Evaluating Pharmacotherapy Optimization in Pharmacist-Led Management of Type 2 Diabetes Utilizing Continuous Glucose Monitors.

Abstract

Continuous Glucose Monitors (CGMs) offer critical insight into glucose trends, aiding significantly in overall type 2 diabetes (T2DM) management. Few studies have evaluated pharmacist involvement in CGM management. This was a retrospective study, conducted at two primary care offices within a community health system. The aim of this study was to assess pharmacist impact on the deprescribing of high-risk medications in patients with T2DM utilizing CGM data. The primary outcome was the percentage of patients that experienced deprescribing of a high-risk medication (defined as reduction or discontinuation in total daily dosage of insulin, sulfonylureas, and thiazolidinediones). The secondary outcomes were rate of hospitalizations and changes in total daily insulin dose. Chi-square tests and <i>t</i>-tests were utilized to analyze primary and secondary outcomes. Among 317 participants, 58% of patients on CGMs had pharmacists involved in their care. Of patients in the pharmacist-led group, 11.4% experienced deprescribing of a high-risk medication compared to about 8.3% in the usual care group. Overall, hospitalizations were 3.2% lower in the pharmacist-led group compared to the usual care group during the study period. In addition, patients in the pharmacist-led group experienced a reduction in total daily insulin dose, while an increase in total daily insulin dosage for the usual care group was observed. While our study did not find a statistically significant difference in pharmacist-led deprescribing, there was a trend towards reduction in high-risk medication use. This suggests potential clinical significance, emphasizing the role of pharmacist involvement in prescribing practices of medications used to treat T2DM, including deprescribing high-risk medications and initiating non-high-risk medications with additional benefits. Further studies are needed to determine a difference in prescribing practice in pharmacist-led management of T2DM.