Pharmacist-Led Digital Care Improved Community Diabetes Control in China—An Observational Study in a Large Population Sample

Abstract

Objective: To evaluate the effects of digital diabetic care and pilot-test the healthcare ecosystem with retail pharmacists as the care provider. Methods: We managed to build a digital healthcare ecosystem that engages diabetic patients and pharmacists with a cloud engine that operates 5 different algorithms for diabetic care support. A set of glucose tele-monitor and an App was installed in the drug stores and pharmacists provided personalized interventions to the walk-in patients according to the onsite glucose tests and the supporting App contents generated by the cloud engine in real-time. Between Jun 6th 2015 and Dec 26th 2017, we served a total of 283,938 patients in 4,035 pharmacies in 183 cities, and 14,609 of them were selected in this analysis following 4 inclusion criteria: 1) the baseline fasting blood glucose (FBG) or random blood glucose (RBG) were diabetic, 2) the intervention duration was ≥ 1 month, 3) the number of received diabetic care was ≥ 3 times, and 4) the baseline characteristics were complete. Among them, 11,131 received FBG tests, 4,731 had RBG tests and 1,253 had both. Results: FBG and RBG were reduced on average by 0.8 mM (baseline: 9.1 ± 2.2 mM, last time: 8.3 ± 2.2 mM, n=11,131, P< 0.001) and 3.2 mM (baseline: 14.5 ± 3.2 mM, last time: 11.3 ± 4.0 mM, n= 4,731, P<0.001), respectively. The diabetes control rates were improved with 3,165 patients of the FBG population (28%) and 2,545 patients of the RBG population (54%) returning to normal. The greatest glycemic control effect took place following the initial intervention with the reduction of FBG by 11% and RBG by 18%. Nonlinear fitting using compound function identified descending glucose reduction to time: FBG, y = 1.122x-1/3 + 7.970; RBG, y = 2.927x-1-0.003x + 11.070. Conclusion: Retail pharmacists equipped with digital tools can effectively control diabetes and are valuable resources to help streamline the process of community healthcare delivery. Disclosure J. Cao: None. Y. Li: None. W. Wang: None. Z. Wang: None. D. Li: None. H. Zhang: None. K. Liu: None.