Pharmaceutical care of patients with gestational diabetes mellitus.

Abstract

RATIONALE, AIMS AND OBJECTIVE:

To investigate whether the introduction of a programme of optimising drug treatment, intensive education and self-monitoring of patients diagnosed with gestational diabetes mellitus (GDM) at an early stage (<20 gestational weeks), will improve management outcomes as determined by objective measures of patient knowledge about diabetes, glycaemia control, maternal/neonatal complications, and health-related quality of life.

METHODS:

The study was a randomized, controlled, longitudinal, prospective clinical trial performed at Al-Ain Hospital, Al-Ain, United Arab Emirates. Over an 18-month period, patients diagnosed with GDM were recruited and were randomly assigned to either an intervention or a control group, in a ratio of 3:2. Intervention patients received a structured pharmaceutical care service (including education and introduction of intensive self-monitoring) while control patients received traditional services. Patients were followed up from time of recruitment until 6 months postnatally at scheduled outpatient clinics. A range of clinical and humanistic outcome measures, including maternal and neonatal complications, were used to assess the impact of the intervention.

RESULTS:

A total of 165 patients (99 intervention, 66 control) completed the study. The intervention patients exhibited a range of benefits from the provision of the programme when compared with control group patients. Statistically significant (P < 0.05) improvements were shown in the intervention group for knowledge of diabetes, health-related quality of life (as determined by the SF36), control of plasma glucose and HbA(1c), maternal complications [e.g. decreased incidence of pre-eclampsia (5.1% vs. 16.7%), eclampsia (1.0% vs. 7.6%), episodes of severe hyperglycaemia (3.0% vs. 19.7%) and need for Caesarean section (7.1% vs. 18.2%)], and neonatal complications [e.g. decreased incidence of neonatal hypoglycaemia (2.0% vs. 10.6%), respiratory distress at birth (4.0% vs. 15.2%), hyperbilirubinaemia (1.0% vs. 12.1%) and large for gestational age (9.0% vs. 22.7%)].

CONCLUSION:

The research provides clear evidence that provision of pharmaceutical care adds value to the management of GDM as exemplified by improved maternal and neonatal outcomes.

• Authors: A A Elnour, I T El Mugammar, T Jaber, T Revel, James C McElnay
• Journal: Journal of evaluation in clinical practice (J Eval Clin Pract) Vol. 14 Issue 1 Pg. 131-40 (Feb 2008) ISSN: 1365-2753 [Electronic] England
• PMID: 18211656 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Insulin

Topics

• Adult
• Area Under Curve
• Blood Glucose Self-Monitoring
• Comorbidity
• Diabetes, Gestational (drug therapy)
• Female
• Humans
• Insulin (therapeutic use)
• Longitudinal Studies
• Patient Education as Topic
• Pregnancy
• Pregnancy Outcome
• Prospective Studies
• Quality of Life
• Statistics, Nonparametric
• Surveys and Questionnaires
• Treatment Outcome
• United Arab Emirates