Skip to main content
Log in

Development of an evidence-based checklist for the detection of drug related problems in type 2 diabetes

  • Research Article
  • Published:
Pharmacy World & Science Aims and scope Submit manuscript

Abstract

Objective To develop an evidence-based checklist to identify potential drug related problems (PDRP) in patients with type 2 diabetes. Setting The evidence based checklist was applied to records of ambulatory type 2 diabetes patients in New South Wales, Australia. Method After comprehensive review of the literature, relevant medication groups and potential drug related problems in type 2 diabetes were identified. All the relevant information was then structured in the form of a checklist. To test the utility of the evidence-based checklist a cross-sectional retrospective study was conducted. The PDRP checklist was applied to the data of 148 patients with established type 2 diabetes and poor glycaemic control. The range and extent of DRPs in this population were identified, which were categorized using the PCNE classification. In addition, the relationship between the total as well as each category of DRPs and several of the patients’ clinical parameters was investigated. Main outcome measure: Number and category of DRPs per patient. Results The PDRP checklist was successfully developed and consisted of six main sections. 682 potential DRPs were identified using the checklist, an average of 4.6 (SD = 1.7) per patient. Metabolic and blood pressure control in the study subjects was generally poor: with a mean HbA1c of 8.7% (SD = 1.5) and mean blood pressure of 139.8 mmHg (SD = 18.1)/81.7 mmHg (SD = 11.1). The majority of DRPs was recorded in the categories ‘therapy failure’ (n = 264) and ‘drug choice problem’ (n = 206). Potentially non-adherent patients had a significantly higher HbA1c than patients who adhered to therapy (HbA1c of 9.4% vs. 8.5%; P = 0.01). Conclusion This is the first tool developed specifically to detect potential DRPs in patients with type 2 diabetes. It was used to identify DRPs in a sample of type 2 diabetes patients and demonstrated the high prevalence of DRPs per patient. The checklist may assist pharmacists and other health care professionals to systematically identify issues in therapy and management of their type 2 diabetes patients and enable earlier intervention to improve metabolic control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383–93. doi:10.1056/NEJMoa021778.

    Article  PubMed  Google Scholar 

  2. Bate KL, Jerums G. 3: Preventing complications of diabetes. Med J Aust. 2003;179:498–503.

    PubMed  Google Scholar 

  3. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24:1093–7.

    Article  CAS  PubMed  Google Scholar 

  4. Ellis SL, Billups SJ, Malone DC, Carter BL, Covey D, Mason B, et al. Types of interventions made by clinical pharmacists in the IMPROVE study. Impact of managed pharmaceutical care on resource utilization and outcomes in veterans affairs medical centers. Pharmacotherapy. 2000;20:429–35. doi:10.1592/phco.20.5.429.35055.

    Article  CAS  PubMed  Google Scholar 

  5. American Diabetes Association. Standards of medical care in diabetes—2007. Diabetes Care. 2007;30(Suppl 1):S4–41. doi: 10.2337/dc07-S004.

    Article  Google Scholar 

  6. American Association of Clinical Endocrinologists. Medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13(Suppl 1):1–68.

    Google Scholar 

  7. Diabetes Australia. National Evidence Based Guidelines for the Management of Type 2 Diabetes Mellitus. 2007 [cited 18-01-2008]; Available from: http://www.diabetesaustralia.com.au/For-Health-Professionals/Diabetes-National-Guidelines/.

  8. International Diabetes Federation. Global Guidelines for Type 2 Diabetes. 2005 [cited 18-01-2008]; Available from: http://www.staff.ncl.ac.uk/philip.home/IDF%20GGT2D.pdf.

  9. Australian Medicines Handbook. AMH Pty Ltd. July, 2007. ISBN 0-9757919-5-8.

  10. Drug Interaction Facts on disc v1.0. Medifor Inc July, 2007. ISBN 978-1574392579.

  11. Van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38:859–67. doi:10.1345/aph.1D182.

    Article  PubMed  Google Scholar 

  12. The PCNE Classification V 5.01. 2006 [cited 16-01-2008]; Available from: http://www.pcne.org/dokumenter/DRP/PCNE%20classification%20V5.01.pdf.

  13. Krass I, Armour CL, Mitchell B, Brillant M, Dienaar R, Hughes J, et al. The pharmacy diabetes care program: assessment of a community pharmacy diabetes service model in Australia. Diabet Med. 2007;24:677–83. doi:10.1111/j.1464-5491.2007.02143.x.

    Article  CAS  PubMed  Google Scholar 

  14. Svarstad BL, Chewning BA, Sleath BL, Claesson C. The brief medication questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37:113–24. doi:10.1016/S0738-3991(98)00107-4.

    Article  CAS  PubMed  Google Scholar 

  15. Loboz KK, Shenfield GM. Drug combinations and impaired renal function—the ‘triple whammy’. Br J Clin Pharmacol. 2005;59:239–43. doi:10.1111/j.0306-5251.2004.2188.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Haugbolle LS, Sorensen EW. Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma—interviewing patients at home. Pharm World Sci. 2006;28:239–47. doi:10.1007/s11096-006-9023-9.

