Development and Clinical Outcomes of Pharmacist-Managed Diabetes Care Clinics

Candis M. Morello; Emily B. Zadvorny; Margaret A. Cording; Ryan T. Suemoto; Jilian Skog; Amir Harari


Am J Health Syst Pharm. 2006;63(14):1325-1331. 

In This Article

Abstract and Introduction


Purpose: The development and outcomes of two pharmacist-managed diabetes care clinics (DCCs) are described.
Methods: Retrospective data analysis was performed to determine the outcomes for patients with type 2 diabetes mellitus who were treated in two pharmacist-managed DCCs. Primary outcome measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose, body mass index, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein cholesterol, triglycerides, and blood pressure and documented annual retinal and micro-albumin screening. Secondary outcome measures included the use of aspirin and kidney-sparing agents and annual screening for thyroid-stimulating hormone.
Results: Data from 113 patients in the DCCs were analyzed. After one year, the mean reduction in HbA1c levels was 1.3%, with a mean HbA1c of 7.8%. HbA1c goals were based on the institution's HbA1c normal range of 4.1-6.5%. Compared with baseline, over one third of patients met the HbA1c and blood pressure goals of <7.5% and <130/80 mm Hg, respectively. Mean LDL cholesterol concentration decreased from 110 to 94 mg/dL. The mean concentration of triglycerides decreased from 243 to 178 mg/dL. Mean systolic blood pressure decreased from 136 to 132 mm Hg. Whereas the national average for uncontrolled diabetes (HbA1c > 9.5%) was 36.9%, only 3.5% of patients at the pharmacist-managed DCCs had uncontrolled diabetes. Attainment rates of LDL cholesterol goals and annual retinal and microalbumin screenings were significantly higher in clinic patients compared with national averages. Three-year postclinic inception data revealed similar favorable outcomes, most notably an average HbA1c of 7.6% and 55% of patients meeting their target HbA1c goal of <7.5%.
Conclusion: Compared with national averages, DCCs managed by clinical pharmacists achieved higher screening rates and attained treatment goals more often.


An estimated 20.8 million Americans have diabetes mellitus, accounting for 7% of the U.S. population.[1] By 2050 or possibly sooner, the number of Americans living with diabetes is projected to more than double.[2,3] Type 2 diabetes mellitus represents approximately 90% of patients with this disease.[1] In 2002, the total cost for treating diabetes in our country was an estimated $132 billion, with the majority spent on treatment of long-term complications.[4] Poor glycemic control manifests in costly, lifelong morbidities, including blindness, kidney failure, amputations, and cardiovascular disease. The economic burden of treating long-term diabetes complications is well documented.[4,5] Improving glycemic control in patients with type 2 diabetes mellitus can prevent or delay the onset, or slow the progression, of microvascular and some macrovascular complications.[6,7,8,9]

Patients can benefit from an individualized approach to comprehensive diabetes care. Comprehensive care involves a multidisciplinary approach with evaluation and education from specialty practitioners, such as endocrinologists, pharmacists, exercise physiologists, diabetes educators, nurses, dietitians, podiatrists, and ophthalmologists. A cornerstone of diabetes treatment is drug therapy, often with complex regimens, including multiple oral and injectable agents. A collaborative agreement between physicians and pharmacists is an innovative strategy to treat patients with diabetes that takes advantage of pharmacists' expertise in disease management and drug monitoring. Improved patient outcomes and reduced cost to health care systems are potential benefits of implementing an innovative ambulatory clinic model for diabetes treatment.

The Naval Medical Center San Diego (NMCSD) treats over 5000 patients with diabetes. NMCSD is a 500-bed comprehensive teaching hospital with more than 20 general and specialty ambulatory care clinics. In mid-1999, ambulatory care pharmacist specialists were specifically hired to expand the current pharmacist-managed ambulatory care services in anticoagulation and lipid clinics and to create new clinics. This article describes the development of two pharmacist-managed diabetes care clinics (DCCs) established at NMCSD and the diabetes-related outcomes of enrolled patients, comparing these outcomes to national averages.


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