Pharmaceutical Care Program Reduces Vascular Risk Factors in Type 2

Pharmacist involvement contributed to improvement in HbA1c independently of pharmacotherapeutic changes The objective of the study was to examine the effect of a 12-month pharmaceutical care (PC) program on vascular risk in type 2 diabetes.

198 community-based patients were randomized to PC or usual care. PC patients had face-to-face goal-directed medication and lifestyle counseling at baseline and at 6 and 12 months plus 6-weekly telephone assessments and provision of other educational material. Clinical, biochemical, and medication-related data were sent regularly to each patient’s physician(s). The main outcome measure was change in HbA1c. A diabetes-specific risk engine was used to estimate changes in 10-year coronary heart disease (CHD) and stroke risk in patients without a history of cardiovascular disease.

At total of 180 patients (91%) completed the study. Mean (95% CI) reductions were greater in PC case subjects (n = 92) than control subjects (n = 88) for HbA1c (–0.5% [95% CI –0.7 to –0.3] vs. 0 [–0.2 to 0.2]) and systolic (–14 mmHg [–19 to –9] vs. –7 [–11 to –2]) and diastolic (–5 mmHg [–8 to –3] vs. –2 [–4 to 1]) blood pressure (P 0.043). The improvement in HbA1c persisted after adjustment for baseline value and demographic and treatment-specific variables. The median (interquartile range) 10-year estimated risk of a first CHD event decreased in the PC case subjects (25.1% [15.6–36.2] to 20.3 [14.6–30.2]; n = 42, P = 0.002) but not in the control subjects (26.1% [17.2–39.4] vs. 26.4 [16.7–38.0]; n = 52, P = 0.17).

From the results it was concluded that 12-month PC program in type 2 diabetes reduced glycemia and blood pressure. Pharmacist involvement contributed to improvement in HbA1c independently of pharmacotherapeutic changes. The community-based PC patients in our study lowered their HbA1c by a mean of 0.5% over 12 months from a baseline of 7.5%, while there was no change in the control group. Systolic and diastolic blood pressure fell in both groups over 12 months but to a greater extent in PC patients. The mean systolic blood pressure reduction in the PC group was 14 mmHg, double that in the control subjects and equivalent to, in U.K. Prospective Diabetes Study epidemiological analyses, a 17% reduction in myocardial infarction and 27% reduction in stroke PC could prove a valuable component of community-based multidisciplinary diabetes care.
Diabetes Care 28:771-776, 2005
https://care.diabetesjournals.org/cgi/content/abstract/28/4/771

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See Item #5 in This Weeks Newsletter