DEPARTMENT OF PHARM
ACY
UNIVERSI
TY OF MA
LTA
THE IMPACT OF PHARMACIST ADVICE ON THE METABOLIC SYNDROME
Stephanie L. Magro, Lilian M. Azzopardi
Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
Department of Pharmacy
University of Malta
email: stephanie.l-magro@gov.mt, lilian.m.azzopardi@edu.mt
1. INTRODUCTION
2. AIM
The metabolic syndrome is nowadays a major health threat and major
To determine the effect of community pharmacist intervention on lifestyle
1
public health challenge. The primary cause of the metabolic syndrome is
and pharmacological treatment on patients suffering from the metabolic
obesity. Obesity causes hyperinsulinaemia, which in turn causes activation
syndrome.
of the
sympathetic nervous system. It also exerts negative actions on the
cardiovascular, renal and vascular systems, resulting in hypertension.
Hyperinsulinaemia also causes an increases the chance of type II diabetes
2
and hypercholesterolaemia.
The patients’ weight was taken using the Beurer® BF Limited Edition 2013
3. METHOD
electronic scale. The Beurer® BM 55 blood pressure monitor was used to
35 patients were recruited from a community clinic. The inclusion criteria
were: a waist circumference of 94cm or more in males, and 80cm or more in
obtain systolic blood pressure (SBP), diastolic blood pressure (DBP) and
pulse readings.
females, and suffering or on treatment for a combination of 2 or all of the
®
following conditions: diabetes, hypertension and hypercholesterolaemia.
The AccuTrend Plus instrument was used to quantitatively measure blood
triglycerides (Tg), blood total cholesterol (TC) and fasting blood glucose
During the first intervention, a questionnaire was administered to the
patients. The aim of the questionnaire was to gather information about
medical
check-ups,
medication
taking
patterns,
side-effects,
self-
(FBG). Patients were given advice and information leaflets on diet and
exercise, the metabolic syndrome, cardiovascular diseases, cholesterol, diabetes and obesity were given to patients.
monitoring, the family and social history and the dietary and exercising
After three months, the second intervention took place. A questionnaire
patterns of the patients.
with the aim to gain information about change in treatment and lifestyle
The patients’ anthropometric and biochemical parameters were measured.
The patients’ waist and height measurement was taken using a measuring
was administered. The anthropometric and biochemical parameters were
measured.
tape.
4. RESULTS
35 patients took part in the study of whom 4 were male and 31 were
female. The mean age was 70. The commonest combination of metabolic
syndrome components was hypertension and dyslipidaemia (n=18).
Table 1 Patient compliance before (t=0) and after (t=1) pharmacist
intervention (n=35)
Compliance
(t=1)
Total
Yes
No
20
Count
20
0
Yes
%
100.0%
0.0%
100.0%
Compliance
(t=0)
Count
10
5
15
No
%
66.7%
33.3%
100.0%
Count
30
5
35
Total
%
85.7%
14.3%
100.0%
2
X (1) = 7.778, P-value = 0.005
Before pharmacist intervention, the number of patients rarely missing a
dose of their medication was 15 patients. The commonest reasons for
missing a dose were forgetfulness (n=11). The number of patients reporting
2
to missing a dose after pharmacist intervention was 5 patients. The X test
showed a p-value of 0.005, hence implying that pharmacist intervention
increased patient compliance (Table 1).
The total number of patients experiencing side-effects before pharmacist
intervention was 14 patients. The
Table 2 Comparison of side-effect occurrence before and after pharmacist
intervention (n=35)
Side-effects
(t=1)
Total
Yes
No
14
Count
4
10
Yes
%
28.6%
71.4%
100.0%
Side-effects
(t=0)
Count
0
21
21
No
%
0%
100%
100.0%
Count
4
31
35
Total
%
11.4%
88.6%
100.0%
2
X (1) = 6.774, P-value = 0.009
commonest side-effects reported
included faintness (n=4), increased frequency in urination (n=4), swollen
ankles (n=5), diarrhoea (n=5), muscle weakness (n=4), muscle cramps (n=3)
and muscle pain (n=3). After intervention, 10 patients claimed to having
2
stopped experiencing side-effects. The X test showed a p-value of 0.009,
Table 3 Comparison of anthropometric and biochemical parameters before
and after pharmacist intervention (n=35)
Before Intervention
After intervention
Parameters
(n=35)
(n=35)
P value
(mean ± SD)
(mean ± SD)
Weight (kg)
78.65 ± 18.81
77.43 ± 18.26
0.005*
2
BMI (kg/m )
31.37 ± 6.78
30.84 ± 6.30
0.005*
WC (cm)
104.34 ± 11.49
98.11 ± 11.33
0.000*
implying that pharmacist intervention decreased the incidence of side-
SBP (mmHg)
151.61 ± 23.10
147.30 ± 18.43
0.075
effects (Table 2).
DBP (mmHg)
89.86 ± 11.30
88.13 ± 12.52
0.224
FBG (mmol/L)
5.45 ± 1.61
4.89 ± 1.61
0.015*
The anthropometric and biochemical findings are compared in Table 3. The
TC (mmol/L)
5.39 ± 0.9
5.05 ± 0.90
0.001*
mean parameters for weight, BMI, waist circumference, fasting blood
Tg (mmol/L)
1.73 ± 1.13
1.45 ± 1.09
*p value ≤ 0.05 is considered statistically significant
0.000*
glucose, total cholesterol and triglycerides significantly decreased in all
patients after pharmacist intervention. The mean readings for systolic and
diastolic blood pressure decreased after pharmacist intervention. However,
the improvement was not enough to be significant.
5. CONCLUSION
The results obtained show that pharmacists are in a great position to play an important intervention in the management of patients suffering from the
metabolic syndrome. Pharmacists have the ability to advice patients on their disease states, the beneficial effects of pharmacological treatment, the expected
side-effects and how they can be effectively managed. Pharmacists can have a role in the identification, management and prevention of side-effects.
Pharmacist intervention by means of face-to-face advice and information leaflets had a positive impact on lifestyle. One may conclude that pharmacist advice
and intervention can help reduce morbidity and mortality in patients suffering from the metabolic syndrome.
Acknowledgement The research work disclosed in this publication is partially funded by the MASTER it! Scholarship Scheme. The scholarship is part-financed by the European Union – European Social Fund.
References
1 Zimmet P, Alberti KG, Serrano Ríos M. A new international diabetes federation worldwide definition of the metabolic syndrome: the rationale and the results. Rev Esp Cardiol. 2005;58(12):1371-1376.
2 Landsberg L. Obesity and the insulin resistance syndrome. Hypertension Research. 1996;19 Suppl 1:S51-55.