Improvement in medication adherence and self-management
                    of diabetes with a clinical pharmacy program: a randomized controlled trial in
                    patients with type 2 diabetes undergoing insulin therapy at a teaching
                    hospital

Cani, Catarina Gomes; Lopes, Laura da Silva Girão; Queiroz, Márcia; Nery, Márcia

doi:10.6061/clinics/2015(02)06

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CLINICAL SCIENCES • Clinics 70 (2) • Feb 2015 • https://doi.org/10.6061/clinics/2015(02)06 copy

Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil.

METHOD:

A randomized controlled trial with a 6-month follow-up period was performed in 70 adults, aged 45 years or older, with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8%. Patients in the control group (CG) (n = 36) received standard care, patients in the intervention group (IG) (n = 34) received an individualized pharmacotherapeutic care plan and diabetes education. The primary outcome measure was change in HbA1c. Secondary outcomes included diabetes and medication knowledge, adherence to medication, insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life. Outcomes were evaluated at baseline and 6 months using questionnaires.

RESULTS:

Diabetes knowledge, medication knowledge, adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group. At the end of the study, mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group. Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group.

CONCLUSION:

The program improved health outcomes and resulted in better glycemic control in patients with type 2 diabetes undergoing insulin therapy.

Diabetes Mellitus Type 2; Medication Adherence; Clinical Pharmacy Services; Self-Management; Outpatient Care

Variable	Control Group (n = 36)	Intervention Group (n = 34)	p	Total
Age (years) (mean (SD))	61.58 (8.14)	61.91 (9.58)	0.877	61.74 (8.81)
Male (n/total (%))	14/36 (38.9)	13/34 (38.2)	0.955	27/70 (38.6)
Duration of diabetes (years), (mean (SD))	14.92 (8.49)	14.56 (7.40)	0.852	14.74 (7.92)

Variable	Assessment	Control Group (n = 36)	Intervention Group (n = 34)	p ^*
Diabetes knowledge (score, mean ± SD)	Initial	9.72±2.71	9.91±2.69	>0.999
	Final	9.75±2.69	15.74±3.03	<0.001
p ^#		>0.999	<0.001
Medication knowledge (score, mean ± SD)	Initial	3.94±0.99	4.47±0.84	0.118
	Final	3.85±0.99	6.58±1.29	<0.001
p ^#		>0.999	<0.001
Adherence, Morisky-Green (% adherent patients)	Initial	27.8%	17.6%	0.313
	Final	25%	70.6%	<0.001
p ^#		>0.999	<0.001
Adherence, AMQ (% adherent patients)	Initial	30.6%	47.1%	0.917
	Final	25%	52.9%	0.016
p ^#		0.500	0.039
Insulin injection technique (% correct)	Initial	59.09±18.24	66.61±15.41	0.404
	Final	57.68±18.21	87.81±10.89	<0.001
p ^#		>0.999	<0.001
Home blood glucose monitoring technique (score, mean ± SD)	Initial	6.31±1.41	6.85±0.93	0.364
	Final	6.25±1.18	8.88±1.04	<0.001
p ^#		>0.999	<0.001
HbA1c (%, mean ± SD)	Initial	9.61±1.38	9.78±1.55	>0.999
	Final	9.53±1.68	9.21±1.41	>0.999
p ^#		>0.999	<0.001
Diabetes-related quality of life (score, mean ± SD)	Initial	162.53±9.71	157.21±13.28	0.354
	Final	166.36±9.94	152.06±14.98	<0.001
p ^#		<0.001	<0.001

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

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[1] AUTHOR CONTRIBUTIONS

This article presents the results of a Master's project developed by Cani CG. She is a pharmacist and she performed the patient consultations and orientations and wrote the manuscript. Lopes LS is a physician and member of the team and she was also responsible for some of the statistical analysis and the manuscript review. Queiroz M is a physician and member of the team. She participated in the development of the study and also revised the manuscript. Nery M is the physician in charge of the Diabetes Unit of the Hospital, she supervised the student and the project, and revised the final version of the manuscript.