Diabetes Intervention Spearheaded by Pharmacist Improves Glycemic Control

Katie Eder, Senior Editor
Published Online: Wednesday, August 6, 2014
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In a recent study, patients with diabetes who were referred to a pharmacist-led clinic by their primary care providers saw their mean HbA1C levels fall by 2.4%.

A pharmacist-led intense disease management clinic successfully aided patients with type 2 diabetes mellitus (T2DM) and their primary care providers (PCPs) in achieving improved glycemic control, according to study results presented at the 74th Scientific Sessions of the American Diabetes Association.
 
In the study, 85 adult patients with T2DM who were referred to the Diabetes Intense Medical Management (DIMM) clinic by their PCPs saw their mean hemoglobin A1C (HbA1C) levels fall by 2.4%, which subsequently resulted in an estimated medical costs savings of $9104 over 3 years for each patient, largely based on improved glycemic control. By comparison, 51 adult patients with T2DM who were treated by PCPs but did not participate in the pharmacist-led DIMM clinic experienced a mere 0.2% drop in mean HbA1C levels, which only translated to a $1803 reduction in 3-year medical costs per patient.
 
Throughout the 6-month intervention, a pharmacist who was also a certified diabetes educator and had full prescribing privileges spent 4 hours per week in the DIMM clinic managing patients with baseline HbA1C >8% on an individual basis. During each 3- to 5-hour clinic visit, the pharmacist focused on “finding the best combination of medications for the individual patient, education on medication adherence, simplifying the drug regimen to fit around the patient’s schedule, and setting personalized goals,” study author Candis M. Morello, PharmD, director of the DIMM clinic in the Veterans Affairs San Diego Healthcare System, told Clinical Endocrinology News. Following each visit, patients returned to their PCPs but were permitted to make follow-up calls to the pharmacist, Morello said.
 
Based on the cumulative estimated $546,240 savings from reduced 3-year costs across a cohort of 60 patients seen annually in the clinic, Morello and her coauthors calculated a $7.81 return on investment (ROI) for every $1 spent on the DIMM clinic pharmacist. Although a secondary analysis reduced the medical cost savings in the clinic group to $6412 per patient, the investigators noted that was “still 3-fold greater cost avoidance than the comparator group” treated by PCPs and resulted in a $5.21 ROI after accounting for the cost of the pharmacist.
 
In light of those findings, the study authors concluded, “Pharmacists are a valuable, cost-efficient resource who can successfully assist patients and physicians to meet diabetes management goals.”

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