Pharmacy World & Science

, Volume 31, Issue 5, pp 580–595 | Cite as

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

  • Bob W. van RoozendaalEmail author
  • Ines Krass
Research Article


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.


Type 2 diabetes Drug related problems Drug therapy Evidence-based medicine Evidence-based pharmacy Diabetes PCNE DRP classification 



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


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


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.


  1. 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.CrossRefPubMedGoogle Scholar
  2. 2.
    Bate KL, Jerums G. 3: Preventing complications of diabetes. Med J Aust. 2003;179:498–503.PubMedGoogle Scholar
  3. 3.
    Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24:1093–7.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 5.
    American Diabetes Association. Standards of medical care in diabetes—2007. Diabetes Care. 2007;30(Suppl 1):S4–41. doi:  10.2337/dc07-S004.CrossRefGoogle Scholar
  6. 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. 7.
    Diabetes Australia. National Evidence Based Guidelines for the Management of Type 2 Diabetes Mellitus. 2007 [cited 18-01-2008]; Available from:
  8. 8.
    International Diabetes Federation. Global Guidelines for Type 2 Diabetes. 2005 [cited 18-01-2008]; Available from:
  9. 9.
    Australian Medicines Handbook. AMH Pty Ltd. July, 2007. ISBN 0-9757919-5-8.Google Scholar
  10. 10.
    Drug Interaction Facts on disc v1.0. Medifor Inc July, 2007. ISBN 978-1574392579.Google Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 12.
    The PCNE Classification V 5.01. 2006 [cited 16-01-2008]; Available from:
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.PubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2009

Authors and Affiliations

  1. 1.Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
  2. 2.Faculty of PharmacyUniversity of SydneySydneyAustralia

Personalised recommendations