Remote Interventions From Pharmacists Shown to Improve Blood Glucose Control for Type 2 Diabetes

The value of the pharmacist generally has been demonstrated for patients with type 2 diabetes (T2D), as their role in reductions to hemoglobin A1c (HbA1c) has been shown in numerous clinical trials and investigations, but there has been a lack of data showing the clinical impact of remote pharmacy-based programs. In a Baylor University Medical Center Proceedings study, remote pharmacist interventions was shown to improve blood glucose control for adult patients who have T2D.¹

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In a 2024 National Association of Chain Drug Stores Total Store Expo session, Jon Easter, BSPharm, professor of the practice and vice chair of practice advancement at the University of North Carolina Eshelman School of Pharmacy, discussed the Community-Based Value Initiative, which was made up of patient identification, screening and pharmacist consultation, and provider communication. Pharmacists lead diabetes education, nutrition education, blood sugar education, heart disease, cholesterol, self-care, and a review of diabetes medication management.²

“Diabetes is obviously something that we all need to be paying attention to, [with a focus on] better treatment and prevention. We launched a telehealth project a couple of years ago that was very successful in rural and underserved areas. Then the latest project, the [CBVI, which has] a focus on diabetes, taught us a lot about the role of the pharmacist there,” Easter said in an interview.³

Over a 6-month period, investigators found that reduction in HbA1c were evident, with a decrease from 9.5% to 9%. Patients were also satisfied with the program. However, pharmacists said that there were improvements in acceptability, but there were declines in feasibility and intent to sustain the program due to reworking workflow after the COVID-19 lockdown.²

In the current study, investigators launched a pilot program in 2023 with 1 pharmacist, with pharmacy technicians and residents in supporting roles. The program was intended to last 6 months and then undergo revision. The centers were from the Baylor Scott & White Quality Alliance, including more than 6000 primary and specialty care physicians, 50 hospitals, and more than 95 post-acute care facilities throughout North and Central Texas.¹

Investigators included individuals with HbA1c­ of less than 8.5% and a large proportion of patients with poorly controlled T2D. Pharmacists incorporated clinical guidelines, evaluation of patient history, consideration of patient preferences, and health insurance benefits. Goals included disease- and patient-specific factors, minimization of polypharmacy, improvement of education, and collaboration between other health care members. Additionally, interventions also included initiation or addition of new medication, discontinuation of medications, or dose adjustments.¹

The primary outcomes included change in HbA1c from baseline to follow-up at 2 to 5 months, and secondary outcomes included appropriate use of American Diabetes Association-supported therapies, including statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers (ACE/ARB), and occurrence of glycemia-related events.¹

Between September 1, 2024, and March 1, 2024, investigators included a total of 28 patients who attended the initial provider appointment with both baseline and follow up blood glucose levels obtained. Eleven patients’ providers accepted the pharmacist recommendation and 17 rejected and continued routine therapy. Approximately 68% were on insulin at the baseline and 21% were on optimally-dosed novel antidiabetic agents, including glucagon-like peptide-1 receptor agonists (GLP-1), tirzepatide, or sodium-glucose cotransporter-2 inhibitors.¹

The mean change in HbA1c from baseline to follow-up at 2 to 5 months was –2.7% and –0.6% for the accepted and rejected groups, respectively. Furthermore, investigators reported that there were no T2D-related emergency room visits or hospitalization across the study individuals. Addition of medication occurred in 2 (addition of statin) in the accepted group and 2 (addition of ACE/ARB and statin) in the rejected group.¹

For pharmacist intervention, pharmacists initiated 12 medications, discontinued 5 medications, and made dose adjustment to 7 medications. Pharmacists were more likely to initiate and optimize novel medications, such as GLP-1 receptor agonists in comparison with physicians.¹

REFERENCES

1. Nuttall EC, Reynolds T, Kataria AD, Paulson D, Lewis J, Straza AC. Evaluation of remote pharmacist intervention on type 2 diabetes hemoglobin A1c reduction in an accountable care organization. Proc (Bayl Univ Med Cent). 2024;37(5):774-780. Published 2024 Jul 23. doi:10.1080/08998280.2024.2379195

2. Gallagher A. Community Pharmacy-Driven Diabetes Intervention Leads Value-Based Care. Pharmacy Times. August 27, 2024. Accessed September 9, 2024. https://www.pharmacytimes.com/view/community-pharmacy-driven-diabetes-intervention-leads-value-based-care

3. Halpern L. Expert: Diabetes Initiatives Led by Community Pharmacists, Students Drive Treatment Innovation. Pharmacy Times. August 18, 2024. Accessed September 9, 2024. https://www.pharmacytimes.com/view/expert-diabetes-initiatives-led-by-community-pharmacists-students-can-drive-treatment-innovation