Caring for Poorly Controlled Diabetes Mellitus: A Randomized Pharmacist Intervention

Abstract

BACKGROUND:

There is limited information from randomized controlled studies about the influence of pharmacist interventions on diabetes control.

OBJECTIVE:

To evaluate the effect of a pharmacist intervention on improving diabetes control; secondary endpoints were medication appropriateness and self-reported adherence.

METHODS:

A randomized, controlled, multi-clinic trial was conducted in the University of Washington Medicine Neighborhood Clinics. Seventy-seven subjects, ⩾18 years old with a hemoglobin (Hb) A_1c ⩾9% at baseline and taking at least one oral diabetes medication, were randomized to receive a pharmacist intervention (n = 43) or usual care (n = 34) for 6 months followed by a 6-month usual-care observation period for both groups. Subjects met with a clinical pharmacist to establish and initiate a diabetes care plan followed by weekly visits or telephone calls to facilitate diabetes management and adherence. HbA_1c, medication appropriateness, and self-reported adherence were assessed at baseline, 6 months, and 12 months.

RESULTS:

The mean HbA_1c did not differ between groups over the 12-month period (p = 0.61). A reduction in HbA_1c was noted for both groups over time compared with baseline (p = 0.001); however, control subjects relied more heavily on provider visits. Medication appropriateness was not improved for diabetes medications (p = 0.65). Self-reported adherence was not significantly improved by the intervention.

CONCLUSIONS:

This pharmacist intervention did not significantly improve diabetes control, but did allow for similar HbA_1c control with fewer physician visits. Medication appropriateness and self-reported adherence compared with usual care in individuals with poorly controlled diabetes were not changed.