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Tailored care package fails to improve glycaemic control

Some cardiovascular benefits are achieved with an enhanced diabetes care package for UK residents of South Asian origin, but improving glycaemic control remains a major challenge, according to a study published in a diabetes special issue of The Lancet (2008;371:1769).

A total of 1,486 newly diagnosed type 2 diabetes patients of South Asian origin from 21 inner city practices in the UK were randomised to receive enhanced care — including additional time with a practice nurse, support from an Asian link worker and input from a diabetes specialist nurse — or standard care. Primary outcomes were changes in blood pressure, total cholesterol and glycaemic control after two years.

The researchers recorded a reduction in diastolic blood pressure (P=0.0001) and arterial pressure (P=0.0180) in the intervention group compared with the placebo group but no difference in total cholesterol, systolic blood pressure or HbA1c.

Over the study population as a whole, the researchers recorded improvements in blood pressure and total cholesterol (but not in HbA1c). These improvements were associated with increased prescribing of antihypertensives and statins and are consistent with those reported by other investigators after the introduction of the Quality and Outcomes Framework (which started during the course of the study), they say.

“In view of the healthcare resources provided, we find it disappointing that neither the QOF incentives nor our culturally sensitive enhanced care package significantly effected glycaemic control,” say the researchers.

The authors of an accompanying editorial (ibid p1728) suggest that a substantial structured patient-education component seemed to be missing from the study.

Alia Gilani, a bilingual prescribing support pharmacist for NHS Glasgow, believes that pharmacists are ideally placed in the community to support South Asian diabetes patients and help reduce inequalities. Pharmacist independent prescribers can allow patients quicker access to medicines and are able to monitor adherence, she added.

Citation: The Pharmaceutical Journal URI: 10025530

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