Coast-Senior E A, Kroner B A, Kelley C L, Trilli L E
Department of Pharmacy, Veterans Affairs Pittsburgh Health Care System, PA, USA.
Ann Pharmacother. 1998 Jun;32(6):636-41. doi: 10.1345/aph.17095.
To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus.
Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose. The pharmacists provided diabetes education, medication counseling, monitoring, and insulin initiation and/or adjustments. All initial patient interactions with the pharmacists were face-to-face. Thereafter, patient-pharmacist interactions were either face-to-face or telephone contacts.
Two primary care clinics in a university-affiliated Veterans Affairs Medical Center.
Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control.
Primary outcome variables were changes from baseline in glycosylated hemoglobin, fasting blood glucose, and random blood glucose measurements. Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia, and the number of emergency room visits or hospitalizations related to diabetes. Twenty-three veterans aged 65-9.4 years completed the study. Fifteen (65%) patients were initiated on insulin by the pharmacists; 8 (35%) were already using insulin. Patients were followed for a mean-SD of 27-10 weeks. Glycosylated hemoglobin, fasting blood glucose concentrations, and random blood glucose concentrations significantly decreased from baseline by 2.2% (p = 0.00004), 65 mg/dL (p < 0.01), and 82 mg/dL (p = 0.00001), respectively. Symptomatic hypoglycemic episodes occurred in 35% of patients. None of these episodes required physician intervention.
This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin.
确定参与直接患者护理的临床药师对2型糖尿病患者血糖控制的影响。
符合条件的患者包括2型糖尿病患者，这些患者接受胰岛素治疗或由药师启动胰岛素治疗，并愿意进行血糖自我监测。药师提供糖尿病教育、用药咨询、监测以及胰岛素起始和/或调整。患者与药师的所有初始互动均为面对面。此后，患者与药师的互动为面对面或电话联系。
一所大学附属退伍军人事务医疗中心的两家初级保健诊所。
研究对象为2型糖尿病患者，他们由初级保健提供者转介给药师以更好地控制血糖。
主要观察变量为糖化血红蛋白、空腹血糖和随机血糖测量值相对于基线的变化。次要观察指标为低血糖症状发作的次数和严重程度，以及与糖尿病相关的急诊就诊或住院次数。23名年龄在65 - 94岁的退伍军人完成了该研究。15名（65%）患者由药师启动胰岛素治疗；8名（35%）患者已在使用胰岛素。患者的随访平均时长为27 - 10周。糖化血红蛋白、空腹血糖浓度和随机血糖浓度相对于基线分别显著降低了2.2%（p = 0.00004）、65 mg/dL（p < 0.01）和82 mg/dL（p = 0.00001）。35%的患者出现了低血糖症状发作。这些发作均无需医生干预。
本研究表明，作为跨学科初级保健团队成员的药师可对需要胰岛素治疗的2型糖尿病患者的血糖控制产生积极影响。
