Pharmacist intervention for glycaemic control in the community (the RxING study)

OBJECTIVE: To determine the effect of a community pharmacist prescribing intervention on glycaemic control in patients with poorly controlled type 2 diabetes. DESIGN: Pragmatic, before–after design. SETTING: 12 community pharmacies in Alberta, Canada. PARTICIPANTS: Type 2 diabetes receiving oral hypoglycaemic medications and with glycated haemoglobin (HbA1c) of 7.5–11%.INTERVENTION: Pharmacists systematically identified potential candidates by inviting patients with type 2 diabetes to test their HbA1c using validated point-of-care technology. Pharmacists prescribed 10 units of insulin glargine at bedtime, adjusted by increments of 1 unit daily to achieve a morning fasting glucose of ≤5.5 mmol/L. The patients were followed up at 2, 4, 8, 14, 20 and 26 weeks. PRIMARY OUTCOME: Change in HbA1c from baseline to week 26. SECONDARY OUTCOMES: Proportion of patients achieving target HbA1c, changes in oral hypoglycaemic agents, quality of life and patient satisfaction, persistence on insulin glargine, number of insulin dosage adjustments per patient and number of hypoglycaemic episodes.RESULTS: We screened 365 patients of whom 111 were eligible. Of those, 100 (90%) were enrolled in the study; all 11 patients who did not consent refused to use insulin. Average age was 64 years (SD 10.4), while average diabetes duration was 10.2 years (SD 7). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9); a change of 1.8% (95% CI 1.4 to 2, p<0.001). Fasting plasma glucose was reduced from 11 (SD 3.3) to 6.9 mmol/L (SD 1.8); a change of 4.1 mmol/L (95% CI of 3.3 to 5, p=0.007). Fifty-one per cent of the patients achieved the target HbA1c of ≤7% at the end of the study.CONCLUSIONS: This is the first completed study of independent prescribing by pharmacists. Our results showed similar improvements in glycaemic control as previous physician-led studies. RxING provides further evidence for the benefit of pharmacist care in diabetes

Overweight, physical activity and high blood pressure in children: a review of the literature

Obesity is a growing problem in developed countries and is likely a major cause of the increased prevalence of high blood pressure in children. The aim of this review is to provide clinicians and clinical scientists with an overview of the current state of the literature describing the negative influence of obesity on blood pressure and it’s determinants in children. In short, we discuss the array of vascular abnormalities seen in overweight children and adolescents, including endothelial dysfunction, arterial stiffening and insulin resistance. We also discuss the potential role of an increased activation of the sympathetic nervous system in the development of high blood pressure and vascular dysfunction associated with obesity. As there is little consensus regarding the methods to prevent or treat high blood pressure in children, we also provide a summary of the evidence supporting relationship between physical activity and blood pressure in children and adolescents. After reviewing a number of physical activity intervention studies performed in children, it appears as though 40 minutes of moderate to vigorous aerobic-based physical activity 3–5 days/week is required to improve vascular function and reduce blood pressure in obese children. Future studies should focus on describing the influence of physical activity on blood pressure control in overweight children

Canadian Physicians' Use of Antiobesity Drugs and Their Referral Patterns to Weight Management Programs or Providers: The SOCCER Study

Antiobesity pharmacotherapy and programs/providers that possess weight management expertise are not commonly used by physicians. The underlying reasons for this are not known. We performed a cross-sectional study in 33 Canadian medical practices (36 physicians) examining 1788 overweight/obese adult patients. The frequency of pharmacotherapy use and referral for further diet, exercise, behavioral management and/or bariatric surgery was documented. If drug treatment or referral was not made, reasons were documented by choosing amongst preselected categories. Logistic regression models were used to identify predictors of antiobesity drug use. No single antiobesity management strategy was recommended by physicians in more than 50% of patients. Referral was most common for exercise (49% of cases) followed by dietary advice (46%), and only 5% of eligible patients were referred for bariatric surgery. Significant predictors of initiating/continuing pharmacotherapy were male sex (OR 0.70; 95% CI 0.52–0.94), increasing BMI (1.02; 95% CI 1.01–1.03), and private drug coverage (1.78; 95% CI 1.39–2.29). “Not considered” and “patient refusal” were the main reasons for not initiating further weight management. We conclude that both physician and patient factors act as barriers to the use of weight management strategies and both need to be addressed to increase uptake of these interventions

Correction to:Methods for identifying 30 chronic conditions: application to administrative data

Following publication of the original manuscript [1], the authors noted several errors in Table 1. Details of the requested corrections are shown below

Hypertension in Canada: Past, Present, and Future

Canada has an extremely successful hypertension detection and treatment program. The aim of this review was to highlight the historic and current infrastructure and initiatives that have led to this success, and the outlook moving forward into the future. We discuss the evolution of hypertension awareness and control in Canada; contributions made by organizations such as the Canadian Hypertension Society, Blood Pressure Canada, and the Canadian Hypertension Education Program; the amalgamation of these organizations into Hypertension Canada; and the impact that Hypertension Canada has had on hypertension care in Canada. The important contribution that public policy and advocacy can have on prevention and control of blood pressure in Canada is described. We also highlight the importance of population-based strategies, health care access and organization, and accurate blood pressure measurement (including ambulatory, home, and automated office modalities) in optimizing hypertension prevention and management. We end by discussing how Hypertension Canada will move forward in the near and longer term to address the unmet residual risk attributable to hypertension and associated cardiovascular risk factors. Hypertension Canada will continue to strive to enhance hypertension prevention and control rates, thereby improving the quality of life and cardiovascular outcomes of Canadians, while at the same time creating a hypertension care model that can be emulated across the world