Intensive diabetes management by ambulatory care pharmacists was associated with improved A1C outcomes that were achieved within 3 to 6 months, according to a poster presented at the American Society of Health-System Pharmacists' (ASHP) virtual 2020 ASHP Midyear Clinical Meeting and Exhibition.

The objective of the study was to evaluate the impact of the ambulatory care pharmacist intervention on A1C changes in patients with uncontrolled type 2 diabetes mellitus (T2DM) during a 2-year period at the diabetes education center. The primary outcome was changes in A1C from baseline to 1 to 3 or 4 to 6 months, and secondary outcomes of changes in systolic and diastolic blood pressures and weight.

A single center, retrospective chart review evaluated A1C changes from baseline to 1 to 3 months and 4 to 6 months in patients with T2DM who were referred to the diabetes education center to be managed by ambulatory care pharmacists. The study was IRB-approved, with inclusion and exclusion criteria including:
 
  • Non-pregnant adults over or equal to 18 years of age.
  • A1C over or equal to 9%.
  • Seen between January 1, 2017, and December 31, 2018.
  • Had baseline and 1- to 3- or 4- to 6-month follow-up A1C.

The enrollment involved 631 referrals, with 408 included and 223 excluded. Out of the 408 included, 86 were included whereas 322 were closed, or not reachable after 3 attempts were closed. The mean age was 50.6 years and 57% of participants were female. The race/ethnicity was 72% Latino, 14% Caucasian, 9% Asian, and 5% Black. At baseline, metformin was 42.3%, followed by insulin (basal/bolus) at 39.5%, sulfonylureas at 24.4%, and insulin (basal) at 22.1%.

The results found that as for A1C change in mean, or transitioning A1C from baseline to 1 to 3 months and 4 to 6 months, there were no severe hypoglycemic episodes or significant blood changes in blood pressure documented. However, there was a mean increase in weight at 1 to 3 months and 4 to 6 months.

As for mean weight change, the average weight for 1 to 3 months increased by 8.8 pounds from the baseline, whereas the weight for 4 to 6 months increased by 13 pounds from the baseline. Additionally, each patient spent an average of 43.2 minutes for each face-to-face encounter with the ambulatory care pharmacist and had an average of 5.9 encounters.

The study authors concluded that additional studies in return on investment for improving glycemic control by pharmacists in diabetes education clinics may help to justify continuation of services in this setting.

REFERENCE
Jun JK, Dinh MH, Nguyen DB, et al. Ambulatory care pharmacists in diabetes education centers can help improve diabetes outcomes. Poster presented at American Society of Health-System Pharmacists' virtual 2020 ASHP Midyear Clinical Meeting and Exhibition; December 6-10, 2020. Accessed December 17, 2020.