882 ■ The Annals of Pharmacotherapy ■ 2009 May, Volume 43 www.theannals.com D iabetes is a common and costly dis- ease that affects more than 7.8% of the US population, with an estimated an- nual cost exceeding $174 billion. 1 Dia- betes is a difficult disease to manage be- cause of the numerous self-care behaviors involved in controlling blood glucose lev- els and other disease aspects. For patients with diabetes, failure to control blood glu- cose levels is associated with microvascu- lar complications such as nephropathy, neuropathy, and retinopathy. 2,3 Controlling cardiovascular risk factors is also impor- tant, because patients with diabetes are at an increased risk of myocardial infarction and stroke. 3 Diabetes is a progressive dis- ease that, once diagnosed, requires lifelong management. Patients diagnosed with dia- betes often are prescribed new medica- tions and educated on important lifestyle changes. Supplementary diabetes manage- ment beyond this initial period is referred to herein as extended diabetes care. Managing diabetes can be difficult, especially for a single provider. Often, physician visits are short and focus on an acute complaint. 4 As a result, physicians may not have enough time to assess drug therapy or provide diabetes education, especially considering the significant lifestyle changes recommended for pa- tients with diabetes. 5,6 Including addi- tional providers such as pharmacists in the care of patients with diabetes has been shown to be beneficial. For example, several studies have shown that pharmacist interventions can decrease hemoglobin A 1c (A1C) levels by 1% or more. 7 The American Diabetes As- sociation has affirmed this and endorses multidisciplinary diabetes care. 8 Some insurers recognize the need for addi- tional instruction about diabetes self-care and pay for spe- Community Pharmacist–Provided Extended Diabetes Care William R Doucette, Matthew J Witry, Karen B Farris, and Randal P McDonough Diabetes Author information provided at the end of the text. BACKGROUND: Pharmacists in various settings have been effective in initiating diabetes treatment. Patients with diabetes require ongoing disease management, and community pharmacists are in a strategic position to provide such extended care. Little is known, however, about the effects of community pharmacist–provided interventions beyond the initial treatment period. OBJECTIVE: To evaluate the effect of community pharmacist–provided extended diabetes care service on primary clinical outcomes, including hemoglobin A 1c (A1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure, and on patients’ reported self-care activities. METHODS: A randomized controlled trial was conducted in patients with diabetes. Participants had already completed at least 2 diabetes education sessions at a local diabetes education center. Nine specially trained pharmacists administered interventions during up to 4 quarterly visits per patient. Interventions included discussing medications, clinical goals, and self-care activities with patients and recommending medication changes to physicians when appropriate. The main outcome measures were 12-month changes in A1C, LDL-C, blood pressure, and self-report of self-care activities. RESULTS: Seventy-eight patients participated in the study (36 intervention, 42 control); 66 were included in the final analysis (31 intervention, 35 control). Compared with changes in the control group, patients who received interventions significantly increased the number of days per week that they engaged in a set of diet and diabetes self-care activities (1.25 and 0.73 more days/wk, respectively). The mean 12-month changes for A1C, LDL-C, and blood pressure were not significantly different between the 2 study groups. CONCLUSIONS: Although pharmacist-provided interventions did not demonstrate statistically significant improvements in clinical outcomes over the study period, study results did show that pharmacists were effective at increasing the number of days that patients spent engaging in healthy diet and diabetes self-care activities. Addressing lifestyle and self-care behaviors can be a beneficial component of a pharmacist-provided extended diabetes care service. KEY WORDS: diabetes, disease management, medication therapy management, pharmacy. Ann Pharmacother 2009;43:882-9. Published Online, 28 Apr 2009, www.theannals.com, DOI 10.1345/aph.1L605 by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from