Pharmaceutical care model for patients with type 2 diabetes: integration of the community pharmacist into the diabetes team – a pilot study

OBJECTIVE: To evaluate the feasibility and impact of a structured approach for community pharmacist input as a member of the multidisciplinary team caring for patients with type-2 diabetes and health professional providing advice on medication. METHODS: Prospective pretest-posttest single group study. Sixty-two patients on oral hypoglycaemic therapy, identified as regular customers of four Scottish (UK) community pharmacies, were recruited. Each patient underwent an initial assessment: review of medical general practice notes/community pharmacy PMR (Patient medication record) system and structured interview. Standardised documentation was completed, a pharmaceutical care plan (PCP) prepared, peer-reviewed and then discussed face-to-face with patients' GPs (general practitioners). A second (final) assessment was conducted 24 to 28 weeks from the initial interview. MAIN OUTCOME MEASURES: Pharmaceutical care issues (PCIs) throughout study period; change in parameters from initial to final assessment: patient knowledge of oral hypoglycaemic and anti-hypertensive therapy; HbA1c; blood pressure; total cholesterol; medication compliance. RESULTS: A total of 178 PCIs were identified (mean [range] 2.9 [1-5] per patient) and categorised: drug therapy problems (n = 76); monitoring (n = 21); and patient knowledge (n = 81). Drug therapy problems discussed with the GPs were agreed for 74 (97%) and resolved for 55 (72%) at final assessment. Biological outcome measures were assessed for 59 patients (3 drop-outs). A reduction (P < 0.05) in HbA1 c, blood pressure and total cholesterol was observed over the study period. Patients knowledge was poor for oral hypoglycaemic therapy but improved (initial-51 %, final-72%, P < 0.05). CONCLUSION: This study demonstrated a feasible pharmaceutical care model for diabetes patients in an European country. The results have shown the pharmacist to be effective and well accepted by GPs and patients.     

沙格列汀与二甲双胍治疗2型糖尿病的临床对照研究

目的探讨沙格列汀与二甲双胍治疗2型糖尿病(T2DM)的临床疗效、安全性以及用药依从性。方法选择我院收治的2型糖尿病患者为研究对象,随机分为沙格列汀组和二甲双胍组,分别给予沙格列汀和二甲双胍控制血糖,观察并记录两组患者治疗前后空腹血糖(FBG)、餐后2 h血糖(PG2h)、糖化血红蛋白(HbA1c)、低血糖发生率、肝肾功能、体重变化情况,同时对两组患者用药的依从性进行对比分析。结果两组总有效率比较差异无统计学意义(P>0.05),但沙格列汀组显效率明显高于二甲双胍组,差异有统计学意义(P<0.05)。治疗12周后,沙格列汀组患者FBG、PG2h、HbA1c水平均较治疗前明显改善(P<0.01);二甲双胍组FBG、PG2h较治疗前明显改善(P<0.01),但HbA1c水平较治疗前改善不明显(P>0.05)。沙格列汀组治疗后FBG、PG2h、HbA1c改善程度均明显优于二甲双胍组,差异均有统计学意义(P<0.01)。两组患者治疗前后血谷丙转氨酶(ALT)、谷草转氨酶(AST)、血尿素氮(BUN)、血肌酐(Scr)等肝肾功能检查指标差异均无统计学意义(P>0.05),两组治疗12周后体重指数与治疗前比较差异无统计学意义(P>0.05)。两组患者用药期间不良反应发生率比较差异无统计学意义(P>0.05),且症状较轻微,均经对症处理后缓解。格列汀组患者用药依从性明显高于二甲双胍组,差异有统计学意义(P<0.05)。结论沙格列汀能有效控制2型糖尿病患者的血糖,降低糖化血红蛋白水平,同时对肝肾功能、体重等无明显影响,且不良反应少,但由于沙格列汀为新药,临床试验随访时间较短,其远期疗效、安全性以及患者的耐药性仍需进行长期的大样本研究加以证实。     

Fructose-fed streptozotocin-injected rat: an alternative model for type 2 diabetes

