Introduction
Diabetes mellitus is a chronic disease with major implications both for the patients and the National Health Service in Scotland.¹ It has been estimated to affect 2% of the population in Great Britain, with 75% of patients being classed as type 2 diabetics.² All patients with diabetes require a high level of health care to prevent the development of diabetic complications. The U.K. Prospective Diabetes Study Group has shown that the long-term complications of diabetes can be decreased with intensive glycaemic control and tight blood pressure control.^3-4 There is also a need for regular monitoring of blood pressure, urine and blood glucose and foot and eye examination. The pharmacist is ideally placed to advise on the use of medication to achieve pharmaceutical care for this patient group.

Aim
The aim of the study was to develop a pharmacist-initiated intervention model relative to the provision of pharmaceutical care and support the management of type 2 diabetes in a primary care setting.

Methods
A protocol was written and piloted to support a model of pharmaceutical care intervention. Before the pilot, training was provided for the pharmacists and a two-page data collection form was developed. Computerised records were searched in eight general practice settings in Glasgow Health Board area and 116 known diabetic patients were identified which met the inclusion criteria. The model was revised further by obtaining written feedback from the pharmacists, discussion at an educational workshop, and also by peer review and input from the medical adviser and project team.

Results
From July through August 1999 a total of 97 (84%) participated in the study. A model was developed which included a patient profile, blood pressure and HbA1c measurements and a specific diabetes data collection form. In addition, quality of life instrument was selected. This process took the pharmacist 20 minutes to one hour to complete. The feedback from the pharmacists has been positive, and with some minor modifications of the protocol and data collection tools the model was developed. From the data collected a target reduction of 1.0 unit HbA1c, with a power of 90% at a 1% significance level would require 300 patients to participate. Three hundreds and ninety patients are required for the main study, which is a randomised controlled trial design.

Conclusion
All the suggestions made by the pharmacists and medical adviser have been incorporated into the model for the next phase of the study which will be undertaken as a randomised control trial due to commence in February 2000. The next phase aims to examine the impact of this pharmacist intervention model in type 2 diabetic patients versus standard care.

References

1. Cromie, D., and Teo, P. Scottish needs assessment programme: diabetes mellitus. Glasgow: Office for Public Health in Scotland, 1999.
2. Leese, B. The cost of diabetes and its complications: a review. York: Woodcock & Pearson, 1991.
3. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 1998, 352, 837-853.
4. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ, 1998, 317, 703-713.