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CANDIS M. MORELLO, PHARM.D., CDE, is Assistant Professor of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California—San Diego, La Jolla; she was formerly Ambulatory Care Pharmacist Specialist, Naval Medical Center San Diego (NMCSD), San Diego, CA. EMILY B. ZADVORNY, PHARM.D., BCPS, is Clinical Pharmacy Specialist, Cardiac Risk Service, Kaiser Permanente, Aurora, CO, and Clinical Assistant Professor, School of Pharmacy, University of Colorado at Denver and Health Sciences Center; she was formerly Ambulatory Care Pharmacist Specialist, NMCSD. MARGARET A. CORDING, PHARM.D., BCPS, is Clinical Pharmacist, NMCSD, and Clinical Assistant Professor, College of Pharmacy, Western University of Health Sciences (WUHS), Pomona, CA. RYAN T. SUEMOTO, PHARM.D., CDM, is Ambulatory Care Pharmacist Specialist, NMCSD, and Clinical Assistant Professor, College of Pharmacy, WUHS. JILIAN SKOG, PHARM.D., is Clinical Pharmacist, Scripps Mercy Hospital, San Diego; she was formerly Ambulatory Care Pharmacist Specialist, NMCSD. AMIR HARARI, M.D., is Senior Medical Officer, USS Peleliu; he was formerly Head of Endocrinology Clinic, NMCSD. All of the authors participated in the design, implementation, or operation of the diabetes care clinics at NMCSD.

Address correspondence to Dr. Morello at the Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California—San Diego, 9500 Gilman Drive, MC 0719, La Jolla, CA 92093-0719 (cmmorello{at}ucsd.edu).

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. Index terms: Ambulatory care; Clinical pharmacists; Diabetes mellitus; Interventions; Pharmaceutical services

 

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