PMID- 31234840 OWN - NLM STAT- MEDLINE DCOM- 20190918 LR - 20200225 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 19 IP - 1 DP - 2019 Jun 24 TI - A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan. PG - 409 LID - 10.1186/s12913-019-4274-z [doi] LID - 409 AB - 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 https://doi.org/10.1186/ISRCTN22657497. FAU - Javaid, Zaida AU - Javaid Z AD - Section of Clinical Pharmacy, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan. FAU - Imtiaz, Unaiza AU - Imtiaz U AD - Murad Clinic, Near Shalamar Hospital Mughalpura, Shalimar Link Road, Lahore, Pakistan. FAU - Khalid, Imtiaz AU - Khalid I AD - Murad Clinic, Near Shalamar Hospital Mughalpura, Shalimar Link Road, Lahore, Pakistan. FAU - Saeed, Hamid AU - Saeed H AUID- ORCID: 0000-0002-1400-4825 AD - Section of Clinical Pharmacy, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan. hamid.pharmacy@pu.edu.pk. FAU - Khan, Rehana Qadir AU - Khan RQ AD - Section of Clinical Pharmacy, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan. FAU - Islam, Muhammad AU - Islam M AD - Section of Clinical Pharmacy, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan. FAU - Saleem, Zikria AU - Saleem Z AD - Section of Clinical Pharmacy, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan. FAU - Sohail, Muhammad Farhan AU - Sohail MF AD - Ripha Institute of Pharmacy, Township, Lahore, Pakistan. FAU - Danish, Zeeshan AU - Danish Z AD - Section of Clinical Pharmacy, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan. FAU - Batool, Farah AU - Batool F AD - Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan. FAU - Anwer, Naveed AU - Anwer N AD - Saulat Institute of Pharmaceutical Sciences, Quaid -i- Azam University, Islamabad, Pakistan. LA - eng GR - HS/PUCP/1926/University of the Punjab/ PT - Journal Article PT - Randomized Controlled Trial DEP - 20190624 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 RN - 0 (Blood Glucose) RN - 0 (Lipids) SB - IM MH - Adult MH - Blood Glucose MH - Blood Pressure MH - Diabetes Mellitus, Type 2/*drug therapy MH - Female MH - Humans MH - Interprofessional Relations MH - Lipids/blood MH - Male MH - Middle Aged MH - Pakistan MH - Pharmacists/*psychology MH - Physicians/psychology MH - Primary Health Care/*organization & administration MH - Professional Role MH - Treatment Outcome PMC - PMC6591859 OTO - NOTNLM OT - Blood pressure OT - Glycemic control OT - HbA1c OT - Lahore OT - Pakistan OT - Pharmaceutical care OT - Pharmacist OT - Randomized control OT - T2DM COIS- The authors declare that they have no competing interests. EDAT- 2019/06/27 06:00 MHDA- 2019/09/19 06:00 PMCR- 2019/06/24 CRDT- 2019/06/26 06:00 PHST- 2019/01/15 00:00 [received] PHST- 2019/06/17 00:00 [accepted] PHST- 2019/06/26 06:00 [entrez] PHST- 2019/06/27 06:00 [pubmed] PHST- 2019/09/19 06:00 [medline] PHST- 2019/06/24 00:00 [pmc-release] AID - 10.1186/s12913-019-4274-z [pii] AID - 4274 [pii] AID - 10.1186/s12913-019-4274-z [doi] PST - epublish SO - BMC Health Serv Res. 2019 Jun 24;19(1):409. doi: 10.1186/s12913-019-4274-z.