Trajectories of glycemic control with clinical pharmacy specialist management of veterans with type 2 diabetes.

Abstract

BACKGROUND\nImproved control of glycemic control likely lowers the risk of diabetes complications and clinical pharmacy specialist (CPS) services can improve glycemic control. Though the pattern of control may also matter in terms of outcomes.\n\n\nOBJECTIVES\nThe objective of this study was to examine the longitudinal trajectories of HbA1c among a large population of Veterans with type 2 diabetes who received CPS-led diabetes management.\n\n\nMETHODS\nThis is an observational, multicenter cohort study of Veterans with type-2 diabetes managed by CPSs between 7/1/2013 and 7/1/2017 with baseline glycosylated hemoglobin (HbA1c) level ≥8%. Two years of HbA1c measurements were used to group patients into distinct patterns of HbA1c trajectories over time using group-based trajectory modeling. Characteristics associated with successful HbA1c trajectories and association of assigned trajectories with all-cause and diabetes-related hospitalizations were analyzed using logistic regression.\n\n\nRESULTS\nA total of 4119 Veterans were included and able to be successfully segmented into six distinct HbA1c trajectory groups over time: High Gradually Decreasing (n\xa0=\xa0325, 7.9%), Moderate Early Decline (n\xa0=\xa01692, 41.1%), Large Early Decline (n\xa0=\xa0231, 5.6%), Uncontrolled Stable (n\xa0=\xa01468, 35.6%), Early Decline/Subsequent Increase (n\xa0=\xa0266, 6.5%), and Very Uncontrolled Stable (n\xa0=\xa0137, 3.3%). The distinguishing factor between successful and less successful trajectories appears to be the progress made within the first six months of pharmacist management.\n\n\nCONCLUSIONS\nSignificant variability exists in the pattern of glycemic control over time of type 2 diabetes patients managed by clinical pharmacy specialists. Limited resources should be first prioritized to managing patients with very elevated HbA1c and into the first six months of CPS management.