Clinical Impact of a Pharmacist-Managed Diabetes Mellitus Drug Therapy Management Service

Study Objective. To evaluate the impact of clinical pharmacist interventions, including drug therapy management, on outcomes relevant to diabetes mellitus.

Design. Retrospective chart review.

SettingAmbulatory, multispecialty physician group practice within a managed care environment in suburban Chicago, Illinois.

Patients. Three hundred sixteen patients aged 18 years or older, with a diagnosis of diabetes mellitus (89% with type 2), who were referred to a clinical pharmacy service.

Intervention. Drug therapy management and education service provided by a clinical pharmacist.

Measurements and Main Results. Data were collected for glycosylated hemoglobin A_1c (A1C), blood pressure, and low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride concentrations. Data also were collected regarding patient adherence with American Diabetes Association guidelines for preventive care, including annual eye and foot examinations, influenza shots, and daily aspirin use at both baseline and follow-up. Mean ± SD A1C reduction was 1.4% ± 1.94% (p<0.001); the percentage of patients whose A1C was at goal level at baseline (< 7%) increased from 14.8% to 43.2% (p<0.001). Mean ± SD LDL level reduction was 14 ± 41.1 mg/dl (p=0.002), mean ± SD triglyceride level reduction 42 ± 97.6 mg/dl (p<0.001). The percentage of patients who reached goal for LDL level (< 100 mg /dl), HDL level (> 40 mg/dl), and blood pressure (< 130/80 mm Hg) did not increase significantly from baseline, whereas those who reached the triglyceride level goal (< 150 mg/dl) increased from 36% to 55% (p<0.005). Frequency of annual dilated retinal examinations and monofilament foot examinations increased by 29% (p<0.05) and 12.5% (p<0.05), respectively. Daily aspirin use increased from 35% to 59% (p<0.05).

Conclusion. Significant clinical improvement occurred in patients referred to the pharmacist in a diabetes drug therapy management program.