Case study involved wheelchair-bound 64-year-old man with hemoglobin A1c of 10 percent
MONDAY, Oct. 28 (HealthDay News) -- Clinical pharmacists can play a role in helping patients with poorly controlled type 2 diabetes, according to a case study published in the October issue of Clinical Diabetes.
Travis E. Sonnett, Pharm.D., from Washington State University, and Tyler Galloway, Pharm.D., from the Mann-Grandstaff Veteran Affairs Medical Center -- both in Spokane, examined the impact of a clinical pharmacy specialist on management of a wheelchair-bound, 64-year-old man with a history of uncontrolled type 2 diabetes (hemoglobin A1c [A1c], 10.0 percent). The patient reported poor adherence to his insulin regimen, but close adherence to his oral medication regimen. He experienced progression of peripheral neuropathy and retinopathy.
The authors reported that the clinical pharmacist used a motivational interview technique to discuss the patient's failure to follow the current insulin regimen and poor eating. They developed a plan to monitor progress and agreed on an initial goal of A1c <9 percent and a long-term goal of <8.0 percent, in accordance with the Veterans Affairs/Department of Defense (VA/DoD) guidelines. Follow-up was via phone contact and the pharmacist adjusted the insulin regimen in accordance with changes in blood glucose. At the end of 12 weeks, the patient's A1c was 7.1 percent, and he reported noticeable improvement in peripheral neuropathy and improvement in visual impairment.
"The case described here is considered a success within the VA/DoD setting by virtue of the patient's goal achievement," the authors write.