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A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan

BACKGROUND: The role of a pharmacist in primary health care settings of Pakistan is still obscure. Thus, we aimed to demonstrate the pharmacist-led improvements in glycemic, blood pressure and lipid controls in type 2 diabetes mellitus (T2DM) patients of Lahore, Pakistan. METHODS: The first open lab...

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Autores principales: Javaid, Zaida, Imtiaz, Unaiza, Khalid, Imtiaz, Saeed, Hamid, Khan, Rehana Qadir, Islam, Muhammad, Saleem, Zikria, Sohail, Muhammad Farhan, Danish, Zeeshan, Batool, Farah, Anwer, Naveed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591859/
https://www.ncbi.nlm.nih.gov/pubmed/31234840
http://dx.doi.org/10.1186/s12913-019-4274-z
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author Javaid, Zaida
Imtiaz, Unaiza
Khalid, Imtiaz
Saeed, Hamid
Khan, Rehana Qadir
Islam, Muhammad
Saleem, Zikria
Sohail, Muhammad Farhan
Danish, Zeeshan
Batool, Farah
Anwer, Naveed
author_facet Javaid, Zaida
Imtiaz, Unaiza
Khalid, Imtiaz
Saeed, Hamid
Khan, Rehana Qadir
Islam, Muhammad
Saleem, Zikria
Sohail, Muhammad Farhan
Danish, Zeeshan
Batool, Farah
Anwer, Naveed
author_sort Javaid, Zaida
collection PubMed
description BACKGROUND: The role of a pharmacist in primary health care settings of Pakistan is still obscure. Thus, we aimed to demonstrate the pharmacist-led improvements in glycemic, blood pressure and lipid controls in type 2 diabetes mellitus (T2DM) patients of Lahore, Pakistan. METHODS: The first open label, randomized control trial conducted at a primary health care facility of Lahore, Pakistan by enrolling 244 uncontrolled type 2 diabetes (hemoglobin A1 c, (HbA1c); 10.85 ± 1.74) patients. The pharmacological intervention included identification of drug related problems, drug interactions, change in dose, frequency and therapy switches in collaboration with physician, while non-pharmacological intervention consisted of diet, lifestyle and behavior counseling. Outcome measures were glycemic (HbA1c), blood pressure and lipid controls. RESULTS: In intra-group comparison, compared to control arm (C, n = 52), subjects in the intervention arm (I, n = 83) demonstrated significant differences in process outcome measures; baseline vs final, such as HbA1c (C; 10.3 ± 1.3 vs 9.7 ± 1.3, p <  0.001, I; 10.9 ± 1.7 vs 7.7 ± 0.9, p <  0.0001), systolic blood pressure (SBP) (C; 129.9 ± 13.9 vs 136 ± 7.1, p = 0.0001, I; 145 ± 20.4 vs 123.9 ± 9.9 mmHg, p <  0.0001), diastolic blood pressure (DBP) (C; + 4, p = 0.03, I; − 7 mmHg, p <  0.0001), cholesterol (C; 235.8 ± 57.7 vs 220.9 ± 53.2, p = 0.15, I; 224 ± 55.2 vs 153 ± 25.9 mg/dL, p < 0.0001), triglycerides (C; 213.2 ± 86.6 vs 172.4 ± 48.7, p = 0.001, I; 273 ± 119.4 vs 143 ± 31.6 mg/dL, p < 0.0001) and estimated glomerular filtration rate (eGFR) (C; 77.5 ± 18.6 vs 76 ± 14.2, p = 0.5, I; 69.4 ± 21.3 vs 93.8 ± 15.2 ml/min/1.73m(2), p < 0.0001). Likewise, inter-group improvements were more significant in the subjects of intervention group at final follow up in comparison to control for various process outcome measures; HbA1c (p < 0.001), SBP (p < 0.0001), DBP (p = 0.02), cholesterol (p < 0.0001), triglycerides (p < 0.0001), SCr (p < 0.001), eGFR (p < 0.001). Moreover, both male and female subjects exhibited similar responses towards intervention with similar improvements in outcome measures. CONCLUSION: These data suggested that pharmacist intervention in collaboration with physician in primary health care settings may result in significant improvements in glycemic, blood pressure and lipid controls in Pakistani population. TRIAL REGISTRATION: The trial was registered retrospectively with International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry on July 26, 2017 under nutritional, metabolic, endocrine category with assigned registration # ISRCTN22657497 and can be assessed at 10.1186/ISRCTN22657497 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4274-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-65918592019-07-08 