Wingate, NC—Increasing pharmacist involvement could help diabetes patients reach their goal HbA1c, according to a new study.
The article, published recently in the American Journal of Therapeutics, notes that the American Diabetes Association recommends insulin initiation when A1c is greater than or equal to 10%.
A study team led by researchers from the Wingate University School of Pharmacy in Wingate, North Carolina, sought to determine ways to increase adherence with insulin initiation at an outpatient family medicine clinic.
The investigation also looked at whether initiation of insulin within 3 weeks of a high A1c reading increased or decreased the time to achieve an A1c below 7% and also to determine whether pharmacist involvement increased how many patients were able to reach that goal.
For the retrospective, observational, cohort study, 120 patients with type 2 diabetes mellitus and an A1c at 10% or over were identified in 2014, with 55 patients meeting the inclusion criteria. Those patients had a mean age of 55, a mean duration of diabetes of 6.4 years, and a mean baseline A1c of 11.7%. Patients already receiving insulin or those without a follow-up A1c were excluded.
Most of the patients were receiving no therapy (29%), monotherapy (27%), or dual therapy (29%) at baseline.
Insulin was initiated in five patients within 3 weeks of the qualifying A1c, while another five patients received insulin at some point during the study. An A1c lower than 7% was achieved in 35.6% of patients not receiving insulin, 20% of patients receiving early insulin, and no patients who received insulin after 3 weeks, according to the report.
Results indicate that the mean time to an A1c lower than 7% was 6 months for patients not on insulin and 3 months for those receiving early insulin. The percentage of patients reaching that goal after meeting with a pharmacist was 33%, compared to 30% who did not.
“Adherence to insulin initiation guidelines and rate of achieving A1c <7% in patients with A1c ≥10% is low,” study authors conclude. “Increasing pharmacy involvement may increase the rate of reaching goal A1c.”
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