Reducing HbA1c Levels Through Resident Pharmacy Visits

Using a multidisciplinary approach when treating diabetes can both prevent diabetes-related complications and aid in disease management. Previous research has shown that direct collaboration between pharmacists and primary care physicians has led to improvement in hemoglobin A1c (HbA1c) levels for patients with type 2 diabetes, but little research exists examining if this holds true when the monitoring is done by a pharmacy resident with remote pharmacist supervision.

A poster presented by Talin Bchakjian, PharmD, aPGY-2 Ambulatory Care Resident at USC School of Pharmacy in Porter Ranch, California, at the American Society of Health-System Pharmacists 2022 Summer Meetings and Exhibition in Phoenix, Arizona, offered some needed information.

Bchakjian conducted a retrospective observational study from August 10, 2021, toFebruary 28, 2022, in which 1 pharmacy resident started a diabetes management service at a large academic medical center in Los Angeles and received supervision remotely from a preceptor. The resident pharmacist spent 8 hours per week at the clinic. Any patient with an HbA1c level above 9% was referred to the program by primary care physicians, and anyone aged 18 years and older was included in the study. A baseline HbA1c, which was the value closest to the initial visit, and a final HbA1c value, which was collected at the end of the study period, were collected

A total of 20 patients with a mean age of 48.15±15.48 years. Most were women who were insured through Medicaid. The most common comorbid conditions were dyslipidemia (85%), obesity (70%), and hypertension (40%). All but 2 of the patients met the criteria for metabolic syndrome, but no one had a recorded diagnosis in their medical records.

The average baseline HbA1c value was 10.66%±0.02;average final value was 9.37%±0.02, with a statistically significant difference occurring over 7 months (P=.0449). Over the course of the program, the resident pharmacist completed 75 visits averaging 26 minutes, with 71 being conducted via phone and 4 conducted in-person. Each patient had an average of 3.75 visits.

At the start of the program, the average number of medications used were3.55±1.47 and 14 patients were using insulin. When the program concluded, the average number of medications was 3.85±1.31 with16 were using insulin.

"Patients with type 2 diabetes under the care of a PGY-2 ambulatory care pharmacy resident had a clinically significant [Hb]A1c reduction over 7 months with less than 4 visits,” Bchakjian concluded. “This study indicates that a PGY-2 resident pharmacist-led diabetes service positively impacted patients’ [Hb]A1c levels.”

Further research should conduct multiple regression analyses to identify factors impacting HbA1c will be undertaken.

Reference

Bchakjian T. A1c change in patients with type 2 diabetes under a residentpharmacist-led diabetes clinic. Presented at American Society of Health-SystemPharmacists 2022 Summer Meetings & Exhibition; June 11-15, 2022; Phoenix, AZ. Poster 5-M.