Background

Improved 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.

Objectives

The 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.

Methods

This 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.

Results

A total of 4119 Veterans were included and able to be successfully segmented into six distinct HbA1c trajectory groups over time: High Gradually Decreasing (n = 325, 7.9%), Moderate Early Decline (n = 1692, 41.1%), Large Early Decline (n = 231, 5.6%), Uncontrolled Stable (n = 1468, 35.6%), Early Decline/Subsequent Increase (n = 266, 6.5%), and Very Uncontrolled Stable (n = 137, 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.

Conclusions

Significant 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.

中文翻译：

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2型糖尿病退伍军人临床药学专家管理的血糖控制轨迹

背景

改善血糖控制可能会降低糖尿病并发症的风险，临床药学专家 (CPS) 服务可以改善血糖控制。尽管控制模式在结果方面也可能很重要。

目标

本研究的目的是检查接受 CPS 主导的糖尿病管理的大量 2 型糖尿病退伍军人中 HbA1c 的纵向轨迹。

方法

这是一项观察性、多中心队列研究，对象为 2013 年 7 月 1 日至 2017 年 7 月 1 日期间由 CPS 管理的 2 型糖尿病退伍军人，基线糖化血红蛋白 (HbA1c) 水平≥8%。两年的 HbA1c 测量用于使用基于组的轨迹建模将患者分组为不同的 HbA1c 轨迹模式。使用逻辑回归分析与成功 HbA1c 轨迹相关的特征以及指定轨迹与全因和糖尿病相关住院的关联。

结果

共有 4119 名退伍军人被纳入，随着时间的推移，他们能够成功地分成六个不同的 HbA1c 轨迹组：高度逐渐下降（n = 325, 7.9%）、中度早期下降（n = 1692, 41.1%）、早期大幅下降（ n = 231, 5.6%)、不受控制的稳定 (n = 1468, 35.6%)、早期下降/后续增加 (n = 266, 6.5%) 和非常不受控制的稳定 (n = 137, 3.3%)。成功和不太成功的轨迹之间的区别因素似乎是药剂师管理的前六个月内取得的进展。

结论

由临床药学专家管理的 2 型糖尿病患者的血糖控制模式随时间推移存在显着差异。有限的资源应首先优先用于管理 HbA1c 非常高的患者并进入 CPS 管理的前六个月。