Comparison of Type 2 Diabetes Mellitus Management by an Ambulatory Care Pharmacist vs Usual Care in a Medically Underserved Population

Abstract

Pharmacists have been shown to improve HbA1c reduction among medically underserved Type 2 diabetes mellitus (T2DM) patients when compared to standard of care. However, there is limited literature exploring the difference in prescribing patterns between these 2 cohorts. This study evaluated the impact of pharmacy-driven T2DM management utilizing a collaborative practice agreement (CPA) compared to usual care at a family medicine clinic by comparing HbA1c reduction and prescribing patterns. This single-center, retrospective chart review identified patients with an HbA1c >9% within a 1-year period. Patients had to be at least 18 years of age, have a diagnosis of T2DM, and have a repeat HbA1c measurement documented within 6 months of baseline HbA1c. In total, 307 charts were reviewed with 126 patients included (provider, n = 70; pharmacist, n = 56). A significantly greater reduction in HbA1c was found in the pharmacist group (−2.61% ± 2.22% vs −1.87% ± 1.97%, P = 0.03), and the pharmacist group achieved statistically significantly higher percentages of patients achieving HbA1c <7% (23% vs 11%, P = 0.04) and <8% (50% vs 33%, P = 0.03). Prescribing of basal insulin was significantly higher in the pharmacist group (55% vs 33%, P = 0.011), while prescribing of other medication classes was similar between cohorts. Pharmacist-driven management of T2DM in a medically underserved population resulted in greater HbA1c reduction and more basal insulin utilization compared to the provider-managed group. Low usage of GLP-1 agonists and SGLT2 inhibitors was noted in both groups.