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© 2005 by the American Diabetes Association, Inc.
Clinical Care/Education/Nutrition |
Effect of a Pharmaceutical Care Program on Vascular Risk Factors in Type 2 Diabetes
The Fremantle Diabetes Study
1 School of Pharmacy, Curtin University of Technology, Bentley, Australia
2 School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, Australia
Address correspondencereprint requests to Professor Timothy M.E. Davis, DPhil, School of MedicinePharmacology, Fremantle Hospital, P.O. Box 480, Fremantle, Western Australia 6959, Australia. E-mail: tdavis{at}cyllene.uwa.edu.au
OBJECTIVE—To examine the effect of a 12-month pharmaceutical care (PC) program on vascular risk in type 2 diabetes.
RESEARCH DESIGN AND METHODS—We recruited 198 community-based patients 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.
RESULTS—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).
CONCLUSIONS—A 12-month PC program in type 2 diabetes reduced glycemia and blood pressure. Pharmacist involvement contributed to improvement in HbA1c independently of pharmacotherapeutic changes. PC could prove a valuable component of community-based multidisciplinary diabetes care.
Abbreviations: CHD, coronary heart disease • FDS, Fremantle Diabetes Study • PC, pharmaceutical care
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