Pharmaceutical care of adolescents with diabetes mellitus type 1: the DIADEMA study, a randomized controlled trial.
BACKGROUND
Physiological and psychological changes during puberty and a low adherence to complex treatment regimens often result in poor glycemic control in adolescents with type 1 diabetes mellitus (T1DM). The benefit of pharmaceutical care in adults with diabetes mellitus type 2 has been explored; however, evidence in adolescents with T1DM is scarce.


OBJECTIVE
To evaluate the impact of pharmaceutical care in adolescents with T1DM provided by pharmacists, in collaboration with physicians and diabetes educators on important clinical outcomes (e.g., HbA1c and severe hypoglycemia)


METHODS
At the outpatient Helios Paediatric Clinic and at the 12 regular community pharmacies of the study patients with 14 pharmacists in the Krefeld area, Germany, and at the University Pediatric Clinic with one clinical pharmacist on-site in Sarajevo, Bosnia-Herzegovina.


METHODS
A randomized, controlled, prospective, multicenter study in 68 adolescents with T1DM. The intervention group received monthly structured pharmaceutical care visits delivered by pharmacists plus supplementary visits and phone calls on an as needed basis, for 6 months. The control group received usual diabetic care. Data were collected at baseline and after 3 and 6 months.


METHODS
The between-group difference in the change from baseline in glycosylated hemoglobin (HbA1c) and the number of severe hypoglycemic events in both groups.


RESULTS
The improvement from baseline in HbA1c was significantly greater in the intervention group than in the control group after 6 months (change from baseline -0.54 vs. +0.32%, p = 0.0075), even after adjustment for country-specific variables (p = 0.0078). However, the effect was more pronounced after only 3 months (-1.09 vs. +0.23%, p = 0.00002). There was no significant between-group difference in the number of severe hypoglycemia events. (p = 0.1276).


CONCLUSIONS
This study suggests that multidisciplinary PhC may add value in the management of T1DM in adolescents with inadequate glycemic control. However, the optimal methods on how to achieve sustained, long-term improvements in this challenging population require further study.
Department of Clinical Pharmacy and Therapeutics, Heinrich Heine University, Universitätsstrasse 1, 40225, Düsseldorf, Germany. Emina.Obarcanin@uni-duesseldorf.de.
Emina
E
Obarcanin
Linner Pharmacy, Krefeld, Germany.
Manfred
M
Krüger
Helios Pediatric Clinic, Krefeld, Germany.
Petra
P
Müller
Helios Pediatric Clinic, Krefeld, Germany.
Verena
V
Nemitz
Mathematical Institute, Heinrich Heine University, Düsseldorf, Germany.
Holger
H
Schwender
Pediatric Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia-Herzegovina.
Snijezana
S
Hasanbegovic
Pediatric Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia-Herzegovina.
Sena
S
Kalajdzisalihovic
Department of Clinical Pharmacy and Therapeutics, Heinrich Heine University, Universitätsstrasse 1, 40225, Düsseldorf, Germany.
Stephanie
S
Läer
D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010593:Pharmaceutical Services / Q000458:organization & administration*
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
Adolescents; Bosnia-Herzegovina; Germany; Glycemic control; Pharmaceutical care; Pharmacists; Type 1 diabetes mellitus