EVALUATION COMMITTEE

The Faculty Council has appointed the following adjudication committee to evaluate the thesis and the associated lecture: 

• Doctor Ariana Dagliati, Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
• Associate Professor Anne-Marie Aas, Department of Clinical Service, Oslo University, Norge
• Associate Professor Henrik Bøggild, Aalborg Universitet, Denmark (Chairman).

Moderator: Associate Professor Maciej Plocharski, Health Science and Technology, Aalborg University

ABSTRACT

The adherence to oral antidiabetic drugs (OADs) is in general low among people with type 2 diabetes (T2D), which may result in a decreased effect of the drug and thereby suboptimal glycemic control. As the goal of the antidiabetic treatment is to obtain glycemic control, increasing the adherence is imperative. Thus, the aim of this doctoral thesis was to investigate adherence to OADs with the goal of providing personalized guidance to support people with T2D obtain better adherence.

The adherence to OADs in people with T2D was assessed in two different studies: a systematic review and an epidemiological study of people with T2D in Northern Denmark. In the systematic review, previously published studies reporting the adherence level based on quantitative metrics was identified in a systematic literature search. These adherence levels were summarized in a narrative synthesize.
   The same quantitative adherence metrics that were identified in the systematic review was used to quantify the adherence to OADs in a population of people with T2D living in the North Denmark Region. The findings of this epidemiological study were compared with the findings of the systematic review to determine if the adherence levels established in the systematic review could be generalized to the Danish subpopulation.

Oral semaglutide is the first and currently only marketed oral glucagon-like peptide-1 receptor agonists (GLP-1 RA). This OAD have, in clinical trials, shown good results in terms of glycemic control and weight management. However, oral semaglutide have rather strict and complex dosing conditions i.e., pre- and post-dose fasting and restricted water intake at dosing time, that may act as an adherence barrier. These adherence behaviors cannot be assessed in the retrospective cohort studies of the systematic review nor the epidemiological study, as the adherence levels in these were calculated based on pharmacy claims. Therefore, a clinical trial was developed and initiated to investigate the effect of adherence to the dosing instructions to the OAD oral semaglutide.
   As pre- and post-fasting are parts of the dosing instructions, a meal detection algorithm based solely on continuous glucose monitoring (CGM)-recorded interstitial glucose was developed to determine if the fasting requirements were met.