How Pharmacists Improve Glycemic Control in Diabetes Care

Pharmacist-led collaborative care management programs for type 2 diabetes are associated with better glycemic control and lower health care costs compared with primary care settings that lack these programs.

Researchers from the University of Utah in Salt Lake City retrospectively analyzed the effects of pharmacist-led diabetes collaborative drug therapy management programs on patients with type 2 diabetes, as well as the short-term economic outcomes of such programs in primary care.

The researchers noted that the availability of clinical pharmacy services in community-based primary care isn’t widespread. They noted that one reason for this is because there are limited reimbursement opportunities for clinical pharmacy services participants. Additionally, data demonstrating the importance of these services are limited.

The investigators collected data on patients who were referred to diabetes collaborative care management intervention programs between 2009 and 2012. A total of 303 patients were referred to diabetes management programs, and another group of 394 patients were used as a comparison.

The intervention group had a mean age of 57.4 years, while the control group had a mean age of 59.9 years.

The comparison group was made up of patients with type 2 diabetes who were treated from 2008 to 2012 by providers at 1 of 5 clinics without a diabetes collaborative care management program or a sixth clinic that had a pharmacist on staff to provide clinical comprehensive medication management services.

The researchers measured glycemic control at 90-day intervals from the index date until the end of the study period.

The mean baseline HbA1C levels for the intervention patients were higher than the control patients, but the gap narrowed around the 15- to 18-month time period. Those in the intervention group with HbA1C levels ≥8.0% had higher levels than the control group at baseline, but they achieved lower HbA1C levels compared with the control group by the end of the study.

When controlling for only baseline HbA1C, participating in the intervention was associated with a 0.21% lower HbA1C at any time after the post-index date compared with the control group.

The researchers also found that patients who were enrolled in the diabetes program saw significant reductions in HbA1C, but 9 months after the index date, the differences in glycemic control identified at baseline between both groups was no longer observed.

The researchers argued that since lifestyle changes can be hard to maintain, it would be worth it for pharmacists to follow up with patients about reinforcement of educational messages and potential adjustment of therapy.

The study authors also found that the all-cause total medical charges for the intervention group were higher in the pre- and post-index periods, but when controlling for potential confounders, the intervention group had significantly smaller increases in outpatient and total charges.

Outpatient charges in the intervention group demonstrated a mean increase of $534 in the post-index period, and total medical charges were about $250 higher. Meanwhile, outpatient charges in the control cohort increased by $1129, and the total medical charges totaled $1341.

“This study has identified that a pharmacist-led collaborative diabetes management program is associated with better glycemic control and improved all-cause medical cost trends in patients with uncontrolled type 2 diabetes treated in a patient-centered primary care setting,” the study authors concluded. “These findings contribute to efforts to establish the value of clinical pharmacy services to patients, providers, and payers and provide data for payers who may be considering options for reimbursing for pharmacist-led diabetes drug therapy management.”

These findings were published in the Journal of Managed Care & Specialty Pharmacy.