1. Evaluating clinical pharmacist impact on diabetes control: outcomes on hemoglobin A1c Mark Amoo PharmD Candidate, Dalton Walsh PharmD Candidate, Kalyani Sonawane BS, Emily M. Armstrong, PharmD, BCACP Background  Several studies have shown that pharmacist collaboration in the management of chronic disease states will improve outcomes 4,5  In particular, studies have demonstrated significant improvements in hemoglobin A1c (HbA1c), blood pressure, and lipid levels of diabetic patients who are routinely seen by a clinical pharmacist 1,2,3  The objective of this study is to evaluate the impact of a pharmacist’s management in a collaborative care setting on diabetes mellitus in an outpatient internal medicine clinic Methods  Approved by the Institutional Review Boards for University of South Alabama and Auburn University  Retrospective chart review  Patient population from internal medicine outpatient clinic  De-identified data obtained by chart review and electronic medical record  Inclusion Criteria:  ICD-9 code for Type 2 Diabetes  Valid patient-provider relationship with the clinical pharmacist  Seen between January 1, 2010 and December 31, 2012  Exclusion Criteria:  Pregnant  Significant renal or hepatic disease  Age less than 19 Conclusions  HbA1c was significantly reduced compared to baseline at all follow- up periods  HbA1c began trending upward at months 9 and 12, however this may be due to the low number of HbA1c levels at the follow-up periods  A significantly higher percentage of patients reached HbA1c goals compared to baseline  The limitation of the small sample size at 9 and 12 months may have contributed to non-significant values in the secondary outcomes  This study illustrates that clinical pharmacists can have a positive impact on diabetes management when working in a collaborative environment Results & Analysis  929 charts identified  76 charts with results at this time  Average number of diabetic medications increased from 1.7 to 1.8 medications per person  The total number of patients converted to insulin was 9 (11.8%) StrengthsLimitations Inexpensive Data readily accessible Uses existing data Patient population Retrospective Relies on accuracy of written record One pharmacist at clinic References 1. Cranor CW, Christensen DB. The Asheville Project: Factors Associated With Outcomes of Community Pharmacy Diabetes Care Program. Journal of the American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2):160-172. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCthree.pdfhttp://www.ncpharmacists.org/associations/4188/files/NCCPCthree.pdf 2. Cranor CW, Christensen DB. The Asheville Project: Short-Term Outcomes of Community Pharmacy Diabetes Care Program. Journal of American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2):149- 159. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCtwo.pdfhttp://www.ncpharmacists.org/associations/4188/files/NCCPCtwo.pdf 3. Cranor CW, Bunting BA, Christensen DB. 3. The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program. Journal of American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2): 173-184. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCfour.pdf http://www.ncpharmacists.org/associations/4188/files/NCCPCfour.pdf 4. Anaya JP, Rivera JO, et al. Evaluation of pharmacist-managed diabetes mellitus under a collaborative drug therapy agreement. American Journal Health-Systems Pharmacy [Internet]. 2008 October [cited 2012 November 6]; 65: 1841- 1845. Available from: http://www.ncbi.nlm.nih.gov.libproxy2.usouthal.edu/pubmed/18796426http://www.ncbi.nlm.nih.gov.libproxy2.usouthal.edu/pubmed/18796426 5. Wubben DP, Vivian EM. Effects of Pharmacist Outpatient Interventions on Adults with Diabetes Mellitus: A Systematic Review. Pharmacotherapy [Internet]. 2008 November [cited 2012 November 6]; 28(4): 421-436. Available from: http://pharmacotherapyjournal.org.libproxy2.usouthal.edu/doi/pdf/10.1592/phco.28.4.421 http://pharmacotherapyjournal.org.libproxy2.usouthal.edu/doi/pdf/10.1592/phco.28.4.421 Disclosure Authors of this presentation have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation. Objectives Primary Objective HbA1c levels for patients managed by collaborative patient care Secondary Objectives Total number of diabetic medications required Classes of diabetic medications included Number of patients initiated on insulin therapy Baseline Characteristics VariableMeanSDMinMaxPercent Age59.779.883677 Female70.27% Non-White45.21% Total Comorbid Conditions4.972.02111 Total Number Medications8.43.9218 HbA1C (%)8.825.813.2 Scr (mg/dL)0.930.530.474.8 Na (mmol/L)139.22.81133144 K (mmol/L)4.30.43.45.3 AST (IU/L)26.418.229116 ALT (IU/L)28.220.546116 Urine microalb/Cr ratio (mg/g creat)57.91106.371.3653.3 Results VariableBaseline3 months6 months9 months12 months Patients reaching HbA1c goal (%) 2564.5*77.6*79.0*77.6* SCr (mg/dL) 0.930.900.930.830.84 Urine microalb/Cr 45.577.540.842.943.9 AST (IU/L) 26.424.424.921.922.2 ALT (IU/L) 28.226.427.924.125.6 *Indicates p < 0.05 compared to baseline Drug classes not used: α-glucosidase inhbitor, glinides, NPH and regular insulin. *Indicates p < 0.05 compared to baseline *