Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic.
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.
Cioffi
Seth T
ST
Ambulatory and Primary Care, Veterans Affairs Connecticut Healthcare System, Newington, CT, USA.
Caron
Michael F
MF
Kalus
James S
JS
Hill
Patricia
P
Buckley
Thomas E
TE
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
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008074:Lipoproteins