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.
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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.
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None.
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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.
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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
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DOI: https://doi.org/10.1007/s11096-009-9312-1