A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan Javaid, Zaida Imtiaz, Unaiza Khalid, Imtiaz Saeed, Hamid Khan, Rehana Qadir Islam, Muhammad Saleem, Zikria Sohail, Muhammad Farhan Danish, Zeeshan Batool, Farah Anwer, Naveed BMC Health Serv Res Research Article BACKGROUND: The role of a pharmacist in primary health care settings of Pakistan is still obscure. Thus, we aimed to demonstrate the pharmacist-led improvements in glycemic, blood pressure and lipid controls in type 2 diabetes mellitus (T2DM) patients of Lahore, Pakistan. METHODS: The first open label, randomized control trial conducted at a primary health care facility of Lahore, Pakistan by enrolling 244 uncontrolled type 2 diabetes (hemoglobin A1 c, (HbA1c); 10.85 ± 1.74) patients. The pharmacological intervention included identification of drug related problems, drug interactions, change in dose, frequency and therapy switches in collaboration with physician, while non-pharmacological intervention consisted of diet, lifestyle and behavior counseling. Outcome measures were glycemic (HbA1c), blood pressure and lipid controls. RESULTS: In intra-group comparison, compared to control arm (C, n = 52), subjects in the intervention arm (I, n = 83) demonstrated significant differences in process outcome measures; baseline vs final, such as HbA1c (C; 10.3 ± 1.3 vs 9.7 ± 1.3, p <  0.001, I; 10.9 ± 1.7 vs 7.7 ± 0.9, p <  0.0001), systolic blood pressure (SBP) (C; 129.9 ± 13.9 vs 136 ± 7.1, p = 0.0001, I; 145 ± 20.4 vs 123.9 ± 9.9 mmHg, p <  0.0001), diastolic blood pressure (DBP) (C; + 4, p = 0.03, I; − 7 mmHg, p <  0.0001), cholesterol (C; 235.8 ± 57.7 vs 220.9 ± 53.2, p = 0.15, I; 224 ± 55.2 vs 153 ± 25.9 mg/dL, p < 0.0001), triglycerides (C; 213.2 ± 86.6 vs 172.4 ± 48.7, p = 0.001, I; 273 ± 119.4 vs 143 ± 31.6 mg/dL, p < 0.0001) and estimated glomerular filtration rate (eGFR) (C; 77.5 ± 18.6 vs 76 ± 14.2, p = 0.5, I; 69.4 ± 21.3 vs 93.8 ± 15.2 ml/min/1.73m(2), p < 0.0001). Likewise, inter-group improvements were more significant in the subjects of intervention group at final follow up in comparison to control for various process outcome measures; HbA1c (p < 0.001), SBP (p < 0.0001), DBP (p = 0.02), cholesterol (p < 0.0001), triglycerides (p < 0.0001), SCr (p < 0.001), eGFR (p < 0.001). Moreover, both male and female subjects exhibited similar responses towards intervention with similar improvements in outcome measures. CONCLUSION: These data suggested that pharmacist intervention in collaboration with physician in primary health care settings may result in significant improvements in glycemic, blood pressure and lipid controls in Pakistani population. TRIAL REGISTRATION: The trial was registered retrospectively with International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry on July 26, 2017 under nutritional, metabolic, endocrine category with assigned registration # ISRCTN22657497 and can be assessed at 10.1186/ISRCTN22657497 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4274-z) contains supplementary material, which is available to authorized users. BioMed Central 2019-06-24 /pmc/articles/PMC6591859/ /pubmed/31234840 http://dx.doi.org/10.1186/s12913-019-4274-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Javaid, Zaida
Imtiaz, Unaiza
Khalid, Imtiaz
Saeed, Hamid
Khan, Rehana Qadir
Islam, Muhammad
Saleem, Zikria
Sohail, Muhammad Farhan
Danish, Zeeshan
Batool, Farah
Anwer, Naveed
A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan
title A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan
title_full A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan
title_fullStr A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan
title_full_unstemmed A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan
title_short A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan
title_sort randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in pakistan
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591859/
https://www.ncbi.nlm.nih.gov/pubmed/31234840
http://dx.doi.org/10.1186/s12913-019-4274-z
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