Development and clinical outcomes of pharmacist-managed diabetes care clinics

Abstract

The development and outcomes of two pharmacist-managed diabetes care clinics (DCCs) are described. Retrospective data analysis was performed to determine the outcomes for patients with type 2 diabetes mellitus who were treated in two pharmacist-managed DCCs. Primary outcome measures included changes in glycosylated hemoglobin (HbA(1c)), fasting plasma glucose, body mass index, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein cholesterol, triglycerides, and blood pressure and documented annual retinal and micro-albumin screening. Secondary outcome measures included the use of aspirin and kidney-sparing agents and annual screening for thyroid-stimulating hormone. Data from 113 patients in the DCCs were analyzed. After one year, the mean reduction in HbA(1c) levels was 1.3%, with a mean HbA(1c) of 7.8%. HbA(1c) goals were based on the institution's HbA(1c) normal range of 4.1-6.5%. Compared with baseline, over one third of patients met the HbA(1c) and blood pressure goals of <7.5% and <130/80 mm Hg, respectively. Mean LDL cholesterol concentration decreased from 110 to 94 mg/dL. The mean concentration of triglycerides decreased from 243 to 178 mg/dL. Mean systolic blood pressure decreased from 136 to 132 mm Hg. Whereas the national average for uncontrolled diabetes (HbA(1c) > 9.5%) was 36.9%, only 3.5% of patients at the pharmacist-managed DCCs had uncontrolled diabetes. Attainment rates of LDL cholesterol goals and annual retinal and microalbumin screenings were significantly higher in clinic patients compared with national averages. Three-year postclinic inception data revealed similar favorable outcomes, most notably an average HbA(1c) of 7.6% and 55% of patients meeting their target HbA(1c) goal of <7.5%. Compared with national averages, DCCs managed by clinical pharmacists achieved higher screening rates and attained treatment goals more often.