Background Brazilians with type 2 diabetes require action to improve haemoglobin A1C levels considering the fact that approximately 73 % of them have poor glycaemic control. Evidence has shown the potential benefits of pharmaceutical care programs in type 2 diabetes patients. Objective To evaluate the effect of a pharmaceutical care program on blood glucose, blood pressure and lipid profile in hyperglycaemic patients undergoing drug treatment for type 2 diabetes. Setting Six primary care units of the Brazilian public health system, Ouro Preto, Brazil. Method An open, randomised, controlled clinical trial was conducted for 6 months. Subjects aged 18 years or older who were using oral antidiabetic medications and presenting haemoglobin A1C levels ≥7 % were randomly assigned to receive only usual health care or usual health care plus pharmaceutical intervention. Main outcome measure Haemoglobin A1C. Results A total of 129 subjects were enrolled, and 100 patients completed the study. Compared to the control group (n = 50), the intervention group (n = 50) showed a significant reduction of haemoglobin A1C (−0.6 vs 0.7 %, p = 0.001), fasting plasma glucose, total cholesterol, LDL cholesterol, triglycerides and systolic blood pressure and a significant increase in HDL cholesterol and the use of lipid-modifying agents and platelet aggregation inhibitors. Conclusions This study suggests that a pharmaceutical care program may provide important contributions to reduce haemoglobin A1C in type 2 diabetes patients. Moreover, the promotion of the rational use of drugs may be better achieved in a context of pharmaceutical care programs in Brazil.
Brazil Diabetes mellitus Diabetes type 2 Pharmacists Pharmaceutical care Randomised controlled trial
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The authors would like to thank the teachers and students of Education Program for Health Work and the pharmacists who contributed to this research.
The study was supported by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) and Universidade Federal de Ouro Preto.
Conflicts of interest
The authors have no conflict of interest with regard to this study.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14.PubMedCrossRefGoogle Scholar
Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69 years. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes Care. 1992;15:1509–16.PubMedCrossRefGoogle Scholar
Mendes ABV, Fittipaldi JAS, Neves RCS, Chacra AR, Moreira ED. Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil. Acta Diabetol. 2010;47:137–45.PubMedCrossRefGoogle Scholar
Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
Turnacilar M, Sancar M, Apikoglu-Rabus S, Hursitoglu M, Izzettin FV. Improvement of diabetes indices of care by a short pharmaceutical care program. Pharm World Sci. 2009;31:689–95.PubMedCrossRefGoogle Scholar
Fornos AJ, Andrés NF, Andrés JC, Guerra MM, Egea B. A pharmacotherapy follow-up program in patients with type-2 diabetes in community pharmacies in Spain. Pharm World Sci. 2006;28:65–72.PubMedCrossRefGoogle Scholar
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.PubMedCrossRefGoogle Scholar
Clifford RM, Davis WA, Batty KT, Davis TM. Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2005;28:771–6.PubMedCrossRefGoogle Scholar
Correr CJ, Melchiors AC, Fernandes-Llimós F, Pontarolo R. Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil. Int J Clin Pharm. 2011;33:273–80.PubMedCrossRefGoogle Scholar
Neto PRO, Marusic S, Lyra-Júnior DP, Pilger D, Cruciol-Souza JM, Gaeti WP, et al. Effect of a 36-month pharmaceutical care program on coronary heart disease risk in elderly diabetic and hypertensive patients. J Pharm Pharmaceut Sci. 2011;14:249–63.Google Scholar
Borges AP, Guidoni CM, Ferreira LD, de Freitas O, Pereira LR. The pharmaceutical care of patients with type 2 diabetes mellitus. Pharm World Sci. 2010;32:730–6.PubMedCrossRefGoogle Scholar
Al Mazroui NR, Kamal MM, Ghabash NM, Yacout TA, Kole PL, McElnay JC. Influence of pharmaceutical care on health outcomes in patients with type 2 diabetes mellitus. Br J Clin Pharmacol. 2009;67:547–57.PubMedCrossRefGoogle Scholar
Correr CJ, Pontarolo R, Wiens A, Rossignoli P, Melchiors AC, Radominski R, et al. Economic evaluation of pharmacotherapeutic follow-up in type 2 diabetes mellitus patients in community pharmacies. Arq Bras Endocrinol Metab. 2009;53:825–33.CrossRefGoogle Scholar
Cid AS. Avaliação da efetividade da atenção farmacêutica no controle da hipertensão arterial. Dissertação (Mestrado em Ciências Farmacêuticas). Universidade Federal de Ouro Preto, Ouro Preto; 2008.Google Scholar
Friedewald WT, Levi RI, Fredrickson DS. Estimation of the concentration of low density lipoproteins cholesterol in plasma without use of the ultracentrifuge. Clin Chem. 1972;18:499–502.PubMedGoogle Scholar
American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care. 2011;34(Suppl. 1):S11–61.CrossRefGoogle Scholar
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the clinician’s guide. 2nd ed. New York: McGraw-Hill; 2004.Google Scholar
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405–12.PubMedCrossRefGoogle Scholar
Fera T, Bluml BM, Ellis WM. Diabetes ten city challenge: final economic and clinical results. J Am Pharm Assoc. 2009;49(3):383–91.CrossRefGoogle Scholar
Ivama AM, Noblat L, De Castro MS, De Oliveira NVBV, Jaramillo NM, Rech N. Consenso Brasileiro de atenção farmacêutica. Brasília: PAHO/WHO; 2002.Google Scholar