Issue 99 Item 1 Pharmacists As Part of the Diabetes Team Improves Outcomes

Pharmacists achieve drops in HbA1c, lipids and blood pressure. After more then 45 years of just one oral drug available to treat patients with Type 2 diabetes, we now find ourselves with a dramatic increase in just a couple of years of new drugs and combinations to treat patients with diabetes. The pharmacist who is educated in all of these new treatments, interactions, contradictions, etc, can play an important role as part of the diabetes team.

An increasing number of disease management programs utilize pharmacists to assist in the monitoring and management of patients with diabetes. The VA Medical Center in Pittsburgh found that persons with Type 2 diabetes who were enrolled in its pharmacist-based program experienced significant improvements in glycemic control within 6 months. After adjusting for the costs of the program, it was estimated that the net savings to the VA Medical Center for 15 of the most severely ill patients was more than $103,000 per year.

In 1997, Fincham and Lofholm evaluated community pharmacists’ diabetes-related interventions and estimated the one-time cost-savings from the prevention of hospitalizations or unnecessary office visits were $4,295 per patient. A network of community pharmacists saved the city of Asheville, North Carolina, more than $900 per patient per year on diabetes care, while several other authors have reported the positive impact of pharmacist-based services on glycemic control. Nonetheless, managed care organizations have not yet fully utilized community pharmacists to improve the quality of diabetes care.

The objective of this pilot study was to determine whether the diabetes patient-management program provided through the OVPCN was an effective means of improving clinical outcomes in persons with Type 2 diabetes.

A network of community pharmacies in West Virginia and southeastern Ohio participated in the study. The program was available to all patients with diabetes who attended the network pharmacies regardless of baseline glycemic control. Of the 47 patients initially enrolled, 32 stayed in the program for at least 6 months during the year-long study (median time in program was 9 months).

The pharmacists provided a basic, standardized diabetes education program during three 1-hour sessions. This was accompanied by a clinical assessment and a report to the patient’s primary care physician. The patients met with the pharmacist every 3 months for continued monitoring. After each visit, the patient’s primary care physician was sent a report along with recommendations for drug therapy modification when appropriate.

HbA1c, blood pressure, total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, body mass index, and the number of drug therapy modifications were monitored for outcomes

The results of the study showed that there was significant improvement in total cholesterol (t=-2.58, p=0.015) and LDL (t=-2.56, p=0.017) for the 32 participating patients. HbA1c, BMI, blood pressure, HDL and triglycerides did not change significantly across all patients. For a subgroup of 10 patients with baseline HbA1c>8%, average HbA1c declined significantly from 9.8% to 8.6% (t=-3.00, p=0.015). During the study, the 32 patients had a total of 53 modifications to their medication regimens. The most common was a change in dose of oral diabetes medications.

It was concluded that community pharmacists who have completed additional training in diabetes care can have a beneficial impact on the care of patients with Type 2 diabetes. Pharmacist-based patient-management services not only help to improve glycemic control in adults with HbA1c >8% but can also identify patients with uncontrolled hypertension and dyslipidemia and produce reductions in total cholesterol and LDL.

Therefore, pharmaceutical care may be beneficial for all patients with diabetes regardless of baseline glycemic control. Managed Care Pharm 8(1):48-53, 2002