Background

Diabetes prevalence is estimated to reach 20.6% by 2030. Studies have illustrated main reasons for uncontrolled patients and concluded: low level of awareness, limited access to healthcare providers, and lack of cooperation between different disciplines. The role of pharmacists has been proven to improve patient-related outcomes, including an improvement in HgA1C readings between 0.54% and 1.6%.

Objectives

This study was conducted to evaluate diabetes-related health outcomes in a pharmacist-led diabetes clinic in terms of HgbA1C level, guideline-recommended routine screenings, medication adherence, and biomarkers of other comorbidities.

Method

A prospective cohort study conducted from August 2017 until July 2018 at an academic hospital. The pharmacist-led diabetes clinic was providing the service for a half-day per week. The study included all adult diabetic patients referred to the pharmacist-led clinic and had -at least- three 3-month apart follow-up visits with no exclusions. The baseline assessments for patients receiving routine diabetic care was performed using HgbA1C level, blood pressure, lipid and thyroid panel, eye and foot examinations, preventive measures, and adherence. The baseline results were compared to the follow-up results thereafter. A descriptive analysis was used to report the differences between intervals. Main outcome measure: (a) Reduction in HgbA1c levels, (b) intervention made by clinical pharmacists in an outpatient setting.

Result

The study included thirty-five patients. The mean ± SD age was 56 ± 10 years old. At baseline, mean HgbA1C was 9.5% ± 1.3%. HgbA1C was ≥10% for 13 patients. Albuminuria was never previously assessed for 14 patients. Twenty percent were receiving incorrect dose compared to the guideline-recommended statin therapy. By the end of study, mean HgbA1C had significantly improved to be 8.3% ± 1.4% (p = 0.0004). Nine patients achieved their HgbA1C goal of <7%. All patients were assessed for albuminuria, and managed accordingly. Thirty-two patients were eligible to receive statin therapy, and prescribed appropriate doses. Additionally, peripheral neuropathy was assessed for all cohort, and seven patients received recommended vaccinations.

Conclusion

Involving clinical pharmacists in diabetes management clinic can provide valuable services, help patients to adhere to the therapeutic plans, and assist physicians to achieve better treatment outcomes.

中文翻译：

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临床药剂师主导的糖尿病管理诊所对沙特阿拉伯利雅得一家学术医院健康结果的影响：一项前瞻性队列研究

背景

预计到 2030 年，糖尿病患病率将达到 20.6%。研究阐明了患者不受控制的主要原因，并得出结论：认识水平低、获得医疗服务的机会有限以及不同学科之间缺乏合作。事实证明，药剂师的作用可以改善患者相关的结果，包括 HgA1C 读数改善 0.54% 至 1.6%。

目标

本研究旨在评估药剂师主导的糖尿病诊所的糖尿病相关健康结果，包括 HgbA1C 水平、指南推荐的常规筛查、用药依从性和其他合并症的生物标志物。

方法

2017 年 8 月至 2018 年 7 月在一家学术医院进行的一项前瞻性队列研究。药剂师领导的糖尿病诊所每周提供半天的服务。该研究纳入了转诊至药剂师主导诊所的所有成年糖尿病患者，并进行了至少 3 次间隔 3 个月的随访，无一例外。使用 HgbA1C 水平、血压、血脂和甲状腺检查、眼部和足部检查、预防措施和依从性对接受常规糖尿病护理的患者进行基线评估。将基线结果与此后的后续结果进行比较。使用描述性分析来报告间隔之间的差异。主要结果指标：(a) HgbA1c 水平降低，(b) 临床药剂师在门诊进行的干预。

结果

该研究包括三十五名患者。平均±标准差年龄为56±10岁。基线时，平均 HgbA1C 为 9.5% ± 1.3%。13 名患者的 HgbA1C ≥10%。之前从未评估过 14 名患者的蛋白尿。与指南推荐的他汀类药物治疗相比，百分之二十的人接受了错误的剂量。到研究结束时，平均 HgbA1C 显着改善至 8.3% ± 1.4% (p = 0.0004)。9 名患者实现了 HgbA1C <7% 的目标。所有患者均接受蛋白尿评估，并进行相应管理。32 名患者有资格接受他汀类药物治疗，并开了适当的剂量。此外，对所有队列的周围神经病变进行了评估，七名患者接受了推荐的疫苗接种。

结论

让临床药师参与糖尿病管理诊所可以提供有价值的服务，帮助患者遵守治疗计划，并协助医生取得更好的治疗结果。