Pharmacist Interventions Improve Diabetes Control, Reduce CVD Risk

The No. 1 cause of death, cardiovascular disease, is preventable.

The No. 1 cause of death, cardiovascular disease (CVD), is preventable.

Diabetes avoidance, blood glucose control, physical activity, lipid control, and smoking cessation can all diminish CVD risk. However, almost half of all community-dwelling patients with type 2 diabetes aren’t at their glycosylated hemoglobin (HbA1C) goals, according to past studies. Previous research has also found that only 13% of patients meet their HbA1C , blood pressure, and blood cholesterol goals.

Community pharmacists are well positioned to identify high-risk patients and assist in their disease management. Alberta, Canada, recently expanded pharmacists’ scope of practice to include ordering laboratory tests (eg, HbA1C and cholesterol blood testing) and adjusting medication regimens.

The June issue of the Journal of the American College of Cardiologists included a study that shows community pharmacist clinical intervention can significantly reduce cardiovascular events in high-risk individuals.

Pharmacists across 56 locations recruited high-risk participants into the RxEACH randomized, controlled trial. The researchers sorted participants into “usual care” and active intervention (medication therapy management and CVD risk assessment) arms for 3 months.

Patients in the intervention arm were 21% less likely to have experienced a cardiovascular event after just 3 months, and they also had a 0.92% greater absolute HbA1C reduction and a 20% greater relative risk reduction in smoking. Patients in the intervention arm were twice as likely to have a hypoglycemic (39.1% vs 20.9%) or lipid-lowering (18.6% vs 8.6%) medication change.

More than 3 in 4 of the enrolled patients had diabetes, 79% of diabetics had uncontrolled blood glucose, 58% of the total population had high cholesterol, and 40% had chronic kidney disease (CKD). Importantly, the pharmacists identified previously undiagnosed CKD in 40% of CKD patients.

The short duration of follow-up (3 months) limited the impact of change in HbA1C because of the lengthy delay in response to interventions.

Pharmacists’ accessibility complements the expertise of patients’ providers (eg, endocrinologists, cardiologists, and primary care providers) to reduce CVD risk.