ASSESSING
IF PATIENTS WITH DIABETES ARE MEETING THE AMERICAN DIABETES
ASSOCIATION RECOMMENDATIONS WITH THEIR CARE IN COMMUNITY PRACTICE
Dr. Nicole
M. Paolini, Pharm.D.,Clinical Assistant Professor,Department
of Pharmacy Practice, University of Buffalo
Objective:
This study identified whether patients with diabetes were
meeting the Clinical Practice Recommendations set by the the
American Diabetes Association (ADA) for blood glucose, lipid
levels, and blood pressure.
Methods:
This study is an observational needs assessment of patients
with diabetes from five Rite Aid pharmacies in Richmond, Virginia
. Patients were identified for study enrollment at the point
of dispensing and targeted via the Rite Aid computer dispensing
system. Possible study participants were contacted by telephone
and/or by mail. Patients were interviewed by a Rite Aid pharmacist
who obtained demographic information and assessed whether
their current diabetes care met ADA Clinical Practice Recommendations.
In addition, a blood sample to measure fasting blood glucose
(FBG), fasting lipid profile (FLP), and glycosylated hemoglobin
A1C (A1C) was obtained. The pharmacist used an One Touch Ultra,
Cholestech LDX, and DCA 2000+, respectively, to measure the
above values. A blood pressure reading using a manual sphygmomanometer
(aneroid) was also obtained.
Results:
A total of 50 patients were invited and completed
the evaluation. Fifty percent (n=25) were female and fifty
percent (n=25) were male. The average age of the participants
was 60 (range: 26-86; median: 62). Two percent of the participants
evaluated were patients with Type 1 diabetes, and 98% were
patients with Type 2 diabetes. The average blood pressure
was 133/79 mmHg (range: 110/56 mmHg-170/102 mmHg; median:
135/80 mmHg). The average total cholesterol (TC) was 178 mg/dl
(range: 110-248 mg/dl; median: 178 mg/dl), average high-density
lipoprotein (HDL) was 41 mg/dl (range: 23-77 mg/dl; median:
40 mg/dl), and average low-density lipoprotein (LDL) was 109
mg/dl (range: 51-179 mg/dl; median: 112 mg/dl). The average
A1C was 7.7% (range: 4.0-10.3%; median: 7.4%), and the average
blood glucose (FBG) was 152 mg/dl (range: 82-373 mg/dl; median:
140 mg/dl).
Conclusions:
For this patient population, median blood glucose, A1C, LDL,
and blood pressure are not within the acceptable goal ranges
outlined in the ADA Clinical Practice Recommendations. Analysis
of the data demonstrates that the majority of patients with
diabetes do not meet the ADA Clinical Practice Recommendations
for blood glucose, lipid levels, and blood pressure.
Future
Implications: The results of this project can be
used to design programs, interventions, and a plan of care
for those patients NOT meeting the ADA recommended goals.
It is clear that education about diabetes and its complications
in a community pharmacy setting, is not only needed but warranted.
Co-morbid disease states, current medications, and future
medical therapy can all be correlated and tailored to each
patient with diabetes.
Dr.
Paolini is a Doctor of Pharmacy graduate from Virginia
Commonwealth University, Medical College of Virginia Campus
in Richmond, Virginia. She completed an accredited Community
Care Pharmacy Practice Residency in conjunction with Virginia
Commonwealth University and Rite Aid pharmacy. She is currently
a Clinical Assistant Professor and Clinical Practice Liaison
for the University at Buffalo and Rite Aid pharmacy. Dr. Paolini
teaches in various areas of the pharmacy curriculum, including
areas relevant to community pharmacy practice. She is intimately
involved with the development and implementation of clinical
services at her practice site. Diabetes education and medication
management is a passion of hers, however, she holds specialty
certificates in areas outside of diabetes including hyperlipidemia,
osteoporosis, asthma, and immunization. Her practice site
also offers disease state management programs in hypertension
and smoking cessation. Being based in a community practice
setting enables Dr. Paolini to work one-on-one with her patients
and make a tangible difference in the control of their disease
and the quality of their lives.
