Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Pharmaceutical care programmes delivered by pharmacists are known to improve quality of care for both ambulatory and hospitalized patients with a variety of chronic and acute conditions. • Reduction of HbA1c and normalization of blood pressure are key targets for diabetes care programmes, since they are key to reducing diabetes complications.• Good knowledge about disease, medications, diet and exercise requirements can improve the effectiveness of self-management of diabetes. WHAT THIS STUDY ADDS• In a randomized, controlled clinical trial, a comprehensive pharmaceutical care programme (consisting of patient education and advice on medication adherence, metabolic control and life style) delivered by a clinical pharmacist over a 12-month period, significantly improved glycaemic control and health-related quality of life in Type 2 diabetes patients attending a military hospital outpatient clinic in the United Arab Emirates (UAE).• A significant reduction in HbA1c was important in the reduction of the 10-year coronary heart disease risk scores (by British National Formulary and Framingham methods) seen in patients who received the present care programme.• The outcomes of this study advocate an increased role for clinical pharmacists in the healthcare system in the UAE. AIMSTo examine the influence of a pharmaceutical care programme on disease control and health-related quality of life in Type 2 diabetes patients in the United Arab Emirates. METHODSA total of 240 Type 2 diabetes patients were recruited into a randomized, controlled, prospective clinical trial with a 12-month follow-up. A range of clinical measures, medication adherence and health-related quality of life (Short Form 36) were evaluated at baseline and up to 12 months. Intervention group patients received pharmaceutical care from a clinical pharmacist, whereas control group patients received their usual care from medical and nursing staff. The primary outcome measure was change in HbA 1c. British National Formulary and Framingham scoring methods were used to estimate changes in 10-year coronary heart disease risk scores in all patients. RESULTSA total of 234 patients completed the study. 85.2 mmHg (83.5, 86.8) vs. 76.3 mmHg (74.9, 77.7)] were observed in the intervention group; no significant changes were noted in the control group. The mean Framingham risk prediction score in the intervention group was 10.56% (9.7, 11.4) at baseline; this decreased to 7.7% (6.9, 8.5) (P < 0.001) at 12 months but remained unchanged in the control group. CONCLUSIONSThe pharmaceutical care programme resulted in better glycaemic control and reduced cardiovascular risk scores in Type 2 diabetes patients over a 12-month period.

Effect of a 36-month Pharmaceutical Care Program on the Coronary Heart Disease Risk in Elderly Diabetic and Hypertensive Patients

“…Other studies have also reported a reduction in this parameter, which can be attributed to the effectiveness of pharmaceutical care in identifying and resolving drug-related problems and in optimizing adherence to lifestyle modifications (4,25,27,28). However, the changes observed in the present study were more significant.…”

“…These reductions can also be attributed to the effectiveness of pharmaceutical care in identifying and resolving drug-related problems and in optimizing adherence to lifestyle modifications (25)(26)(27)(28). A study with a shorter duration than the present one reported a smaller reduction in fasting glucose (<15 mg/dL) and hemoglobin A1C (<0.5%) (29).…”

“…A study with a shorter duration than the present one reported a smaller reduction in fasting glucose (<15 mg/dL) and hemoglobin A1C (<0.5%) (29). Other studies (14,28) have shown a greater reduction in fasting glucose (>54.9 mg/dL) and hemoglobin A1C (>2.2%) over a shorter period (12 months), but from higher baseline values (>166 mg/dL and >8.5%, respectively) and in a different health system setting. These results suggest that the effectiveness of pharmaceutical care in the control of blood glucose levels depends on patient characteristics, the duration of the study, and the characteristics of the health system where the study is conducted.…”

“…The Fremantle Diabetes Study identified a reduction in mean SBP and DBP values over 12 months (29). Significant reductions (P < 0.001) in SBP and DBP over 12 months were also reported by Al Mazroui et al (28). In a study conducted by Lee et al (30), patients who submitted to a pharmaceutical care program for 18 months significantly reduced their mean SBP values (P = 0.005) but demonstrated no significant differences in DBP.…”

Effects of an additional pharmaceutical care intervention versus usual care on clinical outcomes of Type 2 diabetes patients in Nigeria: A comparative study

“…Interventions to optimize adherence to lifestyle modifications, identify and resolve drug-related problems, particularly the drug-related problems concerning the need for additional therapy such as statins and fibrates (Al-Mazroui et al, 2009;Mazzolini et al, 2005) supported to this result. Other studies had also demonstrated the effectiveness of pharmaceutical care programs in lowering lipid levels, but with varying figures in the results (Al-Mazroui et al, 2009;Clifford et al, 2005;Mazzolini et al, 2005).…”