Glycemic Control and Preventive Care Measures of Indigent Diabetes Patients Within a Pharmacist-Managed Insulin Titration Program vs Standard Care

Abstract

Studies assessing pharmacist-led services have noted positive clinical diabetes outcomes; however, studies assessing pharmacist impact on glycemic control through insulin titration and adherence to American Diabetes Association (ADA) preventive care measures in an indigent population are limited. To assess the impact of a pharmacist-managed insulin titration program compared to standard medical care on glycemic control and preventive care measures in an indigent population with diabetes. This retrospective cohort study compared pharmacist-managed insulin titration to standard care; all patients received primary care services through a county-funded health center serving a low-income minority population. The pharmacist-managed patients, referred by the primary care provider, received telephone calls to assess blood glucose levels, encourage preventive care examinations, and titrate insulin doses through collaborative drug therapy management. Standard care patients received diabetes care solely from the primary care provider. Student t test was used to evaluate the primary outcome, glycemic control, assessed by change in hemoglobin A(1c) (A1C) between groups from baseline to various time points and study end. Secondary outcomes included attainment of preventive care measures and A1C goal of less than 7% and change in weight and total daily insulin dose from baseline to study end. Sixty-nine patients in the pharmacist-managed group (intervention) and 57 standard care patients (control) were evaluated. The pharmacist-managed group showed a significant difference in A1C at all time points, including, study end, compared to standard care (-1.3% vs -0.18%, respectively; p = 0.001). In addition, the intervention group more often completed the ADA's recommended preventive care measures; all differences were statistically significant. Pharmacist-provider collaboration can result in significant clinical improvements, including A1C reduction and adherence to preventive care measures, when compared to standard care in a medically underserved population with diabetes.