Oct-Dec, 2011 - Indian Journal of Pharmacy Practice
Oct-Dec, 2011 - Indian Journal of Pharmacy Practice Oct-Dec, 2011 - Indian Journal of Pharmacy Practice
Dinesh KU - Evaluation of the Impact of a Pharmaceutical Care Program for Diabetes Patients in Nepal: A Preliminary StudyAlcohol intakeEveryday 1 3 0Occasional 0 1 1Former 3 3 2Never 6 4 7Smoking StatusEveryday 0 1 0Occasional 0 1 1Former 6 3 1Never 4 6 8Monthly Income (Nrs.)0-10000 6 7 410001-20000 2 1 420001-30000 1 2 130001-40000 0 1 140001-50000 1 0 0Family typeJoint 7 6 7Separate 3 5 3Family history of diseaseFather 0 1 1Mother 0 0 1Both 0 0 0BMI= Body Mass Index, NRs = Nepali rupeesDiabetic history: Two (6.45%) had their father alone while 1(3.22%) had their mother alone suffered from diabetes. Thefamily history of 28 (90.32%) patients was unknown.Therapeutic category of medication prescribed:Altogether 75 drugs were prescribed in the study population.Antidiabetics were the commonest class of drugs prescribedaccounting for 36 (48%) of the total drugs followed bycardiovascular drugs 22 (29.33%). Other medicines were17(22.66%) in number which included diuretics, vitaminsupplements, proton pump inhibitors and antimicrobials.Utilization of antidiabetics in study population: Out of 36antidiabetics prescribed, 17 (47.22%) drugs were foundcommonly prescribed from the class of biguanides followedby sulfonylureas 12 (33.33%), Insulin preparation 5(13.88%), Thiazolidinedione group of drugs 1(2.77%) andalpha glucosidase inhibitors 1(2.77%). Insulin was used in 2(12.5%) patients of CG, 1(14.28%) of TG-1 and 2(15.38%) ofTG-2 patients. Biguanides was used in 7 (43.75%) patients ofCG, 4 (57.14%) of TG-1 and 6(46.15%) of TG-2 patients.Sulfonylurea class of drugs was used in 6 (37.5%) patients ofCG followed by 2 (28.57%) of TG-1 and 4 (30.76%) of TG-2patients. Only one patient of TG-2 group and one patient ofCG were prescribed thiazolidinedione and alpha glucosidaseinhibitor class of drugs , respectively.Comparison of blood glucose pattern: All three grouppatients were evaluated for their blood sugar level at baselineand after intervention and median interquartile range wasobtained and compared for any significant effect. It was foundthat the patients of TG-2 shown the significant improvementin terms of their blood glucose level [FBS (P value= 0.008)PPBG (P value= 0.008)] as compared to TG-1 [FBS (P value=0.025) PPBG (P value= 0.050)].This significant improvementin test group-2 patients might be due to demonstration ofdiabetic kit to TG-2 subjects which made them more clearabout the fate of fatty and sugary substances once they areconsumed in the body. The median for all three groups arementioned in Table 2.Response to knowledge questions: The response of thepatients regarding the knowledge questions at baseline andafter intervention was done. The number of patientsresponding correctly to the knowledge questions ismentioned in Table 3.Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 54
Dinesh KU - Evaluation of the Impact of a Pharmaceutical Care Program for Diabetes Patients in Nepal: A Preliminary StudyGroupsCG(n=10)TG-1(n=11)TG-2(n=10)stBaseline (1 day of visit to thehospital) Median(interquartile range)RBSFBSPPBS339 (204-438)208 (148-287)348 (322-386)GroupsCG(n=8)Intervention (2 months from the dateof enrollment)Median (interquartile range)-P value90.5 (79-103)CG pre FBS Vs CG postFBS 0.012180 (138-211) CG pre PPBS Vs CG postPPBS 0.012HbA1c - - -RBS397 (209-423)--FBS135 (122-260)98.5 (84-108)TG-1 pre FBS Vs postTG-1FBS 0.025PPBS 249 (155-379) (n=8)130 (103-140) TG-1 pre PPBS Vs postPPBS 0.050HbA1c - - -RBSTable 2: Comparison of blood glucose level of all three groups360 (210-388)FBS244 (159-360)104 (93-114)TG-2 pre FBS Vs postTG-2FBS 0.008PPBS 379 (235-416) (n=9)118 (104-188) TG-2 pre PPBS Vs postPPBS 0.008HbA1c 9.2 (8.8-10) - ----Table 3: Number of patient responding correctly to the Knowledge questionsControl group Test group-1 Test group-2Questions Baseline 2 months Baseline 2 months Baseline 2 months(n=10) (n=8) (n=11) (n=8) (n=10) (n=9)n (%) n (%) n (%) n (%) n (%) n (%)1 2 (20) 6 (75) 5 (45.455) 8 (100) 8 (80) 9 (100)2 0 0 1 (9.09) 1 (12.5) 1 (10) 2 (22.22)3 0 0 2 (18.18) 2 (25) 1 (10) 7 (77.78)4 1 (10) 3 (37.5) 4 (36.36) 8 (100) 3 (30) 8 (88.89)5 3 (30) 5 (62.5) 6 (54.55) 8 (100) 7 (70) 9 (100)6 0 2 (25) 4 (36.36) 8 (100) 6 (60) 7 (77.78)7 5 (50) 7 (87.5) 9 (81.82) 8 (100) 6 (60) 9 (100)8 2 (20) 5 (62.5) 8 (72.73) 8 (100) 8 (80) 9 (100)9 2 (20) 3 (37.5) 7 (63.64) 8 (100) 8 (80) 8 (88.89)10 0 0 1 (9.09) 2 (25) 2 (20) 1 (11.11)11 1 (10) 3 (37.5) 4 (36.36) 8 (100) 7 (70) 8 (88.89)12 2 (20) 0 2 (18.18) 4 (50) 4 (40) 7 (77.78)13 0 2 (25) 4 (36.36) 7 (87.5) 4 (40) 6 (66.67)14 4 (40) 4 (50) 6 (54.55) 8 (100) 9 (90) 8 (88.89)15 7 (70) 7 (87.5) 8 (72.73) 8 (100) 10 (100) 9 (100)16 3 (30) 2 (25) 3 (27.27) 7 (87.5) 5 (50) 8 (88.89)17 1 (10) 1 (12.5) 2 (18.18) 7 (87.5) 5 (50) 5 (55.56)18 0 2 (25) 4 (36.36) 8 (100) 6 (50) 8 (88.89)Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 55
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Dinesh KU - Evaluation <strong>of</strong> the Impact <strong>of</strong> a Pharmaceutical Care Program for Diabetes Patients in Nepal: A Preliminary StudyAlcohol intakeEveryday 1 3 0Occasional 0 1 1Former 3 3 2Never 6 4 7Smoking StatusEveryday 0 1 0Occasional 0 1 1Former 6 3 1Never 4 6 8Monthly Income (Nrs.)0-10000 6 7 410001-20000 2 1 420001-30000 1 2 130001-40000 0 1 140001-50000 1 0 0Family typeJoint 7 6 7Separate 3 5 3Family history <strong>of</strong> diseaseFather 0 1 1Mother 0 0 1Both 0 0 0BMI= Body Mass Index, NRs = Nepali rupeesDiabetic history: Two (6.45%) had their father alone while 1(3.22%) had their mother alone suffered from diabetes. Thefamily history <strong>of</strong> 28 (90.32%) patients was unknown.Therapeutic category <strong>of</strong> medication prescribed:Altogether 75 drugs were prescribed in the study population.Antidiabetics were the commonest class <strong>of</strong> drugs prescribedaccounting for 36 (48%) <strong>of</strong> the total drugs followed bycardiovascular drugs 22 (29.33%). Other medicines were17(22.66%) in number which included diuretics, vitaminsupplements, proton pump inhibitors and antimicrobials.Utilization <strong>of</strong> antidiabetics in study population: Out <strong>of</strong> 36antidiabetics prescribed, 17 (47.22%) drugs were foundcommonly prescribed from the class <strong>of</strong> biguanides followedby sulfonylureas 12 (33.33%), Insulin preparation 5(13.88%), Thiazolidinedione group <strong>of</strong> drugs 1(2.77%) andalpha glucosidase inhibitors 1(2.77%). Insulin was used in 2(12.5%) patients <strong>of</strong> CG, 1(14.28%) <strong>of</strong> TG-1 and 2(15.38%) <strong>of</strong>TG-2 patients. Biguanides was used in 7 (43.75%) patients <strong>of</strong>CG, 4 (57.14%) <strong>of</strong> TG-1 and 6(46.15%) <strong>of</strong> TG-2 patients.Sulfonylurea class <strong>of</strong> drugs was used in 6 (37.5%) patients <strong>of</strong>CG followed by 2 (28.57%) <strong>of</strong> TG-1 and 4 (30.76%) <strong>of</strong> TG-2patients. Only one patient <strong>of</strong> TG-2 group and one patient <strong>of</strong>CG were prescribed thiazolidinedione and alpha glucosidaseinhibitor class <strong>of</strong> drugs , respectively.Comparison <strong>of</strong> blood glucose pattern: All three grouppatients were evaluated for their blood sugar level at baselineand after intervention and median interquartile range wasobtained and compared for any significant effect. It was foundthat the patients <strong>of</strong> TG-2 shown the significant improvementin terms <strong>of</strong> their blood glucose level [FBS (P value= 0.008)PPBG (P value= 0.008)] as compared to TG-1 [FBS (P value=0.025) PPBG (P value= 0.050)].This significant improvementin test group-2 patients might be due to demonstration <strong>of</strong>diabetic kit to TG-2 subjects which made them more clearabout the fate <strong>of</strong> fatty and sugary substances once they areconsumed in the body. The median for all three groups arementioned in Table 2.Response to knowledge questions: The response <strong>of</strong> thepatients regarding the knowledge questions at baseline andafter intervention was done. The number <strong>of</strong> patientsresponding correctly to the knowledge questions ismentioned in Table 3.<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong> Volume 4 Issue 4 <strong>Oct</strong> - <strong>Dec</strong>, <strong>2011</strong> 54