Please select the eligibility criteria that correspond to the clinical trial below.
Title: Pharmacist Intervention for Glycemic Control in The Community (The RxING Study)
Brief Summary: Background: Approximately 1.9 million Canadians are living with diabetes and this is estimated to increase by 75% over the next few decades. Pharmacists are front line primary healthcare professionals who see patients with diabetes frequently and in Alberta, they have been allowed to prescribe medications and order laboratory tests. As such, pharmacists could systematically identify poorly controlled diabetes patients and provide greater access to diabetes interventions to improve blood sugar control.

Objective: The aim of this study is to determine the effect of a community pharmacist intervention on blood sugar control in individuals with poorly controlled diabetes.

Project description:

100 adults with type 2 diabetes and uncontrolled blood sugar will be defined by the participating pharmacists. Blood sugar control is going to assessed using hemoglobin A1c test (a blood test to measure individual's blood sugar control over the last 3 months). This test requires obtaining a blood spot from the patient which will be obtained by pricking his/her fingertip. Based on the hemoglobin A1c test result the pharmacist will assess the patient's need for insulin glargine, if the patient needs insulin glargine the pharmacist is going to prescribe it for him/her and educate him/her on its use. Patients are going to be followed up closely by the pharmacists for 6 months with regular updates to the patients' family physicians. This multi-centre study should demonstrate pharmacists' ability to improve glycemic control and improve access to care.


Options:
A: Inclusion Criteria:

* Male or Female over 18 years of age
* Type 2 diabetes for at least 6 months
* Taking 1 or more oral hypoglycemic agents
* Patient attending your community pharmacy where you decided that addition of insulin glargine may be of benefit to the patient
* Baseline HbA1c 7.5 - 11%
* Signed informed consent

Exclusion Criteria:

* Have used, or currently using, Insulin
* History of ketoacidosis
* Pregnant
* Works night shift
* Renal impairment(Serum Creatinine: females ≥ 124 mmol/l, males ≥ 133 mmol/l)
* Clinically unstable
* Unwilling/unable to attend follow up visits
* Unlikely to adhere to study procedures (eg. due to cognitive limitations, severe psychiatric disorder or alcoholism)
B: Inclusion Criteria:

* Patients with last recorded blood pressure greater or equal to the British Hypertension Society audit standard

Exclusion Criteria:

* Secondary hypertension
* Housebound
* Non-English speaking
* Another major illness likely to dominate pattern of care e.g. advanced cancer, dementia
C: Inclusion Criteria:

* Adults (≥18 years of age) at high risk for cardiovascular events, including:

  * Patients with diabetes
  * Patients with chronic kidney disease \[eGFR \<60 ml/min/1.73m2 and/or (ACR \>= 30 mg/mmol or two consecutive ACR tests which are \>= 3 mg/mmol)\]
  * Patients with established atherosclerotic vascular disease including cerebrovascular disease (prior stroke or transient ischemic attack), cardiovascular disease (myocardial infarction, acute coronary syndrome, stable angina, or revascularization), or peripheral arterial disease (symptomatic and/or ankle brachial index \<0.9).
  * Primary prevention patients with multiple risk factors and Framingham risk score \>20%
  * In order to qualify for inclusion, all patients must have at least one uncontrolled risk factor (i.e., blood pressure, LDL-cholesterol, HbA1c, or current smoking)

Exclusion Criteria:

* Unwilling to participate/sign consent form
* Unwilling or unable to participate in regular follow-up visits
* Pregnancy
D: Inclusion Criteria:

* All diabetic veterans with a Hb-A1c between 7.0- 9.0 % within the last 6 months will be eligible for the study

Exclusion Criteria:

* Patients without an Hb-A1c checked within the last 6 months.
* Patients who are unable to attend the group sessions, either because of lack of transportation, psychiatric instability (suicidal, psychotic), or organic brain injury that preclude them from diabetes self-care.

Answer: A