Introduction: Diabetes affects 34 million Americans and is the 7th leading cause of death in the United States. According to the American Diabetes Association (ADA) the A1c goal for most patients is less than 7%; however, in patients at risk for hypoglycemia or with complications that goal can be increased up to less than 8%. Management of diabetes with diet and exercise is essential, but insufficient for most patients and pharmacologic intervention is necessary to achieve therapeutic goals. Reducing A1c is associated with lower cardiovascular risk and a reduction in diabetes-associated complications. Previous studies have shown that pharmacist management of the type 2 diabetes pharmacologic regimen has produced statistically significant reductions in A1c as compared to no pharmacy involvement.
Purpose: This research project was created to quantify impact on the A1c values of patients diagnosed with uncontrolled type 2 diabetes following a pharmacist intervention. These pharmacist interventions are designed to improve the effectiveness of the pharmacological treatment for their diabetes. The interventions took place within a Clinically Integrated Network (CIN). The Advantage Point-Laurel Highlands CIN consists of both employed and independent primary care physician (PCP) practices who joined together to improve care and reduce costs.
Methods: The project is designed to be a retrospective data analysis. Patients were patients of the CIN who were referred to the pharmacy team due to poor control. The pharmacist interventions included: addition, deletion, substitution, or dose alteration of antihyperglycemic pharmacologic therapy under physician approval; medication counseling on proper administration times and technique; and diet and exercise education. Change in A1c (repeat – initial and final – initial) was assessed within patients who received at least one of the pharmacist interventions listed above. Retrospectively, data was extracted from the electronic medical records of adult patients (age ≥18 years) diagnosed with type 2 diabetes who had both a baseline A1c of ≥ 8% who received pharmacy intervention and at least one subsequent A1c from December 2019 through March 2021.
Results: A total of 171 patients met the criteria described previously. The average starting A1c was 10.0% ± 1.51%, the average subsequent A1c was 8.5% ± 1.3% with an average decrease of 1.5% (P < 0.001) over an average of 6 months. The average final A1c was 8.3% ± 1.3%; and, when compared to the starting A1C, the average decrease was 1.7% (P < 0.001) over an average of 8 months. Additionally, 47% of patients achieved an A1c of < 8%, 74% of patients achieved an A1C of < 9%, and 63% of patients achieved the A1c target set by their 3rd party payer.
Conclusion: Patients with type 2 diabetes who received a pharmacist intervention within the CIN realized a statistically significant decrease in A1c. However, the lack of a comparator group makes it not feasible to comment on differences in A1c reduction between patients who do and do not receive pharmacist intervention based on these results.
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Evans CR, Held K, Thomas S, Spencer J. Evaluating A1C Reduction in Patients with Diabetes Receiving Pharmacy Intervention. Advances in Clinical Medical Research and Healthcare Delivery. 2021; 1(2). doi: 10.53785/2769-2779.1028.