Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes - The Fremantle Diabetes study

OBJECTIVE - To examine the effect of a 12-month pharmaceutical care (PC) proram on vascular risk in type 2 diabetes. RESEARCH DESIGN AND METHODS- We recruited 198 community-based patients randomized to PC or usual care. PC patients had face-to-face goal-directed medication and h restyle counseling at baseline and at 6 and 12 months plus 6-weekly telephone assessments and. provision of other educational material. Clinical, biochemical, and medication-related data were sent regularly to each patient's physician(s). The main outcome measure was change in HbA(IC). A diabetes-specific risk engine was used to estimate changes in 10-year coronary heart disease (CHD) and stroke risk in patients without a history of cardiovascular disease. RESULTS - At total of 180 patients (91%) completed the study. Mean (95% CI) reductions were greater in PC case subjects (n = 92) than control subjects (n = 88) for HbA(IC) (-0.59% [95% CI 0.7 to 0.4] vs. 0[0.2 to 0.2]) and systolic (-14 mmHg [-19 to -9] vs. -7 [-11 to -2] and diastolic (-5 mmHg [-8 to -3] vs. -2 [-4 to1]) blood pressure (P <= 0.043). The improvernent in HbA(IC) persisted after adjustment for baseline value and demographic and treatruent-specific variables. The median (interquartile range) 10-year estimated risk of first CHD event decreased in the PC case sub jects (25.1% [15.6-36.2] to 20.3 [14.6-30.2] n = 42, P = 0.002) but not in the control subjects (26.1% [17.2-39.4] vs. 26.4 [16.7-38.0]; n = 52, P = 0. 17). CONCLUSIONS - A 12-month PC program in type 2 diabetes reduced glycernia and blood pressure. Pharmacist involvement contributed to improvement in HbA(IC) independently of pharmacotherapeutic changes. PC could prove a valuable component of community-based mullidisciplinary diabetes care.