By Annette M. Boyle
SAN DIEGO — Many veterans drift for years with out-of-control diabetes, despite regular visits with their primary care physician and prescriptions for anti-glycemic agents.
In an effort to help veterans with complex Type 2 diabetes better manage their care, clinical pharmacists at the VA San Diego Healthcare System have partnered with an endocrinologist—with very positive financial and medical results.
In a pair of recently published articles in the Journal of Managed Care and Specialty Pharmacy and the Annals of Pharmacotherapy, the researchers reported a more than 2.4% improvement in mean A1c and projected a reduction in the cost of care of more than $5,200 per patient over three years for those seen at the clinic, compared to those who continued with usual care.1,2
The Diabetes Intensive Medical Management (DIMM) “tune-up” clinic is a collaboration between a pharmacist, endocrinologist and several pharmacy students. It is designed to personalize medication therapy management and patient education to help veterans better understand how to manage their diabetes.
“The best patients for the clinic are people who have out-of-control diabetes, who have multiple comorbidities and perhaps adherence issues, take a lot of medications and have a tough time understanding when to take them. They really need to be ‘tuned up’ and given a regimen that is completely specialized to them that they can adhere to,” explained Candis Morello, PharmD, CDE, director of the Diabetes Intense Medical Management Clinic at the San Diego VA and an author of both studies.
The researchers compared 99 patients referred to the clinic to 56 veterans who continued to receive diabetes care only through their primary care physician. All participants had Type 2 diabetes mellitus, glycosylated hemoglobin (A1c) above 8%, and a visit to a VAMC within the previous six months. Veterans referred to the DIMM clinic met with a clinical pharmacist for two to four one-hour sessions over six months. Patients in both groups took 12 to 14 medications daily and had about eight comorbidities on average. Demographics were similar between the two groups.
Veterans in the DIMM clinic achieved a 2.4 drop in A1c in six months compared to a reduction of 0.8 in the usual care group. At baseline, patients referred to the clinic had a higher mean A1c than those who continued receiving diabetes care through their usual provider, 10.5 vs. 9.7. After three months, the DIMM group had a mean A1c slightly below the usual care group, 9.9 vs. 9.0, and almost two-thirds had reached the VA performance goal of A1c below 9.0.
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Research on fibromyalgia, a poorly understood, chronically disabling pain syndrome, generally has focused on its clinical presentation and treatment.
The VA is expanding remote management of patients to improve disease prevention and care.