Medication use and disease management of type 2 diabetes in Belgium.
OBJECTIVE
The aim of this study was (International Diabetes Federation. Diabetes Atlas Second Edition Executive Summary. Brussels: International Diabetes Federation; 2003) to describe the current status of medication use and disease management of type 2 diabetic patients in Flanders (Belgium), (World Health Organization. Prevention of diabetes mellitus. Technical report series no. 844. Geneva: World Health Organization; 1994) to identify the aspects of type 2 diabetes care a community pharmacist could provide additional educational services for, and (American Diabetes Association. Diabetes Care 2006;29:S4-42) to propose these services as a pharmacist intervention.


METHODS
We recruited 338 patients in 77 community pharmacies in Flanders (Belgium). Each patient completed a questionnaire collecting personal data, information on duration of diabetes, medication, diabetes symptoms and self-management. At inclusion, patients measured their fasting plasma glucose (FPG) on three consecutive days. Prescription drugs (antidiabetic and other) purchased by each patient during the 12 months prior to inclusion in the study were reviewed from anonymized computerized pharmacy records.


METHODS
Degree of self-management, glycaemic control and medication use.


RESULTS
The mean FPG of the sample was 150.7+/-43.0 mg/dl. Controlled glycaemia (FPG between 90 and 130 mg/dl (5.0-7.2 mmol/l)) was achieved in only 34.9% of the patients. Mainstay of hypoglycemic treatment consisted of metformin monotherapy (29.6%) and metformin combined with sulfonylurea (29.0%). Regarding co-medication, 76.9% of the patients used antihypertensive drugs whereas only 33.1% and 39.9% were on aspirin and statin therapy, respectively. ADA recommendations for annual eye and foot examination were not followed in 38.8% (eye) and 39.2% (feet) of the patients.


CONCLUSIONS
The current management of type 2 diabetic Flemish patients falls short of recommended treatment goals. Community pharmacists may play a role in enhancing the awareness of glycaemic control and in stimulating self-management in diabetic patients by motivating patients towards correct medication use, better medication adherence, healthy lifestyle and smoking cessation.
Mehuys
Els
E
Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Harelbekestraat 72, Gent 9000, Belgium. Els.Mehuys@UGent.be
De Bolle
Leen
L
Van Bortel
Luc
L
Annemans
Lieven
L
Van Tongelen
Inge
I
Remon
Jean-Paul
JP
Giri
Mimi
M
D001530:Belgium; D001549:Benzamides / Q000627:therapeutic use; D015190:Blood Glucose Self-Monitoring; D003157:Community Pharmacy Services; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D019468:Disease Management; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010353:Patient Education as Topic; D010595:Pharmacists; D024382:Professional Role; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D001549:Benzamides; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; C030516:meglitinide; D008687:Metformin