Pharmaceutical care of elderly patients with poorly controlled type 2 diabetes mellitus: a randomized controlled trial
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Background Care of the elderly with diabetes is more complicated than that for other age groups. The elderly and/or those with multiple comorbidities are often excluded from randomized controlled trials of treatments for diabetes. The heterogeneity of health status of the elderly also increases the difficulty in diabetes care; therefore, diabetes care for the elderly should be individualized. Motivated patients educated about diabetes benefit the most from collaborating with a multidisciplinary patient-care team. A pharmacist is an important team member by serving as an educator, coach, healthcare manager, and pharmaceutical care provider. Objective To evaluate the effects of pharmaceutical care on glycemic control of ambulatory elderly patients with type 2 diabetes. Setting A 421-bed district hospital in Nantou City, Taiwan. Method We conducted a randomized controlled clinical trial involving 100 patients with type 2 diabetes with poor glycemic control (HbA1c levels of ≥9.0 %) aged ≥65 years over 6 months. Participants were randomly assigned to a standard-care (control, n = 50) or pharmaceutical-care (intervention, n = 50) group. Pharmaceutical care was provided by a certified diabetes-educator pharmacist who identified and resolved drug-related problems and established a procedure for consultations pertaining to medication. The Mann–Whitney test was used to evaluate nonparametric quantitative data. Statistical significance was defined as P < 0.05. Main outcome measure The change in the mean HbA1c level from the baseline to the next level within 6 months after recruiting. Results Nonparametric data (Mann–Whitney test) showed that the mean HbA1c level significantly decreased (0.83 %) after 6 months for the intervention group compared with an increase of 0.43 % for the control group (P ≤ 0.001). Medical expenses between groups did not significantly differ (−624.06 vs. −418.7, P = 0.767). There was no significant difference in hospitalization rates between groups. Conclusion The pharmacist intervention program provided pharmaceutical services that improved long-term, safe control of blood sugar levels for ambulatory elderly patients with diabetes and did not increase medical expenses.
KeywordsClinical trials Diabetes Elderly Pharmaceutical care Taiwan
The authors thank the patients who participated in the study and the physicians, nurses (Huei-Yu Jheng), dietitians, and staff (Ker-Cheng Lin, Su-Mi Chen) at the Nantou Hospital, Ministry of Health and Welfare, Taiwan (ROC).
This study was supported by a Grant from the Department of Health, Executive Yuan, Taiwan (ROC) (100-MID-08).
Conflicts of interest
No potential conflicts of interest relevant to this article were reported.
- 4.Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.Google Scholar
- 10.McLean DL, McAlister FA, Johnson JA, King KM, Makowsky MJ, Jones CA, et al. A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus: study of cardiovascular risk intervention by pharmacists-hypertension (SCRIP-HTN). Arch Intern Med. 2008;168:2355–61.CrossRefPubMedGoogle Scholar
- 19.Guo NW, Liu HC, Wong PF, Liao KK, Yan SH, Lin KP, et al. Chinese version and norms of the mini-mental state examination. J Rehabil Med. 1988;16:52–9.Google Scholar