Evaluation of pharmacist-initiated glycemic control in adult medicine patients with diabetes

Introduction

Historically, clinical pharmacists' management of inpatient glycemic control has been driven by institutional protocols or the collaboration of multi-disciplinary glycemic control teams.

Objectives

The purpose of this study was to describe the impact of a pharmacist's expanded scope of practice (ESOP) on glycemic control in hospitalized patients with diabetes.

Methods

This was a single-center, descriptive, retrospective cohort study of adult hospitalized patients with diabetes who had active, scheduled insulin orders initiated or titrated for more than 48 hours by an internal medicine pharmacist. The primary outcome was to determine the mean daily blood glucose (BG) levels for patients started on scheduled insulin therapy between Provider-initiated and Pharmacist-initiated groups. Other outcomes included the percentage of Level 1 hypoglycemia (BG 54–70 mg/dL), Level 2 hypoglycemia (BG <54 mg/dL), hyperglycemia (BG 181–239 mg/dL), and severe hyperglycemia (BG ≥240 mg/dL).

Results

A total of 111 patients were included: 50 in the Pharmacist-initiated group and 61 in the Provider-initiated group. There were similar outcomes between Pharmacist-initiated and Provider-initiated groups when comparing time within goal BG range (45% vs. 38%, p = 0.104) and percentage of hypoglycemia (1% vs. 4%, p = 0.175). The Pharmacist-initiated group had significantly less percentage of Level 2 hypoglycemia compared with the Provider-initiated group (0.1% vs. 1.2%, p = 0.004). Severe hyperglycemia occurred more frequently in the Provider-initiated group (19% vs. 33%, p = 0.005), but there was more hyperglycemia seen in the Pharmacist-initiated group (34% vs. 26%, p = 0.005).

Conclusion

Pharmacist glycemic management for hospitalized adult medicine patients can be achieved through a pharmacist's ESOP in collaboration with providers and can have similar efficacy and improved safety. Further changes to the ESOP, including early identification and initiation of glycemic therapy, can enhance the effectiveness of this service.