Making it Easier for Patients to Help Themselves

Text messages could hasten tuberculosis drug compliance
Original source: The Lancet Volume 373, Issue 9657
Authors: Eliza Barclay
Publication date: 3 January 2009
DOI (digital document ID): 10.1016/S0140-6736(08)61938-8
Requires subscription? No
Publicly-available abstract: No

Synopsis:
The use of SMS (Short Message System) technology is examined as an option for improving patient compliance in terms of taking pills for the treatment of tuberculosis. Techniques examined include text messages to cellphones with follow-ups if the patients do not respond to the messages, pill bottles with SIM cards that alert a central server when the bottle has been opened (ostensibly for the patient to take the medication), asking patients to speed-dial a special cellphone number after taking their medication, or asking patients to text back a code from a post-medication urine test. The use of financial and other incentives to follow the regimen is also discussed.

Reliability:
The compliance techniques are currently being investigated. The letter does not address the possibility of false compliance (response to the message without taking the medication; opening the pill bottle without removing a pill; speed-dialing the appropriate phone number without taking the medication).

Practical Applications:
While these techniques are being investigated for the management of tuberculosis patients in Africa, there are many people in industrialized nations who don't take their medications because they forget, or because they have not correctly processed a change in their medication regimens, or because they have so many medications that it is difficult to keep track of which one to take when. This is particularly, but not exclusively, true of elderly patients. There are also patients who don't correctly take their medications for economic reasons.

People with Type 2 diabetes, who are often on several medications in addition to those for glycemic control, fall into this category. In addition, many of us don't test as often as we should, or log our blood glucose readings reliably.

Some insurance companies and hospitals offer a reminder service where they phone these groups of patients to remind them to take their medications. The SMS techniques discussed in this letter may be useful either as adjuncts to the phone-reminder services, or as a new service where none currently exists.

This synopsis was based on the complete article.

Can combined oral therapy improve muscular fitness?

Combined thiazolidinedione–metformin treatment synergistically improves insulin signalling to insulin receptor substrate-1-dependent phosphatidylinositol 3-kinase, atypical protein kinase C and protein kinase B/Akt in human diabetic muscle
Original source: Diabetologia Volume 52, Number 1
Authors: N. Temofonte, M. P. Sajan, S. Nimal, T. Pastoor, C. Fumero, L. Casaubon, J. L. Powe, M. L. Standaert1, and R. V. Farese (corresponding author)
Publication date: January, 2009
DOI (digital document ID): DOI: 10.1007/s00125-008-1180-z
Requires subscription? Yes
Publicly-available abstract: Yes

Synopsis:
Impaired insulin responses in Type 2 diabetes can make it difficult for glucose to get to muscles, where they are needed. It is believed that this is because certain insulin-activated protein enzymes (atypical protein kinase C (aPKC) and protein kinase B (PKB/Akt)) are not as thoroughly activated as they should be. Both metformin and thiazolidinediones (a class of oral diabetes-management drugs that includes rosiglitazone (Avandia) and pioglitazone (Actos)) improve this deficiency. The investigators wanted to know if adding both drugs together would create an even greater improvement.

Combined metformin-thiazolidinedione therapy was administered to Type 2 test ubjects for 5-6 weeks and the results measured. The investigators observed improved glucose movement and improved insulin-induced activity of four muscle signalling factors (insulin receptors plus two protein kinases). Despite this improved activity, the levels of aPKC in muscle tissues were not improved.

Because of the improvement in the four signalling factors, the investigators consider this test successful.

Reliability:
The number of patients tested was not available in the abstract, nor was any CONSORT statement, so it's difficult to tell whether the sample size was large enough to counteract small-sample skew. Several of the investigators are associated with a Veteran's Administration (VA) center. VA patients often get the worst possible levels of care, so it is hard to tell how far along the subjects' T2 had progressed, or how well it had been treated before the test. That we are looking at combined therapy and it is being called "therapeutically useful" even though depressed muscular aPKC levels were not affected by the treatment suggests that this is the sort of experiment that would be funded by a drug manufacturer, with an eye towards pushing more expensive drugs (such as Avandamet, a combination of Avandia and metformin) on the T2 public.

Practical Applications:
Improved muscular uptake of glucose could improve physical performance, and with it, positive incentives toward exercise. This could result in T2 patients being more interested in exercising, and thereby, improving both physical fitness and insulin sensitivity.

This synopsis was based on the abstract only.