The main objective of the study was to develop an alternative non-genetic rat model for type 2 diabetes (T2D). Six-week-old male Sprague-Dawley rats (190.56 ± 23.60 g) were randomly divided into six groups, namely: Normal Control (NC), Diabetic Control (DBC), Fructose-10 (FR10), Fructose-20 (FR20), Fructose-30 (FR30) and Fructose-40 (FR40) and were fed a normal rat pellet diet ad libitum for 2 weeks. During this period, the two control groups received normal drinking water whilst the fructose groups received 10, 20, 30 and 40% fructose in drinking water ad libitum, respectively. After two weeks of dietary manipulation, all groups except the NC group received a single injection (i.p.) of streptozotocin (STZ) (40 mg/kg b.w.) dissolved in citrate buffer (pH 4.4). The NC group received only a vehicle buffer injection (i.p.). One week after the STZ injection, animals with non-fasting blood glucose levels > 300 mg/dl were considered as diabetic. Three weeks after the STZ injection, the animals in FR20, FR30 and FR40 groups were eliminated from the study due to the severity of diabetes and the FR10 group was selected for the remainder of the 11 weeks experimental period. The significantly (p < 0.05) higher fluid intake, blood glucose, serum lipids, liver glycogen, liver function enzymes and insulin resistance (HOMA-IR) and significantly (p < 0.05) lower body weight, oral glucose tolerance, number of pancreatic β-cells and pancreatic β-cell functions (HOMA-β) of FR10 group demonstrate that the 10% fructose-fed followed by 40 mg/kg of BWSTZ injected rat can be a new and alternative model for T2D.     

实验性2型糖尿病大鼠模型的研究

目的　制作一种与人类 2型糖尿病发病过程类似的动物模型。方法　选体重 16 0～ 180 gWistar大鼠 ,雌雄各半 ,先喂以高脂高糖饲料 4周 ,促发胰岛素抵抗 ,继以小剂量链脲佐菌素 (STZ) (30mg/kg ,每周 1次 )连续腹腔注射 2次 ,诱导建立 2型糖尿病模型。结果　高脂高糖饲料喂养 4周后大鼠空腹胰岛素显著高于对照组(P <0 0 5 ) ,出现胰岛素抵抗 (胰岛素敏感指数ISI =- 5 72± 0 4 3,对照组ISI =- 4 37± 0 6 1,P <0 0 1) ,第 2次注射STZ后大鼠于 1周始出现葡萄糖负荷后 6 0、12 0min血糖显著升高 (P <0 0 1) ,造模成功 ;18周时出现空腹和葡萄糖负荷后血糖均明显升高 (P <0 0 5 ) ,而空腹胰岛素分泌与对照组相比差异无显著性 (P >0 0 5 )。结论　本实验方法建立的 2型糖尿病大鼠模型 ,与人类 2型糖尿病代谢特征相似 ,是研究人类 2型糖尿病较理想的动物模型     

Professional development of pharmaceutical care in type 2 diabetes mellitus: a multidisciplinary conceptual model

Objective To generate a validated model of care providing a framework for continued professional development of the community pharmacist for patients with type 2 diabetes mellitus. Setting A purposive sample of medical, nursing and community pharmacist interviewees in 10 health boards in Scotland. Method Investigation, using a semi‐structured questionnaire approach, of the views held by 19 healthcare practitioners. Key findings A model of multidisciplinary diabetes care was generated to aid definition of pharmaceutical care provision. Processes emphasised in the model were: compliance monitoring, agreed multidisciplinary protocols and the continuity of patient education. Potential areas for community pharmacist contributions included the running of diabetes clinics, provision of patient education, near‐patient testing, repeat dispensing and identification of clinic defaulters. Conclusions Development of the community pharmacists' role for patients with type 2 diabetes mellitus requires extensions to current independently delivered patient‐centred services through working in partnership with other professionals. Methods of improved communication and attention to methods of referral, where appropriate, are important focal points. The targeting of this care and the care model that is best suited to particular settings will be subject to local variation. The generation of a diabetes care model offers pharmacists a means of matching learning opportunities to their needs. It is also a step towards the development of appropriate continued professional development tools and systems to equip community pharmacists for the future.     

链脲菌素制备2型糖尿病大鼠模型的研究

目的优化建立操作简便、条件稳定、成模率高、造模周期短、具有胰岛素抵抗的2型糖尿病模型。方法 6周龄大鼠以高糖高脂饲料喂养4周后,禁水禁食18 h,一次性腹腔注射1%链脲菌素(STZ)溶液35mg·kg-1,注射后继续禁水禁食1 h;对照组腹腔注射相同剂量柠檬酸-柠檬酸钠缓冲液。结果 STZ注射后14 d空腹血糖值稳定,口服葡萄糖耐量实验符合糖尿病标准,空腹胰岛素水平接近对照组,成模率93%,模型死亡率0%。结论成功制备了2型糖尿病模型,优化了2型糖尿病造模过程及提高了成模率。     

