Efficacy of a pharmacist-managed diabetes clinic in high-risk diabetes patients, a randomized controlled trial-"Pharm-MD"
Journal of General Internal Medicine
BACKGROUND: Diabetes mellitus affects 13% of American adults. To address the complex care requirements necessary to avoid diabetes-related morbidity, the American Diabetes Association recommends utilization of multidisciplinary teams. Research shows pharmacists have a positive impact on multiple clinical diabetic outcomes. We aimed to determine impact of an education-focused pharmacist managed diabetes clinic model (PMDC) on hemoglobin A1c (HbA1c) and other diabetes core measures at 6 and 12 months follow-up. METHODS: Open-label randomized controlled trial with 1:1 allocation. Patients 18-75 years old with type 2 diabetes mellitus and most recent HbA1c ≥9% were enrolled from a single institution resident- run outpatient medicine clinic. Standard of care (SOC) patients continued with routine follow up with their primary provider whereas the PMDC group had an additional 6 visits with the pharmacist within 6 months from enrollment. Patients were followed for 12 months from enrollment. Data collected included HbA1c, lipid panel, statin use, blood pressure control, immunization status for influenza and pneumonia, and evidence of diabetic complications (retinopathy, nephropathy, neuropathy). Data analysis was done in the intention-to-treat and per-protocol populations. RESULTS: Forty-two patients were enrolled in the PMDC group and 44 patients in the SOC group. Three patients dropped out (2 patients from the PMDC group and 1 patient from the SOC group). Average decrease in HbA1c for the intervention compared to the control group at 6 months was -2.99% vs. -1.01%, (p = 0.0021). (Figure 1) Additionally, the odds of achieving a goal HbA1c of ≤8% at 6 months was 3.03 (95% CI= 1.01, 9.12, p= 0.0488) in the intervention versus control group. There was no statistically significant difference in the remaining secondary outcomes measured. Missing data during follow up limited power of secondary outcomes analyses. CONCLUSIONS: Addition of pharmacist-managed care for patients with type 2 diabetes mellitus is associated with significant improvements in HbA1c compared with standard of care alone.
Halalau A, Sonmez M, Uddin A, Karabon P, Scherzer Z, Keeney S. Efficacy of a pharmacist-managed diabetes clinic in high-risk diabetes patients, a randomized controlled trial-"Pharm-MD". J Gen Intern Med. 2021 Jul 23;36(Supp 1):S19.