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Background: Few studies have examined the effect of pharmacist-led telemanagement on diabetes outcomes during the COVID-19 pandemic., Objectives: Assess for noninferiority for the absolute change in mean A1C between telehealth and hybrid groups versus the in-office group during the COVID-19 pandemic. Secondary objectives were to compare the percentage of patients achieving population health A1C goals and patient no-show rates between study groups., Methods: A retrospective, noninferiority analysis was conducted for patients seen by a primary care pharmacist from November 1, 2020 to May 31, 2021 across 17 primary care clinics in the Northeast Ohio region of Cleveland Clinic. The noninferiority margin was prespecified at > 0.3% A1C reduction. Patients with a baseline A1C of 8% or greater were included. Patients were separated into 3 study groups (telehealth, in-office, and hybrid) based on the visit types that were conducted by the pharmacist during the study period., Results: Hybrid care delivery (N = 366) was noninferior to in-office care delivery (N = 180), with regards to absolute change in mean A1C reduction (0.24% [95% CI: -0.13, 0.61], P = 0.002). Similar results were shown when comparing the telehealth group (N = 691) to the in-office group (0.04 [95% CI: -0.28, 0.36], P = 0.02). The mean A1C reduction in the in-office (1.36 ± 1.9), hybrid (1.60 ± 2.2), and telehealth (1.40 ± 2.0) groups were not significantly different (P = 0.23). Subgroup analyses showed that newly consulted patients had a larger reduction in A1C compared to the overall population, in all groups. No-show rates and percentage of patients achieving population health A1C goals were not significantly different based on visit type., Conclusion: Telehealth and hybrid visit types were noninferior to in-office visits with regards to mean change in A1C reduction. Results demonstrate the importance of primary care pharmacists continuing to offer diverse visit types based on patient preference., (Copyright © 2023 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Health care reform and the projected shortage of primary care physicians necessitate more efficient use of multidisciplinary collaboration. No studies, to date, have evaluated factors associated with treatment success among patients referred to a clinical pharmacist., Objective: To develop a prediction model using patient factors to assist in selecting patients with diabetes most likely to benefit from pharmacy interventions., Methods: A retrospective, nested case-control study was performed. A prediction model using multivariable logistic regression was developed, with model calibration and internal validation. Adult patients with diabetes who had a baseline hemoglobin A 1C (A1C) ≥9%, who were consulted for collaborative pharmacy care between July 2009 and July 2014 were included. Success (cases) was defined as a decrease in A1C by 2% or a value of A1C <8% 1 year after the initial visit. Failures were those who did not achieve the A1C goal or were lost to follow-up., Results: A total of 544 unique patients were included, with 243 (44.7%) classified as clinical successes and 301 as clinical failures. Independent factors associated with success included past medical history of cerebrovascular accident and higher baseline A1C, whereas use of short-acting insulin and higher number of classes of diabetic medications at baseline corresponded with failure. A prediction model for success using these factors had an optimism-adjusted C-statistics of 0.629, with good calibration., Conclusion: Referred patients with diabetes have baseline characteristics that are predictive of clinical success. A predictive model based on those factors performed well and might be utilized to improve pharmacist efficiency in the face of constrained resources.

Because type 2 diabetes mellitus is a progressive disease, most patients eventually need insulin. When and how to start insulin therapy are not one-size-fits-all decisions but rather must be individualized. This paper reviews the indications, goals, and options for insulin therapy in type 2 diabetes., (Copyright © 2015 Cleveland Clinic.)