胰岛素增敏剂-文迪雅治疗2型糖尿病的临床观察

目的对胰岛素增敏剂-马来酸罗格列酮（文迪雅）联合其他降糖药物治疗2型糖尿病的临床疗效及安全性进行观察。方法对30例2型糖尿病患者进行为期12周的文迪雅治疗观察。结果文迪雅治疗12周前后相比，患者FBG、PG2h、HbA1c水平均有显著下降。治疗后体重略有增加，TG水平有下降，TC、HDL—C、LDL—C无明显变化。收缩压和舒张压均有降低。结论文迪雅用于原降糖治疗效果不满意的2型糖尿病患者，可显著降低糖化血红蛋白、空腹及餐后血糖，提高胰岛素敏感性，减少胰岛素抵抗，未见肝肾功能损害等严重药物不良反应，是治疗2型糖尿病的有效和安全的新型口服降糖药。     

Altered expression of CYP in TSOD mice: a model of type 2 diabetes and obesity

1. To investigate the pharmacokinetic characteristics in TSOD (Tsumura, Suzuki, obese, diabetes) mice, a model of type 2 diabetes and obesity, the expressions of major hepatic CYP enzymes in TSOD and TSNO (Tsumura, Suzuki, non-obesity; control) mice were compared.

2. The 7-month-old TSOD mice, which represented severe obesity/diabetes-related pathophysiology, showed higher expressions of Cyp2c and Cyp3a compared with TSNO mice, while those of Cyp1a and Cyp2e were lower. Cyp3a metabolic activity was also higher in TSOD mice.

3. In the 7-month-old liver, pregnane X receptor (PXR) (nuclear receptor) and peroxisome proliferator-activated receptor-gamma coactivator-1alpha (PGC-1alpha) (cofactor) mRNA expression were higher in TSOD mice, possibly playing a role in the altered expression of Cyp3a.

4. This specifically altered CYP expression in TSOD mice suggests that the biotransformation of drugs metabolized by these CYP enzymes differs from that in normal animals. Based on these findings, further investigation on the relationship between altered CYP expression and pathophysiology may be useful in elucidating changes in pharmacokinetics in obese/diabetic patients.

     

Medicine taking behaviours of people with type 2 diabetes in Indonesia: a qualitative study

International Journal of Clinical Pharmacy - Background Medicine-taking behaviour of people in Indonesia is particularly complex because of Indonesia’s pluralistic health system, in which...     

Tesaglitazar: a promising approach in type 2 diabetes

While glycemic control remains the cornerstone of clinical management for patients with type 2 diabetes, the importance of a more comprehensive approach that addresses the multiple metabolic abnormalities seen in this population is now widely recognized. Abnormal lipid metabolism resulting in dyslipidemia contributes greatly to the markedly increased risks of cardiovascular disease observed in diabetic patients and in prediabetic patients with signs of insulin resistance. The peroxisome proliferator-activated receptors (PPARs) play a key role in the regulation of energy homeostasis and the coordination of inflammatory responses. As such, they are interesting targets for addressing both the glucose and lipid abnormalities associated with insulin resistance. The thiazolidinediones (TZDs), which activate PPARgamma, appear to improve glycemic control primarily by increasing peripheral insulin sensitivity and reducing hepatic glucose production, thereby helping to preserve beta-cell function. They have also demonstrated modest beneficial effects on some lipid parameters. The fibrate drugs, which activate PPARalpha, produce robust improvements in dyslipidemia, decrease atherosclerotic lesions and may have an effect on cardiovascular events, but do not affect glycemia. Theoretically, a compound targeting both the alpha and gamma PPARs simultaneously might combine the benefits of TZDs and fibrates. Tesaglitazar is a dual-acting PPARalpha/gamma agonist currently being investigated in phase III clinical trials as an alternative treatment for insulin resistance and the characteristic dyslypidemia of type 2 diabetes. This article reviews the available data on the clinical efficacy and safety of tesaglitazar in patients with type 2 diabetes and in individuals without diabetes but with insulin resistance.     

