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MTM Pharmacists Improve Patient Outcomes in Type 2 Diabetes
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Key Takeaways
- Comprehensive medication reviews (CMRs) improve oral antidiabetic drug adherence and statin utilization in type 2 diabetes patients.
- No significant differences in emergency department or hospitalization rates were found between CMR recipients and nonrecipients.
Research shows comprehensive medication reviews enhance medication adherence in those with type 2 diabetes, highlighting pharmacists' vital role in improving health outcomes.
Since 2006, Medicare Part D benefits have required medication therapy management (MTM) services, which have positively influenced improvements in diabetes care and adherence. Yet evidence of MTM effectiveness in patients with type 2 diabetes (T2D) has been inconclusive.
The MTM program is expanding in 2025 | Image credit: Prin Productions | stock.adobe.com
Given the 2025 expansion of the MTM program,1 researchers from the University of Minnesota College of Pharmacy set out to examine the impact of comprehensive medication reviews (CMRs), a critical MTM service, on medication quality measures. Their findings, published in the Journal of the American Geriatrics Society, indicate patients with T2D who received a CMR have improved oral antidiabetic drug (OAD) adherence and statin utilization compared with nonrecipients.2
In a retrospective observational study using 2013 to 2019 Medicare claims and MTM data, these researchers compared a total of 35,816 CMR recipients with 71,114 CMR nonrecipients, 20% samples of the larger population. In addition to the 2 medication quality measures, they also evaluated CMR impact on hospital encounters because of the strong associations among diabetes medication adherence, improved glycemic control, and reduced health services utilization. The study measured outcomes in participants over a 1-year period after receiving a CMR.2
The study results indicated statistically significant improvements of 2% and 1.4% in the proportion of OAD-adherent and statin users, respectively, in CMR recipients compared with nonrecipients. Even when the researchers increased the threshold of OAD adherence from 80% proportion of days covered (PDC) to 90%, participants still experienced a significant improvement of 1.1%. In contrast, the 2 groups had similar emergency department/hospitalization rates and frequencies.2
The researchers suggest that the modest impact of CMR on OAD adherence could be due to appropriate pharmacist recommendations that may lower adherence rates (eg, to discontinue unindicated medications or adjust treatments due to adverse effects). They also explain that the lack of impact of CMR on hospitalizations may be due to improvement of clinical outcomes, such as glycemic control. Outcomes like that would require more than 1 year to produce significant results.2
Compared with prior studies limited to individual health systems, these findings are more generalizable because this study was conducted using a large comprehensive national sample of Medicare Part D beneficiaries. Further studies are warranted, especially of the impact in patients with T2D using injectables (insulin, glucagon-like peptide-1 agonists), cumulative effect of CMRs, and longer-term evaluations.2
These results add to the growing body of evidence supporting the engagement of pharmacists to manage patients' chronic health conditions. As key figures in patients’ medication management, pharmacists can help improve adherence during CMR encounters through personalized guidance and tailored counseling and support. As of 2020, it is estimated only 35% of eligible patients receive an annual CMR through the Part D program. The low rate of CMR completion is an opportunity for MTM pharmacists to be integrated into the diabetes care team to optimize patient outcomes.
