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AMBULATORY CARE

Glycosylated Hemoglobin, Cardiovascular, and Renal Outcomes in a Pharmacist-Managed Clinic

Clinical Pharmacy Specialist, Ambulatory and Primary Care, Veterans Affairs Connecticut Healthcare System, Newington, CT

Michael F Caron, PharmD

Assistant Professor, College of Pharmacy, University of Rhode Island, Kingston, RI; Clinical Pharmacy Specialist—Cardiology, Pharmacy Services, Rhode Island Hospital, Providence, RI

James S Kalus, PharmD BCPS

Assistant Professor, College of Pharmacy and Allied Health Professions, Wayne State University, Detroit, MI

Patricia Hill, MD

Staff Internist, Ambulatory and Primary Care, Veterans Affairs Connecticut Healthcare System

Thomas E Buckley, BSPharm MPH

Clinical Education Consultant, Pfizer Inc., Avon, CT

Reprints: Michael F Caron PharmD, University of Rhode Island, Pharmacy Practice, 144 Fogarty Hall, Kingston, RI 02881-1966, fax 401/444-4984, mcaron{at}uri.edu

BACKGROUND: Pharmacists' responsibilities in caring for patients with diabetes mellitus are expanding. However, few data are available to support pharmacists optimizing therapy and improving outcomes in these patients.

OBJECTIVE: To determine the effect of a clinical pharmacist–directed diabetes management clinic on glycemic control and cardiovascular and renal parameters in patients with type 2 diabetes.

METHODS: A nonrandomized, prospective study was conducted in 70 Veterans Affairs patients. Patients met with the pharmacist every 6–8 weeks for approximately 30 minutes for education, medication counseling, monitoring, and management. The primary endpoint was the impact of 9–12 months of participation in the clinic on glycosylated hemoglobin (HbA_1C). Secondarily, we evaluated body weight, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, and level of microalbuminuria. All comparisons were made using a paired t-test at a significance level of p 0.05.

RESULTS: HbA_1C significantly decreased from 10.3% ± 2.2% at baseline to 6.9% ± 1.1% (mean ± SD) during the 9- to 12-month evaluation period (p < 0.001). The secondary endpoints including systolic (p < 0.001) and diastolic (p < 0.001) blood pressure, total cholesterol (p < 0.001), LDL-C (p < 0.001), triglycerides (p = 0.006), and level of microalbuminuria (p < 0.001) also were reduced at 9–12 months.

CONCLUSIONS: This study demonstrated that a clinical pharmacist can effectively care for patients with diabetes referred by their primary care provider because of poor glycemic control.

Key Words: diabetes mellitus, glycosylated hemoglobin

Published Online, March 23, 2004. www.theannals.com, DOI 10.1345/aph.1D359

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