly the same whether they take it or not,” he says.
Redzepagic says many of the patients from Manukau Superclinic are shift workers or have limited transport options open to them which can further impact on their ability to fill prescriptions. He says non-adherence to medicine is estimated to cost the country $1 billion annually.
“By delivering the medicine to their door, scheduling calls with a multi-lingual team of pharmacists and introducing an app in their health care routine that can monitor how frequently they are taking their medication, we hope to remove some of the key barriers which prevent them taking their medication as prescribed by their doctor.”
“When diabetics don't take the medication, they can end up presenting acutely as their eyes and kidneys start deteriorating which adds congestion to emergency departments. In comparison regular adherence to medication is a much lower cost alternative.”
“The new system also takes pressure off doctors as technology allows better monitoring and early intervention to keep patients on track in between visits to their GP,” he says.
Redzepagic says data from the study will be analysed later in the year by the DHB and has the potential to be expanded into other regions if successful.
A second trial, which is underway at Auckland University’s Department of Medicine, aims to identify the impact of diabetic patient demographics such as ethnicity and their body’s response to different treatment regimes.
The Worth Study will examine how patients respond to two commonly prescribed medications for diabetes.
Lead pharmacist for Zoom Pharmacy Dale Griffiths, who will manage the randomised distribution of the medication to patients in the trial, says the research is important as getting the right medication is an important factor in being able to control the disease.
“What we know is that there are a number of variables which influence how you respond to certain medications.”
“If we can get a better understanding of which medication may work better for your ethnicity or body type, it may mean you can better manage your symptoms and also avoid side effects from taking an alternative medicine.”
Griffiths says the new methodology has applications in other medicine trials as well.
“One of the limitations of real world trials is ensuring patients strictly follow the dosage laid out by the researchers. Without this adherence, the integrity of the study can be compromised.”
“By introducing the Zoom adherence service, digital monitoring and intervention by phone, we anticipate that patients in the study will stick more closely to the medication schedule provided to them - providing a more accurate outcome for researchers,” he says.