Effects of Lifestyle Intervention Performed by Community Pharmacists on Glycemic Control in Patients with Type 2 Diabetes: The Community Pharmacists Assist (Compass) Project, a Pragmatic Cluster Randomized Trial

摘要

Background: Community pharmacists should be involved in diabetes care, while there has been less evidence about whether a brief lifestyle intervention is effective for diabetes care in community pharmacies. Objectives: To examine the effects of brief lifestyle intervention on glycemic control in patients with type 2 diabetes mellitus (T2D) by using a coaching style, provided by community pharmacists. Methods: A prospective, cluster-randomized, controlled trial was conducted in 50 groups of community pharmacies in Japan. In all, 132 patients with T2D (age, 20 - 75 years, ≥8.0% of hemoglobin A1c (HbA1c)) were assigned to the intervention group (n = 90) or the usual care group (n = 42). The intervention group (IG) underwent brief lifestyle coaching for self-care of T2D for 6 months. The standard care group (CG) received usual care by pharmacists and was given a general newsletter. The primary outcome was changes in HbA1c levels. Results: After 6 months, the IG had significantly improved HbA1c (IG: -0.6 ± 0.9 vs. CG: -0.2% ± 0.9%; p = 0.021 using the last observation carried forward analysis). Although the number of drugs reduced from 2.3 ± 0.8 to 2.0 ± 1.2 in the IG, the number increased from 2.3 ± 1.1 to 2.5 ± 1.1 in the CG (-0.2 ± 0.9 in IG vs. 0.2 ± 0.6 in CG; p = 0.023). Conclusions: The brief lifestyle intervention by community pharmacists improved glycemic control in patients with T2D. Community pharmacists may more positively participate as lifestyle coaches for diabetes care.