Repaglinide in type 2 diabetes: a 24-week, fixed-dose efficacy and safety study

In this 24-week multicenter, double-blind, randomized, fixed-dose trial, 361 patients having type 2 diabetes received daily preprandial treatment with placebo (n = 75), repaglinide 1 mg (n = 140), or repaglinide 4 mg (n = 146). By a last-observation carried-forward calculation, repaglinide 1 mg or 4 mg treatment decreased mean fasting plasma glucose (FPG) values (by -47 mg/dL or -49 mg/dL) while the placebo group had increased FPG values (by 19 mg/dL). For the repaglinide treatment groups at the end of the study, changes in HbA1c from baseline values ranged from 1.8 to 1.9 percentage points lower than the placebo group. There were no events of severe hypoglycemia. Nearly all hypoglycemic symptom episodes had blood glucose levels above 45 mg/dL. Repaglinide was well tolerated in a preprandial fixed-dose regimen of 1 mg or 4 mg, assigned without adjustment for clinical parameters.     

Anagliptin decreases serum lathosterol level in patients with type 2 diabetes: a pilot study

Objective: The mechanism responsible for the lipid-lowering effect of dipeptidyl peptidase-4 (DPP-4) inhibitors remains unknown in humans. We evaluated the effect of anagliptin on serum lipid profiles, including cholesterol synthesis and absorption markers, in Japanese patients with type 2 diabetes.

Methods: Thirty patients with type 2 diabetes (20 – 70 years old, low-density lipoprotein cholesterol (LDL-C) level over 120 mg/dl, and no history of treatment with antidiabetic or antihyperlipidemic drugs) were enrolled. One hundred milligrams of anagliptin were administered twice a day for a month.

Results: After treatment of anagliptin, the LDL-C and total cholesterol (TC) levels did not decrease overall, but the TC level decreased significantly in 28 patients whose HbA1c levels decreased. Lathosterol decreased significantly, whereas no changes in campesterol, sitosterol or cholestanol were observed.

Conclusion: These results of our study show no significant change in LDL-C, a tendency of decrease in TC and non-high-density lipoprotein cholesterol (non-HDL-C) after treatment of anagliptin for 1 month. Anagliptin therapy decreased the cholesterol synthesis marker lathosterol without changing cholesterol absorption markers.     

格列美脲治疗2型糖尿病的系统评价

目的对公开发表的格列美脲治疗2型糖尿病的文献进行系统评价,评价格列美脲对2型糖尿病的疗效。方法检索中文期刊全文数据库(CNKI),收集格列美脲治疗2型糖尿病的随机对照试验(RCT),采用Revman 5.0软件做Meta分析。结果纳入14篇中文RCT,0篇英文文献,共累计病例1 604例。其中,治疗组816例,对照组788例。Meta分析结果显示,两组差异有统计学意义。格列美脲可减少2型糖尿病患者的三酰甘油(TG)、总胆固醇(TC)、空腹血糖(FBG)、低密度脂蛋白(LDL-C),同时,升高高密度脂蛋白(HDL-C)、C肽,其中,格列美脲对TG、TC、FBG及HDL-C的改善优于常用降糖药。敏感性分析结果也与以上研究结果一致。结论格列美脲治疗2型糖尿病明显优于对照组。但由于高质量的文献较少,样本量有限,需做深入研究。     

治疗2型糖尿病新药:利西拉肽

利西拉肽是胰高血糖素样肽1(GLP-1)受体激动剂,于2016年7月27日由美国食品和药物管理局批准上市,结合饮食控制和运动以改善2型糖尿病成年患者的血糖水平。利西拉肽在降低糖化血红蛋白方面有良好的疗效,对患者空腹血糖和体重也有一定的降低作用。利西拉肽初始剂量为10μg·d~(-1),应用14 d后可增加维持剂量至20μg·d~(-1)。常见不良反应为恶心、呕吐、头痛、腹泻、眩晕、低血糖,每日1次皮下注射给药,患者耐受性较好。     

沙格列汀治疗糖尿病安全性的系统评价

目的:系统评价沙格列汀治疗2型糖尿病的安全性。方法:电子检索PubMed,EMBase,Cochrane,CNKI,VIP,CBM数据库,对纳入的随机对照试验(RCT)进行方法学质量评价和Meta分析。结果:共纳入6个RCT。治疗过程中,实验组和对照组严重不良反应及低血糖的发生率低,且组间差异无显著性。常见不良反应包括鼻咽炎,头疼,低血糖,腹泻,上呼吸道感染,尿路感染,关节痛,高血压,背疼,咳嗽和下肢疼痛等。除头疼,关节痛和高血压的发生率实验组高于安慰剂组外,其他不良反应的发生率,实验组与安慰剂组相似或低于安慰剂组。结论:沙格列汀的安全性好,但纳入研究随访时间较短,其长期安全性还需进一步验证。