International Journal of Clinical Pharmacy

, Volume 35, Issue 1, pp 79–86 | Cite as

Pharmaceutical care program for type 2 diabetes patients in Brazil: a randomised controlled trial

  • Aline Oliveira Magalhães Mourão
  • Wandiclécia Rodrigues Ferreira
  • Maria Auxiliadora Parreiras Martins
  • Adriano Max Moreira Reis
  • Maria Ruth Gaede Carrillo
  • Andrea Grabe Guimarães
  • Lisiane Silveira Ev
Research Article

Abstract

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.

Keywords

Brazil Diabetes mellitus Diabetes type 2 Pharmacists Pharmaceutical care Randomised controlled trial 

Notes

Acknowledgments

The authors would like to thank the teachers and students of Education Program for Health Work and the pharmacists who contributed to this research.

Funding

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.

References

  1. 1.
    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
  2. 2.
    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
  3. 3.
    Sociedade Brasileira de Diabetes (SBD). Diretrizes da Sociedade Brasileira de Diabetes. [cited 2012 18 Jul]; Available from: http://www.diabetes.org.br/attachments/diretrizes09_final.pdf.
  4. 4.
    Brasil. Saúde Brasil 2009: uma análise da situação de saúde e da agenda nacional e internacional de prioridades em saúde. [cited 2012 18 Jul]; Available from: http://portal.saude.gov.br/portal/arquivos/pdf/29_11_10_saude_brasil_web.pdf.
  5. 5.
    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
  6. 6.
    World Health Organization. The role of the pharmacist in the health care system. Vancouver, Canada; 1997. [cited 2012 18 Jul]; Available from: www.opas.org.br/medicamentos/site/UploadArq/who-pharm-97-599.pdf.
  7. 7.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  8. 8.
    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
  9. 9.
    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
  10. 10.
    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
  11. 11.
    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
  12. 12.
    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
  13. 13.
    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
  14. 14.
    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
  15. 15.
    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
  16. 16.
    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
  17. 17.
    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
  18. 18.
    World Health Organization. ATC/DDD Index 2010. [cited 2012 18 Jul]; Available from: http://www.whocc.no/atc_ddd_index/.
  19. 19.
    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
  20. 20.
    American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care. 2011;34(Suppl. 1):S11–61.CrossRefGoogle Scholar
  21. 21.
    Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the clinician’s guide. 2nd ed. New York: McGraw-Hill; 2004.Google Scholar
  22. 22.
    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
  23. 23.
    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
  24. 24.
    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
  25. 25.
    Peduzzi M. Multiprofessional healthcare team: concept and typology. Rev Saúde Pública. 2001;35:103–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Grant RW, Buse JB, Meigs JB. Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabetes Care. 2005;28:337–42.PubMedCrossRefGoogle Scholar
  27. 27.
    Zafar A, Davies M, Azhar A, Khunti K. Clinical inertia in management of T2DM. Prim Care Diabetes. 2010;4:203–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med. 2001;135:825–34.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Aline Oliveira Magalhães Mourão
    • 1
  • Wandiclécia Rodrigues Ferreira
    • 2
  • Maria Auxiliadora Parreiras Martins
    • 3
  • Adriano Max Moreira Reis
    • 3
  • Maria Ruth Gaede Carrillo
    • 4
  • Andrea Grabe Guimarães
    • 2
  • Lisiane Silveira Ev
    • 2
  1. 1.Post-Graduate Program in Pharmaceutical Sciences, School of PharmacyFederal University of Ouro PretoOuro PretoBrazil
  2. 2.Department of Pharmacy, School of PharmacyFederal University of Ouro PretoOuro PretoBrazil
  3. 3.Department of Pharmaceutical Products, School of PharmacyFederal University of Minas GeraisBelo HorizonteBrazil
  4. 4.Department of Clinical Analysis, School of PharmacyFederal University of Ouro PretoOuro PretoBrazil

Personalised recommendations