Pharmacist-managed diabetes care and change in A1C: A retrospective matched cohort study

Introduction

Studies have demonstrated the positive impact of pharmacist-managed diabetes care (PMDC) on hemoglobin A1C (A1C) reduction from baseline, but data comparing the pharmacist's impact on usual medical care (UMC) are less robust.

Objectives

This study compared the A1C reduction in patients with diabetes enrolled in PMDC plus UMC (PMDC + UMC) with similar patients receiving UMC independent of clinical pharmacy services.

Methods

This was a retrospective, matched cohort study conducted at a large, not-for-profit healthcare system in North Dakota. Patients with diabetes who received care from an ambulatory care pharmacist in addition to UMC between July 2018 and June 2020 were included in the PMDC+UMC cohort. The comparator cohort included propensity-matched patients solely receiving UMC during the same period. The primary endpoint was the mean change in A1C at 12 months in both cohorts. The secondary endpoint was the percentage of patients in each cohort achieving an A1C <7% at 12 months. Normally distributed continuous variables were analyzed using the Wilcoxon rank sum test. Categorical data were analyzed using Chi-square tests.

Results

In total, 158 patients managed by a pharmacist met the inclusion criteria for the study. A matched cohort of 158 practitioner-managed patients was used for comparison. Pharmacist-managed patients achieved a greater mean reduction in A1C (−1.70%) at 12 months compared with those managed by practitioners only (−1.31%), a between-means difference of −0.39% (p = 0.0073). More patients managed by pharmacists (24.6%) reached an A1C of <7% compared with patients receiving UMC only (22.8%); however, the difference was not statistically significant.

Conclusion

Incorporation of PMDC for patients with diabetes is associated with a greater improvement in A1C at 12 months compared with UMC alone. Although not statistically significant, more patients referred to PMDC reached an A1C of <7%. Implementation of similar PMDC programs may help more patients reach their glycemic goals.