R.Ph. involvement improves A1c levels in Type 2 diabetes

Involving clinical pharmacists in the management of patients with diabetes results in improvements in A_1c levels, blood pressure, and lipid profiles. So reported investigators at the 65th annual scientific sessions of the American Diabetes Association (ADA). Management models that incorporate pharmacists can also reduce healthcare utilization and cost of care.

In a clinical practice study presented by Michelle Jacobs, Pharm.D., 396 patients with Type 2 diabetes and an A_1c value >8% for at least six months were randomized to usual care from their physician (controls) or collaborative care involving integration of a clinical R.Ph. into the patient's management (cases). From baseline to 12 months, patients as signed to usual care had a 0.8% reduction in A_1c, a 10.0-mg/dL decline in low-density lipoprotein (LDL) cholesterol level, and a blood pressure change of +0.6/-0.7 mm Hg. Meanwhile, patients randomized to clinical R.Ph. care had a 1.8% decline in A_1c, a reduction in LDL cholesterol of 29.8 mg/dL, and a blood pressure change of -10.0/-7.4 mm Hg (P<0.05 compared with baseline for all parameters).

Jacobs, who is assistant clinical professor, Northeastern University, Boston, attributes the greater improvements in these values to advanced training of pharmacists in medication management and the increased time and resources devoted to focused management by the pharmacists. "There was no difference in the number of medications people ended with," she said. "Instead, we've optimized regimens to work better for the patient."

A second study, in which the impact of clinical pharmacists as physician extenders was examined, showed that a multidisciplinary model that included pharmacists was superior to nurse practitioner management in decreasing A_1c values in patients with Type 2 diabetes. This was a five-year study conducted in Jackson, Miss., and 70% of the 1,384 patients in the study population consisted of African Americans.

Retrospective chart reviews showed that average A_1c values were equivalent in the two groups during the first year, after which A_1c values improved in the group managed by pharmacists relative to the nurses. So reported Mar shall J. Bouldin, M.D., director of diabetes and metabolism, University of Mississipi Medical Center. After the five years, the average A_1c was 7.2% in the pharmacist group and 8.4% in the nurse practitioner group.

Because of their narrower training, "pharmacists didn't get distracted from the target," Bouldin said. The findings may have significant implications for disease management design, especially in provider shortage areas, he added.

Other clinical studies of note presented at ADA: