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OBJECTIVE -To examine the effect of a 12-month pharmaceutical care (PC) program on vascular risk in type 2 diabetes.RESEARCH DESIGN AND METHODS -We recruited 198 community-based patients randomized to PC or usual care. PC patients had face-to-face goal-directed medication and lifestyle counseling at baseline and at 6 and 12 months plus 6-weekly telephone assessments and provision of other educational material. Clinical, biochemical, and medication-related data were sent regularly to each patient's physician(s). The main outcome measure was change in HbA 1c . A diabetes-specific risk engine was used to estimate changes in 10-year coronary heart disease (CHD) and stroke risk in patients without a history of cardiovascular disease.RESULTS -At total of 180 patients (91%) completed the study. Mean (95% CI) reductions were greater in PC case subjects (n ϭ 92) than control subjects (n ϭ 88) P atients with type 2 diabetes are more likely to die from cardiovascular disease than people without diabetes, and modifiable risk factors such as hyperglycemia, dyslipidemia, and hypertension can be targeted to reduce this risk (1-4). In addition to hospital-based care, there is a need for simple, cost-effective programs implemented in the community that allow the benefits of improved metabolic and blood pressure control to be realized more widely (5). Pharmacists could contribute to such programs through pharmaceutical care (PC). PC comprises the detection, prevention, and solution of drug-related problems (6) and has proved beneficial in diseases such as asthma and cancer (7).Previous PC studies in type 2 diabetes have involved small samples (8 -11), were nonrandomized (9 -13), did not report clinically important outcomes such as HbA 1c (10 -12), had a high attrition rate (13), or did not recruit patients representative of type 2 diabetes in the general population (8 -14). Two studies demonstrated some benefits of pharmacist involvement in the diabetes health care team (15,16), but they did not consider vascular risk factors other than glycemia, and in one (16), clinical pharmacist input was only part of the intervention. It has been suggested that rigorously designed PC studies addressing all aspects of diabetes care are of paramount importance (17). Consistent with this aim, we determined the impact of a PC program in a community-based sample of diabetic patients randomized to PC or usual care. We hypothesized that PC would improve glycemic and blood pressure control and dyslipidemia, with a consequent reduction in vascular risk.RESEARCH DESIGN AND METHODS -Adults with type 2 diabetes from the Fremantle Diabetes Study (FDS) were eligible for the present study, which was carried out between February 2001 and November 2002. The FDS was a prospective observational study of diabetes in a postcode-defined Australian population of 120,097 (18,19). From April 1993 to July 1996, 2,258 eligible subjects were identified and 1,426 (63%) were recruited, including 1,294 type 2 diabetic patients (91% of the sample). There were no difference...

The relatively low GADA prevalence in Anglo-Celt patients with Type 1 diabetes is a feature of this community-based study and suggests that GADA levels do fall with time, given the older age of the sample and a relatively long period between diagnosis and sampling. Southern Europeans had an even lower GADA prevalence, regardless of diabetes type. Variations in GADA frequency in diabetic patients of differing European ethnicity has implications for clinical management and healthcare planning.