Pharmaceutical care of elderly patients with poorly controlled   type 2 diabetes mellitus: a randomized controlled trial.
BACKGROUND
Care of the elderly with diabetes is more complicated than that for other age groups. The elderly and/or those with multiple comorbidities are often excluded from randomized controlled trials of treatments for diabetes. The heterogeneity of health status of the elderly also increases the difficulty in diabetes care; therefore, diabetes care for the elderly should be individualized. Motivated patients educated about diabetes benefit the most from collaborating with a multidisciplinary patient-care team. A pharmacist is an important team member by serving as an educator, coach, healthcare manager, and pharmaceutical care provider.


OBJECTIVE
To evaluate the effects of pharmaceutical care on glycemic control of ambulatory elderly patients with type 2 diabetes.


METHODS
A 421-bed district hospital in Nantou City, Taiwan.


METHODS
We conducted a randomized controlled clinical trial involving 100 patients with type 2 diabetes with poor glycemic control (HbA1c levels of ≥9.0 %) aged ≥65 years over 6 months. Participants were randomly assigned to a standard-care (control, n = 50) or pharmaceutical-care (intervention, n = 50) group. Pharmaceutical care was provided by a certified diabetes-educator pharmacist who identified and resolved drug-related problems and established a procedure for consultations pertaining to medication. The Mann–Whitney test was used to evaluate nonparametric quantitative data. Statistical significance was defined as P < 0.05.


METHODS
The change in the mean HbA1c level from the baseline to the next level within 6 months after recruiting.


RESULTS
Nonparametric data (Mann–Whitney test) showed that the mean HbA1c level significantly decreased (0.83 %) after 6 months for the intervention group compared with an increase of 0.43 % for the control group (P ≤ 0.001). Medical expenses between groups did not significantly differ (−624.06 vs. −418.7, P = 0.767). There was no significant difference in hospitalization rates between groups.


CONCLUSIONS
The pharmacist intervention program provided pharmaceutical services that improved long-term, safe control of blood sugar levels for ambulatory elderly patients with diabetes and did not increase medical expenses.
Jyun-Hong
JH
Chen
Huang-Tz
HT
Ou
Tzu-Chieh
TC
Lin
Edward Chia-Cheng
EC
Lai
Yea-Huei Yang
YH
Kao
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D017721:Hospital Costs; D006760:Hospitalization; D006767:Hospitals, District; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D054539:Medication Therapy Management / Q000191:economics; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000191:economics; D010595:Pharmacists / Q000191:economics; D010607:Pharmacy Service, Hospital / Q000191:economics; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human