Pharmacist-Led Telephonic Insulin Titration Significantly Improved A1C
Researchers explored the effectiveness of telephonic insulin titration by a clinical pharmacist compared with in-office titration among patients in a medical residency clinic.
Telephonic insulin titration and cooperative management with a clinical pharmacist were found to significantly improve patients’ diabetes outcomes, according to a study published in Patient Related Outcome Measures.1 The study provides evidence that telephonic insulin titration by a pharmacist is an appropriate manner of managing diabetes during times of limited clinical access, such as a pandemic.
“For persons with diabetes, between 48% and 64% of lifetime medical costs are spent on complications related to diabetes,” wrote authors of the study. “As such, finding more strategies to improve patient access to monitoring and titration of their insulin to better control their diabetes is highly important.”
With nearly 37 million Americans reporting diabetes and 31% of them requiring insulin to manage the disease,2 patients with diabetes and the medications or services they need account for 1 in every 4 health care dollars.1 Amid the steep price of diabetes management, as well as rising insulin costs, the federal government was eventually led to capping insulin copays in 2022 through the Inflation Reduction Act.3
Researchers compared patients who received telephonic diabetes management with those that received it in person. | image credit: Graphicroyalty / stock.adobe.com
Despite events that preceded the US capping insulin prices, other pressures also have the potential to impact patients with diabetes.
READ MORE: Once Weekly Insulin Efsitora Alfa Shows Similar Efficacy to Daily Insulin
One of these events was the COVID-19 pandemic, which revealed an unprecedented need in the health care system to improve patient access for those in need of chronic care. Previous research has touched on the decrease in quality for diabetes management following the COVID-19 pandemic. What this research—and the pandemic itself—further uncovered was that alternatives to in-person evaluation are crucial for patients with diabetes during times like the pandemic.
“The goal of this study was to evaluate whether telephonic insulin titration by a clinical pharmacist was as effective at improving A1C compared to in-office titration among patients in a medical residency clinic serving primarily Medicaid and Medicare patients,” wrote authors of the study.1 “We hypothesize that telephonic insulin titration by a clinical pharmacist is as effective as in-person insulin titration."
Researchers conducted a retrospective cohort study comparing the diabetes outcomes of patients in a family medical clinic (control group) with those who received insulin management through the phone (experimental group). Providers facilitating the family clinic consisted of medical residents, faculty physicians, and 1 nurse practitioner. Those on the telephone side, however, included a full-time, residency-trained clinical pharmacist.
The main study outcome was change in A1C compared between the 2 groups. Before the 2 groups were matched with each other, all participants had to be between 18 and 70 years old with insulin-dependent type 1 or type 2 diabetes. They also had to be referred to a pharmacist for insulin titration between April 2020 and April 2021.
“This is one of the first studies to look into the impact of the COVID-19 pandemic on patient’s diabetes, and shows the utility of telephonic insulin titration by pharmacy in helping with diabetic control,” wrote the authors.1 “The preliminary findings of this study show that titration of insulin by a clinical pharmacist is as effective as in-office titration of insulin by a primary care physician.”
Not only did they discover telephonic titration was just as effective as in-person, researchers found that the telephonic group had significantly better outcomes than the in-office group at 3 months. With the telephonic approach’s ability to outshine in-person diabetes management, the study highlights the US health care system’s ability to find alternative methods during unprecedented times.
According to the authors, previous studies have explored the effectiveness of pharmacist-led insulin titration. However, none have explored this during the COVID-19 pandemic, especially with pharmacists exhibiting better capabilities than physicians. Results of the study are beneficial towards underserved populations as well as the expansion of pharmacist-administered clinical services like insulin titration.
“The importance of this study in the literature is that it shows that in primarily underserved populations who have limited access to resources even in the absence of a pandemic, telephonic insulin titration can serve as a safe way to manage their diabetes,” concluded the authors.1 “Additionally, this study shows the importance of a pharmacist in the management of patients with diabetes, and the need for further integration of multi-disciplinary teams not just in residency practices but also in private practice. Lastly, though this studies primary focus was on diabetes, the use of telephonic insulin titration could be expanded and evaluated for other chronic conditions, like asthma control or warfarin monitoring.”
READ MORE: Insulin Management Resource Center
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