Greater Improvement In Glycemic Control Research Articles

The Pharmacist's Role in Continuity of Care in Type 2 Diabetes: An Evaluation of a Model

Background: Evidence suggests that many patients with type 2 diabetes are not achieving current evidence-based therapeutic targets. Objective: To compare the impact of a clinic-only versus continuity-of-care model on clinical and humanistic outcomes of patients with type 2 diabetes. Methods: One hundred eighteen patients were recruited from 2 diabetes clinics and assigned to a clinic-only or continuity-of-care group. The clinic-only patients were assessed by the clinic pharmacist at the initial visit and attended their usual pharmacy until the follow-up clinic visit 6 months later. The continuity-of-care patients were referred to one of 20 participating pharmacies for ongoing care over 6 months. The evaluation used a repeated measures design and compared the clinic-only with the continuity-of-care groups. Results: Within the continuity-of-care group, there was a significant reduction in mean blood glucose over the 6 months (p = 0.04). Compared with the clinic-only group, the continuity-of-care model demonstrated a trend toward a greater improvement in glycemic control. The net benefit of the intervention was an additional 0.27% (95% CI −0.63% to 0.009%) reduction in hemoglobin A1c (p = 0.15). Improvements in negative attitude and understanding of diabetes were seen in both groups; however, improvements in positive attitude to diabetes were seen only in the continuity-of-care group. Conclusions: The continuity-of-care model had a significant impact on clinical and humanistic outcomes. Community pharmacists may enhance the care of patients with type 2 diabetes.

In british asian hypertensive patients, doxazosin provides greater improvement in glycemic control and lipid profile than bendrofluazide

P-405 Key Words: Adrenoceptor Antagonist, Hypertension, Glycemic Control

Nateglinide therapy for type 2 diabetes mellitus.

To review the pharmacology, pharmacokinetics, dosing guidelines, adverse effects, drug interactions, and clinical efficacy of nateglinide. Primary and review articles regarding nateglinide were identified by MEDLINE search (from 1966 to January 2001); abstracts were identified through the Institute for Scientific Information Web of Science (from 1995 to January 2001) and the American Diabetes Association; additional information was obtained from the nateglinide product information. All articles and meeting abstracts identified from the data sources were evaluated and all information deemed relevant was included in this review. Much of the information was from abstracts or the product labeling, since few clinical studies have been published in the medical literature. Nateglinide is a novel nonsulfonylurea oral antidiabetic agent that stimulates insulin secretion from the pancreas. It has a rapid onset and short duration of action, allowing administration before a meal to reduce postprandial hyperglycemia. Improvement in glycemic control with nateglinide monotherapy has been demonstrated in patients not previously treated with antidiabetic medications. Greater improvement in glycemic control was observed when nateglinide was administered in combination with metformin. Nateglinide is similar to repaglinide, but has a quicker onset of action, quicker reversal, and does not usually require dosage titration. Based on the pharmacodynamics of nateglinide and repaglinide, nateglinide produces a more rapid postprandial increase in insulin secretion, and its duration of response is shorter than that of repaglinide. The risk of postabsorptive hypoglycemia should be lower than with either sulfonylureas or repaglinide.

Improved glycemic control reduces the impact of weight gain on cardiovascular risk factors in type 1 diabetes. The Epidemiology of Diabetes Complications Study.

To assess the prevalence and incidence of being overweight in type 1 diabetes, to identify factors associated with weight gain and improved glycemic control, and to examine relationships among weight gain, glycemic control, and cardiovascular risk factors. The prevalence and incidence of being overweight in the Pittsburgh Epidemiology of Diabetes Complications (EDC) cohort (n = 441) were compared with the general population (National Health and Nutrition Examination Survey [NHANES]). Factors associated with weight gain and improved glycemic control were identified, and relationships among weight gain, glycemic control, and cardiovascular risk factors were examined over a 6.9 +/- 2.2-year period. At baseline, the prevalence of being overweight (BMI > 27.8 kg/m2 for men and > 27.3 kg/m2 for women) was 10.4 and 11.4%, respectively, and was lower than the age- and sex-specific estimate for the general population (P < 0.05). The incidence of being overweight was comparable in men (12.6%) and women (11.8%) and did not differ from the general population (P = 0.98). Weight gain correlated with improvements in HbA1c (r = -0.21, P < 0.001). Patients with the highest baseline HbA1c levels gained the most weight and had the greatest improvement in glycemic control. A lower baseline BMI was also associated with a greater improvement in glycemic control. Weight gain favorably influenced the lipid profile in the setting of improved glycemic control, but adversely influenced the lipid profile in the absence of improved glycemic control. Weight change was directly associated with blood pressure change, but the incidence of hypertension was more strongly influenced by the development of nephropathy. The prevalence of being overweight in type 1 diabetes remains lower than that in the general population. Moderate weight gain did not adversely affect the cardiovascular risk profile in the setting of improved glycemic control.

Use of Very-Low-Calorie Diets in the Treatment of Obese Persons with Non-Insulin-Dependent Diabetes Mellitus

This article discusses the use of very-low-calorie diets (VLCDs) in the treatment of obese persons with non-insulin-dependent diabetes mellitus (NIDDM). Research using VLCDs with overweight participants with and without diabetes is reviewed. In both groups of participants, it has been shown that VLCDs used in combination with behavior therapy increase initial weight loss. However, to date, it has not been possible to develop treatment programs that maintain this weight loss long term. Neither intensive maintenance sessions nor intermittent VLCDs have been successful in maintaining the benefits of VLCDs long term. Thus, from the perspective of producing long-term weight loss, balanced low-calorie diets appear to be as effective as VLCDs. However, VLCDs may be useful in treating obese persons with NIDDM, because caloric restriction independent of notable weight loss has marked effects on glycemic control. Several studies have shown that just 7 days of caloric restriction can produce dramatic improvements in glycemic control; moreover, VLCDs produce greater improvements in glycemic control than more moderate diets, even if weight losses are the same. Research is needed to explore new ways to use VLCDs and other approaches to caloric restriction in the treatment of obese persons with NIDDM. J Am Diet Assoc. 1995; 95:569-572.