Background Hyperglycemia is a prevalent situation in hospitalised patients and it has been associated with higher morbidity and mortality. Poor glycemic control is related to higher costs due to longer hospital stays and higher rates of complications. A large percentage of vascular surgery patients in our hospital have diabetes mellitus with a poor glycemic control.
Purpose To assess the impact of a collaborative, pharmacist-managed insulin titration programme compared to standard medical care on glycemic control in patients with neuropathic diabetic foot ulcers in vascular surgery unit.
Materials and Methods It was established a new protocol to control glycemic levels in hyperglycemic patients in our hospital. To assess its effectiveness a prospective cohort study to compare pharmaceutical intervention of insulin titration to standard medical care was implanted. 30 patients were recorded and evaluated, 15 subjects were included as control (standard medical care before implantation of insulin protocol) and 15 in the pharmacist-managed group (insulin titration programme). Patients were selected consecutively on admission to the vascular surgery unit, the control group, one month prior to the implementation of the protocol and the rest one month later. In both groups it was registered: age, diabetes mellitus type, blood glucose levels, diet and drug treatment. Student t test was used to evaluate the glycemic values between groups.
Results Both groups were analysed and compared: 67% of subjects from control group were men vs 92% from the intervention group. No significant differences were found in the composition between both groups (p > 0.05) respect of age, diabetes mellitus type and diet. The pharmacist-managed group showed a lower glycemic level compared to standard medical care group (123 mg/dl vs 170 mg/dl respectively; p < 0.044). The hyperglycemic levels were more frequent in control group than intervention group (78% vs 35%). No statistics differences were found with hypoglycemic situations (2% vs 4.5% p = 0.1).
Conclusions At the end of the study period, the intervention group patients had better glycemic control. Pharmacist-provider collaboration can result in significant clinical improvements when compared to standard care glycemic control in diabetic patient in a surgical unit.
No conflict of interest.
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