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Physician-Pharmacist Collaboration in the Management of Patients With Diabetes Resistant to Usual Care

The first 300 words of the full text of this article appear below.

	Introduction

 
Diabetes affects 20.8 million Americans and accounts for $132 billion in direct and indirect health care costs per year.¹ It is associated with numerous complications including heart disease, stroke, retinopathy, neuropathy, and nephropathy.

The Diabetes Control and Complications Trial and the U.K. Prospective Diabetes Study demonstrated the effectiveness of intensive glycemic control in the reduction of microvascular complications in patients with type 1 and type 2 diabetes, respectively.^2,3 The American Diabetes Association (ADA) publishes annual clinical practice guidelines that recommend a general hemoglobin A (A1C) goal of < 7%, a total cholesterol goal of _1c < 200 mg/dl, an HDL cholesterol goal of > 40 mg/dl for men and > 50 mg/dl for women, a triglyceride goal of < 150 mg/dl, an LDL cholesterol goal of < 100 mg/dl, a systolic blood pressure goal of < 130 mmHg, and a diastolic blood pressure goal of < 80 mmHg.⁴

Despite the publication and wide distribution of these recommendations, many patients with diabetes still do not meet recommended treatment goals.⁵ Numerous barriers to care exist in the primary care setting. These barriers can be related to patients, providers, organizations, and public policy.^6–9 Subsequently, patients with diabetes and other chronic diseases often receive suboptimal care in the outpatient setting.

When patients do not meet treatment goals, ADA recommends several interventions. Some of these include intensifying the treatment regimen, identifying barriers to adherence, and increasing frequency of patient contact.⁴ Multifaceted interventions targeting providers, patients, and organizations have been shown to improve the chronic care of patients with diabetes.^8,10 Efforts should ultimately be focused on increasing patients' knowledge, skills, and confidence in managing their disease.¹¹

Several studies have reported improvements in glycemic control through pharmacist intervention within collaborative practices,^12–15 case management,¹⁶ and interdisciplinary teams.¹⁷ Pharmacists have been involved in diabetes care for many years within the . . . [Full Text of this Article]

	Patients and Methods

 

	Results

 

	Discussion

 

	Conclusion

 

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