    Article  PubMed  Google Scholar 

  17. ETDRS Investigators. Aspirin effects on mortality and morbidity in patients with diabetes mellitus. Early treatment diabetic retinopathy study report 14. JAMA. 1992;268:1292–300. doi:10.1001/jama.268.10.1292.

    Article  Google Scholar 

  18. Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003;361:2005–16. doi:10.1016/S0140-6736(03)12475-0.

    Article  PubMed  Google Scholar 

  19. Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23). BMJ. 1998;316:823–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Burge MR, Sood V, Sobhy TA, Rassam AG, Schade DS. Sulphonylurea-induced hypoglycaemia in type 2 diabetes mellitus: a review. Diabetes Obes Metab. 1999;1:199–206. doi:10.1046/j.1463-1326.1999.00031.x.

    Article  CAS  PubMed  Google Scholar 

  21. Rave K, Flesch S, Kuhn-Velten WN, Hompesch BC, Heinemann L, Heise T. Enhancement of blood glucose lowering effect of a sulfonylurea when coadministered with an ACE inhibitor: results of a glucose-clamp study. Diabetes Metab Res Rev. 2005;21:459–64. doi:10.1002/dmrr.563.

    Article  CAS  PubMed  Google Scholar 

  22. Herings RM, de Boer A, Stricker BH, Leufkens HG, Porsius A. Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme. Lancet. 1995;345:1195–8. doi:10.1016/S0140-6736(95)91988-0.

    Article  CAS  PubMed  Google Scholar 

  23. Donnelly LA, Morris AD, Evans JM. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJM. 2007;100:345–50. doi:10.1093/qjmed/hcm031.

    Article  CAS  PubMed  Google Scholar 

  24. Lindenmeyer A, Hearnshaw H, Vermeire E, Van Royen P, Wens J, Biot Y. Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists. J Clin Pharm Ther. 2006;31:409–19. doi:10.1111/j.1365-2710.2006.00759.x.

    Article  CAS  PubMed  Google Scholar 

  25. Krass I, Taylor SJ, Smith C, Armour CL. P Impact on medication use and adherence of Australian pharmacists’ diabetes care services. JAPhA. 2005;45:33–40.

    PubMed  Google Scholar 

  26. Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121:293–8. doi:10.1016/0002-8703(91)90861-B.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Dr. Bernadette Mitchell and Jane Ludington for their help in reviewing the checklist.

Funding

The Pharmacy Diabetes Care Program was funded by the Australian Government Department of Health & Ageing as part of the Third Community Pharmacy Agreement. This study was partly funded by the Dutch Diabetes Research Foundation.

Conflicts of interest

None.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bob W. van Roozendaal.

Appendix

Appendix

PDRP checklist: medications in type 2 diabetes

This tool is meant to be used by pharmacists in order to detect possible drug related problems and/or potential interventions in patients with type 2 diabetes. It is primarily focused on a patient’s medications, and includes the most commonly used agents for the treatment of hyperglycaemia, hypertension, dyslipidaemia and hypercoagulability. Throughout the tool, several footnotes are used. These refer to the following information:

1 Dietary guidelines for Australian adults are provided by the NHMRC. These can be accessed through http://www.nhmrc.gov.au/publications/synopses/_files/n33.pdf.

2 The Australian Physical Activity guidelines recommend at least 30 minutes of moderate-intensity physical activity on most, preferably all, days. These can be accessed through http://www.ausport.gov.au/fulltext/1999/feddep/physguide.pdf.

3 Renal impairment is defined by the creatinine clearance, which is calculated using the Cockroft-Gault formula:

Creatinine clearance = ((140 − age) * weight * constant)/plasma creatinine

Creatinine clearance in ml/min; age in years; weight in kilograms; constant = 1.23 for men and 1.04 for women; plasma creatinine in mg/dl

1Creatinine clearance <10 ml/min = severe renal impairment

2Creatinine clearance 10–25 ml/min = moderate renal impairment

3Creatinine clearance 25–50 ml/min = mild renal impairment

4Hepatic impairment is present when transaminase levels are >2.5 times the upper limit of normal

5The advised amounts from the NHMRC guidelines are:

For men: an average of no more than 4 standard drinks a day, and no more than 28 standard drinks a week; not more than 6 standard drinks in any one day.

For women: an average of no more than 2 standard drinks a day, and no more than 14 standard drinks a week; not more than 4 standard drinks in any one day.

For both men and women, one or two alcohol free days each week are recommended.

6Heart failure is classified as:

NYHA Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities

NYHA Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion

NYHA Class III: marked limitation of any activity; the patient is comfortable only at rest

NYHA Class IV: any physical activity brings on discomfort and symptoms occur at rest

The Australian Medicines Handbook (AMH Pty Ltd. July, 2007) was used for the information on dosages.

Drug Interaction Facts on disc v1.0 (1999 Facts and Comparisons, Medifor Inc, July 2007 edition) was used for the information on interactions.

Further information was provided by the literature review.

figure a
figure b
figure c
figure d
figure e
figure f
figure g
figure h

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Roozendaal, B.W., Krass, I. Development of an evidence-based checklist for the detection of drug related problems in type 2 diabetes. Pharm World Sci 31, 580–595 (2009). https://doi.org/10.1007/s11096-009-9312-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-009-9312-1

Keywords

Navigation