Time to goal hemoglobin A1c with pharmacist management compared with nonpharmacist management

Abstract

Background

Although there is robust literature showing pharmacist success reducing hemoglobin A1c% (A1c), studies evaluating the impact of pharmacists on time to goal A1c are lacking. This study aimed to assess the difference in time to achieve diabetes control with pharmacist management compared with nonpharmacist management.

Objectives

The primary objective was average time to achieve goal A1c with pharmacist management compared with nonpharmacist management. Secondary objectives included the rate of achieving goal A1c, mean A1c reduction, rate of hospitalization and emergency department visits, and the use of guideline-directed therapy in eligible patients (appropriateness of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and statin or proprotein convertase subtilisin/kexin type 9 inhibitor use).

Methods

This was a retrospective, single-center chart review of adult patients followed by primary care providers at a large academic health system. Patients with a referral to a pharmacist for diabetes management (pharmacist group) were compared with patients managed without pharmacist involvement (nonpharmacist group). Those in the nonpharmacist group received support from the chronic care management team, which included a primary care provider, a diabetes educator, a dietitian, and a nurse who assists with medication adherence.

Results

Of the 355 patients evaluated, 238 were included with 189 patients in the pharmacist group and 49 patients in the nonpharmacist group. Time to achieve goal A1c occurred sooner in patients managed by the pharmacist than the nonpharmacist group (8.8 ± 5.3 months vs. 22.5 ± 13.0 months, respectively, P = 0.001).

Conclusion

Pharmacist management of diabetes resulted in patients achieving their goal A1c approximately 14 months faster than those who did not receive pharmacist support. However, the results of the study do not take into consideration different comorbidities, length of disease, and specific medication classes used, which may have potentially affected the results.