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

Salvo, Marissa C.; Brooks, Amie McCord

doi:10.1345/aph.1q512

Cited by 31 publications

(36 citation statements)

References 18 publications

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“…Clinical Pharmacist Specialists, who have prescribing privileges and work within collaborative practice agreements with primary care or internal medicine physicians, have optimized clinical outcomes for patients with common metabolic disorders, including diabetes. [8][9][10][11][12][13] The Diabetes Intense Medical Management (DIMM) "tune up" clinic was created as a collaborative pharmacist-endocrinologist medication therapy management (MTM) clinic to manage complex type 2 diabetes (T2D) patients and help them achieve metabolic goals (glycosylated hemoglobin [A1C], hypertension [HTN], lipid, weight) within 6 months. 14 Overseen by an endocrinologist at a Veterans Affairs medical center, the DIMM clinic used a short-term model that coupled personalized clinical care with real-time, patient-specific diabetes education during an average of three 60-minute visits over 6 months.…”

Section: Introductionmentioning

confidence: 99%

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Improved Glycemic Control With Minimal Change in Medication Regimen Complexity in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic

et al. 2018

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Outcomes represent the first report demonstrating how treating patients with an innovative DIMM model can help complex T2D patients achieve glycemic control without increasing the MRC to more than a comparator group. With the growing prevalence of T2D and associated elevated treatment costs, identifying effective means for achieving glycemic control without increasing complexity is needed. Application of this model may be considered by other health systems to aid in achieving outcome measures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improved Glycemic Control With Minimal Change in Medication Regimen Complexity in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic

et al. 2018

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“…Four studies of pharmacist care management collectively reduced the HbA1C when compared to the control intervention (MD −0.76, 95% CI −0.93 to −0.59) from a baseline of 9.81 ( Figure 3 ). 27 – 30 Jameson et al had no impact on the HbA1C from a baseline of at least 9 and was excluded from the analysis because it reported skewed data. 31…”

Section: Resultsmentioning

confidence: 99%

How Do Interventions That Exemplify the Joint Principles of the Patient Centered Medical Home Affect Hemoglobin A1C in Patients With Diabetes

Morgan

Everett

Dunlop

2014

Health Services Research and Managerial Epidemiology

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Objective:To review the impact of the Joint Principle of the Patient Centered Medical Home (PCMH) on hemoglobin A1C (HbA1C) in primary care patients with diabetes.Methods:Systematic review of English articles using approximate terms for (1) the 7 principles of the PCMH, (2) primary care, and (3) HbA1C. We included experimental and observational studies. Three authors independently extracted data and obtained summary estimates for concepts with more than 2 high-quality studies.Results:Forty-three studies published between 1998 and 2012 met inclusion criteria, 33 randomized and 10 controlled before–after studies. A physician-directed medical practice (principle 2) lowered HbA1C values when utilizing nursing (mean difference [MD] −0.36, 95% confidence interval [CI] −0.43 to −0.28) or pharmacy care management (MD −0.76; 95% CI −0.93 to −0.59). Whole-person orientation (principle 3) also lowered HbA1C (MD −0.72, 95% CI −0.98 to −0.45). Studies of coordinated and integrated care (principle 4) and quality and safety interventions (principle 5) did not consistently lower HbA1C when reviewed in aggregate. We did not identify high-quality studies to make conclusions for personal physician (principle 1), enhanced access (principle 6), and payment (principle 7).Conclusion:Our review found individual interventions that reduced the HbA1C by up to 2.0% when they met the definitions set by of the Joint Principles of the PCMH. Two of the principles—physician-led team and whole-person orientation—consistently lowered the HbA1C. Other principles had limited data or made little to no impact. Based on current evidence, PCMH principles differentially influence the HbA1C, and there are opportunities for additional research.

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“…Perhaps one of the most important periods when a patient with diabetes requires support is during the initiation and titration of basal insulin. A retrospective cohort study in the USA showed that, compared with physician management alone, a pharmacist-managed insulin-titration program resulted in significantly greater HbA1c reductions, with a greater proportion of patients adhering to recommended preventive care measures [24]. Although guidelines state that most patients can be taught to titrate their own insulin dose using simple algorithms, they also point out that frequent contact may be necessary during this period [2].…”

Section: Role Of the Pharmacist In Diabetes Carementioning

confidence: 99%

Appropriate Titration of Basal Insulin in Type 2 Diabetes and the Potential Role of the Pharmacist

2019

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A substantial proportion of patients with suboptimal control of their type 2 diabetes experience delays in treatment intensification. Additionally, patients often experience overuse of basal insulin, commonly referred to as “over-basalization,” whereby basal insulin continues to be uptitrated in order to meet targets, when addition of a mealtime bolus insulin dose may be a more appropriate option. In order to overcome these challenges, there is a need to develop the capacity of allied healthcare professionals to provide appropriate support to these patients, such as during initiation or titration of basal insulin. Pharmacists play an integral role in healthcare delivery, with patients seeing their pharmacist, on average, seven times more often than their primary care physician. This places pharmacists in a unique position to provide diabetes education and care, which may help patients avoid clinical inertia. Nevertheless, the management of the disease with basal insulin is becoming increasingly complex, with growing numbers of treatment options (such as recent second-generation longer-acting basal insulin formulations) and frequently updated titration algorithms. The two most common titration schedules specify either increasing doses by a set amount every 2–3 days or a treat-to-target strategy. Neither schedule has been shown to be superior, and the decision to use one or the other should be based on a discussion between the clinician and patient after assessment of mental and physical acumen, comfort of both parties, and follow-up plans. This review article discusses basal insulin therapy options and titration algorithms from the unique perspective of the pharmacist in order to help ensure that optimal antidiabetes therapy is initiated, appropriately titrated, and maintained.Funding: Sanofi US, Inc.

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

Abstract: 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.

Cited by 31 publications

References 18 publications

Improved Glycemic Control With Minimal Change in Medication Regimen Complexity in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic

Improved Glycemic Control With Minimal Change in Medication Regimen Complexity in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic

How Do Interventions That Exemplify the Joint Principles of the Patient Centered Medical Home Affect Hemoglobin A1C in Patients With Diabetes

Appropriate Titration of Basal Insulin in Type 2 Diabetes and the Potential Role of the Pharmacist

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