title: Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic.
abstract: BACKGROUND
  Pharmacists' responsibilities in caring for patients with diabetes mellitus are expanding. However, few data are available to support pharmacists optimizing therapy and improving outcomes in these patients.
  
  
  OBJECTIVE
  To determine the effect of a clinical pharmacist-directed diabetes management clinic on glycemic control and cardiovascular and renal parameters in patients with type 2 diabetes.
  
  
  METHODS
  A nonrandomized, prospective study was conducted in 70 Veterans Affairs patients. Patients met with the pharmacist every 6-8 weeks for approximately 30 minutes for education, medication counseling, monitoring, and management. The primary endpoint was the impact of 9-12 months of participation in the clinic on glycosylated hemoglobin (HbA1C). Secondarily, we evaluated body weight, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, and level of microalbuminuria. All comparisons were made using a paired t-test at a significance level of p < or = 0.05.
  
  
  RESULTS
  HbA1C significantly decreased from 10.3% +/- 2.2% at baseline to 6.9% +/- 1.1% (mean +/- SD) during the 9- to 12-month evaluation period (p < 0.001). The secondary endpoints including systolic (p < 0.001) and diastolic (p < 0.001) blood pressure, total cholesterol (p < 0.001), LDL-C (p < 0.001), triglycerides (p = 0.006), and level of microalbuminuria (p < 0.001) also were reduced at 9-12 months.
  
  
  CONCLUSIONS
  This study demonstrated that a clinical pharmacist can effectively care for patients with diabetes referred by their primary care provider because of poor glycemic control.
authors.affiliation: Ambulatory and Primary Care, Veterans Affairs Connecticut Healthcare System, Newington, CT, USA.
authors.forename: Seth T
authors.initials: ST
authors.lastname: Cioffi
authors.forename: Michael F
authors.initials: MF
authors.lastname: Caron
authors.forename: James S
authors.initials: JS
authors.lastname: Kalus
authors.forename: Patricia
authors.initials: P
authors.lastname: Hill
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Buckley
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis*; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008074:Lipoproteins / Q000097:blood; D008297:Male; D010353:Patient Education as Topic; D010593:Pharmaceutical Services / Q000458:organization & administration*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008074:Lipoproteins