Compared benefits of educational programs dedicated to diabetic patients with or without community pharmacist involvement

Abstract

Background: International guidelines on diabetes control strongly encourage the setting-up of therapeutic educational programs (TEP). However, more than half of the patients fail to control their diabetes a few months post-TEP because of a lack of regular follow-up by medical professionals. The DIAB-CH is a TEP associated with the follow-up of diabetic patients by the community pharmacist.

Aim: To compare the glycated hemoglobin (HbA1c) and body mass index (BMI) in diabetic patients of Control (neither TEP-H nor community pharmacist intervention), TEP-H (TEP in hospital only) and DIAB-CH (TEP-H plus community pharmacist follow-up) groups.

Methods: A comparative cohort study design was applied. Patients included in the TEP-H from July 2017 to December 2017 were enrolled in the DIAB-CH group. The TEP-H session was conducted by a multidisciplinary team composed of two diabetologists, two dieticians and seven nurses. The HbA1c level and the BMI (when over 30 kg/m2 at M0) of patients in Control (n = 20), TEP-H (n = 20) and DIAB-CH (n = 20) groups were collected at M0, M0 + 6 and M0 + 12 months. First, HbA1c and BMI were compared between M0, M6 and M12 in the three groups with the Friedman test, followed by the Benjamini-Hochberg post-test. Secondly, the HbA1c and BMI of the three groups were compared at M0, M6 and M12 using the Kruskal-Wallis test.

Findings: While no difference in HbA1c was measured between M0, M6 and M12 in the Control group, Hb1Ac was significantly reduced in both TEP-H and DIAB-CH groups between M0 and M6 (P = 0.0072 and P = 0.0034, respectively), and between M0 and M12 only in the DIAB-CH group (P = 0.0027). In addition, a significant decrease in the difference between the measured HbA1c and the target assigned by diabetologists was observed between M0 and M6 in both TEP-H and DIAB-CH groups (P = 0.0072 and P = 0.0044, respectively) but only for the patients of the DIAB-CH group between M0 and M12 (P = 0.0044). No significant difference (P > 0.05) in BMI between the groups was observed.

Conclusion: The long-lasting benefit on glycemic control of multidisciplinary group sessions associated with community pharmacist-led educational interventions on self-care for diabetic patients was demonstrated in the present study. There is thus evidence pointing to the effectiveness of a community/hospital care collaboration of professionals on diabetes control in primary care.

Keywords: body mass index; community pharmacy; diabetes mellitus; glycated hemoglobin A; patient education; pharmaceutical care.

Figure 1.

Design of the DIAB-CH program. This program relies on a city/hospital collaboration of health professionals: 1/ in hospital, multidisciplinary educational team performs the collective TEP sessions and draws up the TEP report for general practitioners and community pharmacists; 2/ hospital pharmacists forward TEP report and information sheets to community pharmacists; 3/ in city, community pharmacists conduct individual counseling sessions related to the diabetic patients’ difficulties mentioned in the TEP report each time medication is dispensed.

Figure 2.

Evolution of HbA1c measured in the Control (n = 20), TEP (n = 20) and DIAB-CH (n = 20) groups (respectively, in green, blue and red). For each group, the symbol represents the median at M0, M6 and M12 (**P < 0.01).

Figure 3.

Evolution of the difference between HbA1c measured and HbA1c targeted in the Control (n = 20), TEP (n = 20) and DIAB-CH (n = 20) groups at M0, M6 and M12 post-TEP. For each group, the symbol and the error bars represent the median and the 95% confidence interval, respectively (**P < 0.01).