Caring for poorly controlled diabetes mellitus: a randomized pharmacist intervention.
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, > or =18 years old with a hemoglobin (Hb) A(1c) > or =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. HbA(1c), medication appropriateness, and self-reported adherence were assessed at baseline, 6 months, and 12 months.


RESULTS
The mean HbA(1c) did not differ between groups over the 12-month period (p = 0.61). A reduction in HbA(1c) 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 HbA(1c) control with fewer physician visits. Medication appropriateness and self-reported adherence compared with usual care in individuals with poorly controlled diabetes were not changed.
Odegard
Peggy S
PS
School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7630, USA. podegard@u.washington.edu
Goo
Alvin
A
Hummel
Jeff
J
Williams
Kristal L
KL
Gray
Shelly L
SL
D000284:Administration, Oral; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010593:Pharmaceutical Services / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000706:statistics & numerical data*; D024382:Professional Role; D011369:Professional-Patient Relations; D012017:Referral and Consultation
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin