Caring for Poorly Controlled Diabetes Mellitus: A Randomized Pharmacist Intervention

• Published in: The Annals of pharmacotherapy 2005-03, Vol.39 (3), p.433-440
• Main Authors: Odegard, Peggy S, Goo, Alvin, Hummel, Jeff, Williams, Kristal L, Gray, Shelly L
• Format: Article
• Language: English
• Subjects: Administration, Oral; Biological and medical sciences; Diabetes Mellitus, Type 2 - therapy; Disease Management; Drug Therapy, Combination; Female; General and cellular metabolism. Vitamins; Glycated Hemoglobin A; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Male; Medical sciences; Middle Aged; Patient Compliance; Pharmaceutical Services - utilization; Pharmacists - utilization; Pharmacology. Drug treatments; Professional Role; Professional-Patient Relations; Referral and Consultation
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1E438

BACKGROUND: There is limited information from randomized controlled studies about the influence of pharmacist interventions on diabetes control. OBJECTIVE: To evaluate the effect of a pharmacist intervention on improving diabetes control; secondary endpoints were medication appropriateness and self-reported adherence. METHODS: A randomized, controlled, multi-clinic trial was conducted in the University of Washington Medicine Neighborhood Clinics. Seventy-seven subjects, ⩾18 years old with a hemoglobin (Hb) A1c ⩾9% at baseline and taking at least one oral diabetes medication, were randomized to receive a pharmacist intervention (n = 43) or usual care (n = 34) for 6 months followed by a 6-month usual-care observation period for both groups. Subjects met with a clinical pharmacist to establish and initiate a diabetes care plan followed by weekly visits or telephone calls to facilitate diabetes management and adherence. HbA1c, medication appropriateness, and self-reported adherence were assessed at baseline, 6 months, and 12 months. RESULTS: The mean HbA1c did not differ between groups over the 12-month period (p = 0.61). A reduction in HbA1c was noted for both groups over time compared with baseline (p = 0.001); however, control subjects relied more heavily on provider visits. Medication appropriateness was not improved for diabetes medications (p = 0.65). Self-reported adherence was not significantly improved by the intervention. CONCLUSIONS: This pharmacist intervention did not significantly improve diabetes control, but did allow for similar HbA1c control with fewer physician visits. Medication appropriateness and self-reported adherence compared with usual care in individuals with poorly controlled diabetes were not changed.